Example of peer involvement in prison work. The FLEW project (Free to live well with HIV in prison) is the result of collaboration effort between several agencies in Italy. In 2016, 677 people in prison, 107 prison officers, 112 healthcare professionals, 70 educators and office staff, and 28 volunteers were given a questionnaire to assess their knowledge on HIV and HIV transmission. They were also asked to report on the level of stigma attached to HIV among people in prison, prison officers, educators and healthcare professionals.
For example, almost 60% of those interviewed thought that engaging in a fistfight – which can easily lead to bleeding – would not expose them to the risk of HIV transmission. In 10 prisons across seven Italian regions, educational activities were organised for people in detention, prison officers and educators. A group of peer educators – people living with HIV (PLHIV) who also at some point in their lives were imprisoned – conducted a number of activities aimed at people in detention. Their work was essential to meet the project goals of improving HIV prevention in prisons, fighting stigma, and improving the quality of life of PLHIV. Another innovative element was the introduction of HIV rapid testing in prison settings. Over 650 tests were requested, both by people in detention and prison staff. All appreciated the testing opportunities presented by the project. The methods developed in this project are adaptable to other detention facilities.
Since 2014, Public Health England (PHE) Health and Justice has been supporting HM Prison & Probation Service (previously the National Offender Management Service) and National Health Services (NHS) England in the delivery of opt-out testing for blood-borne viruses (BBV) in all adult prisons in England. The evaluations include specific reports of offer and uptake of HIV, hepatitis B and hepatitis C testing within 72 hours of reception to prison as well as referral for treatment for those found infected. These data show that in England in 2016/17, 16 321 tests were conducted for hepatitis B infection, 21 268 for hepatitis C infection and 37 474 for HIV infection. The proportion of new receptions receiving tests for HCV increased from 5.3% in 2010/2011 to 11.5% in 2015/2016.
This training manual was developed within the EU-funded programme, Joint Action on HIV, Viral Hepatitis and Tuberculosis among People Who Inject Drugs in Europe (HA-REACT). The manual is designed to be a complete tool to provide staff in low-threshold settings the knowledge, skills and techniques needed for testing people who use drugs for HIV and HCV and linking them to needed care.
The content of the manual was adopted from previously developed guidelines, manuals and handbooks and is based on international best practices. The curriculum includes eight modules with descriptions of content to be taught and tips for practical exercises. The modules can be used as a complete 3-day training or independently.
The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to:
- Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations
- Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions.