Pilot Condom Distribution in Czech Prison Viktor Mravk

Pilot Condom Distribution in Czech Prison Viktor Mravčík, Heike Zurhold, Tomáš Koňák, Barbara Janíková, Kateřina Grohmannová, Tereza Černíková, Marcus Martens

Background: Czech Prison System • • • Inhabitants: 10, 5 million Prisons: 35 Prisoners: 22 688 (14. 02. 2017) Foreigners: 1 805 (14. 02. 2017) Overcrowded: 109% Ministry of Justice General Directorate of PS CR (includes Prison Health Service) Remand prisons Prisons Forensic detention facilities

Background (2): Situation in CZ prisons • Problem drug users represent 31% of prison population (i. e. drug injecting and/or repeated use of meth, opioids or cocaine one month prior incarceration) • Lifetime prevalence of injecting in prisons: 7% of prisoners • HIV prevalence: 0. 8%, HCV prevalence: 35. 9% (through diagnostic testing, 2016 data) • Substitution maintenance treatment: 10 prisons, 53 patients/year • Needle and syringe programmes: not available • Condoms: in canteens in all prisons and private visitors room in some prisons (Mravčík et al. 2017)

Prison Condom Distribution – preparation • HA-REACT workshop in Prague (18 th-19 th April 2016) • Working group meetings with prison service authorities • Pilot prison identified (Praha Pankrác – 1 000 inmates) • Concept of pilot implementation of condom distribution • Written agreement with pilot prison (condom distribution) • Study visit to Berlin (5 th-7 th October 2016)

What is possible? Packing of condoms

Media attention • Sensitive issue for prison service • Not always useful 30 September 2020

Prison Condom Distribution– implementation • 12 months pilot started in August 2017 • 2 prison units (240 male inmates): 4 vending machines installed in bathroom/toilets • Other units: condoms available on request at prison educational staff (not guards, not health staff) • Prison administration preconditions: • written agreement • information leaflets for staff (about BBDs, STDs and condom distribution) and for inmates (about pilot project and prevention of infectious diseases) • special bins for „dangerous infectious waste“

Vending machines for condom distribution

Special bins for dangerous infectious waste

Evaluation design • Baseline measurement prior start of condom distribution • Follow-up in months 1, 6 and 12 • Tools: • Questionnaire for prisoners and for prison staff • Structured interviews with prisoners and with prison staff • FGs with prison staff and management • Topics: • Experience and opinions on sex in prisons • Opinions on condom distribution and other prevention measures • Experience with risk behaviour in prison • Expectations from condom distributions • Attitudes towards homosexual orientation • For now, baseline and 1 month follow-up available

Results prior: questionnaires • Prisoners N=177, staff N=25 • Age: prisoners mean 39, staff 37. 5% up to 40 • Gender, sexual orientation (%): gender prisoners staff 96, 0 37, 5 female 0, 7 58, 3 transgender 3, 3 4, 2 male sexual orientation heterosexual homosexual bisexual not sure prisoners 89, 2 1, 7 2, 5 6, 7 staff 95, 7 0, 0 4, 3

Results prior: questionnaires • Prisoners have had sex in prison: 3. 6% • Prisoners have witnessed sex in prison: 11. 6% • Opinion on sex in prison (answers „often“, in %): consensual sex 7. 6 26. 1 coercive sex prisoners 10. 8 sex for goods/services 45. 5 6. 8 13. 6 staff

Results prior: questionnaires • Opinions on condom distribution (answers „fully agree“, in %): condoms are beneficial for prevention condoms will increase sexual activity 20. 8 19. 2 16. 7 condoms will trigger coercive sex 16. 7 20. 8 condoms will be used to protect health 19. 7 12. 5 condoms will be misused for other purposes 70. 9 prisoners staff 32. 5 58. 3

Results prior: questionnaires • Opinion on appropriateness of condom distribution via vending machines in prisons (%): fully agree 39. 7 4. 2 18. 3 tend to agree neither/nor tend to disagree fully disagree 16. 7 5. 6 29. 2 prisoners 23. 8 staff 16. 7 12. 7 33. 3

Results prior: interviews with prison staff • Consensual sex and sex for goods/services are common in prisons, but hidden from the staff • Find condom distribution as unnecessary, they see other priority issues (e. g. hygiene, clothes) • No need of preventive measures • Concerns about condom distribution: misuse for drug dealing, drug-free urine, fun, weapon etc.

Results after 1 months: distributed condoms 24 th August – 3 rd October: • 657 condoms distributed in 4 machines • 6 condoms distributed by staff on request

Results after 1 months: focus group with prison staff • No problems, positive evaluation • Find vending machines as a most anonymous and confident way of condom distribution • One unpacked condom thrown from the window • Inmates sending condoms to relatives and inmates in other prisons by post • Inmates are afraid that their female partners get known about the condoms in ward • Inmates are afraid to be seen as homosexuals

Conclusions/Lessons learned • A lot of bureaucratic / technical / formal barriers before start (written agreements, bins etc. ) • Acknowledgement of the measure in the national strategic documents is important • Informal relationship between project team and prison management (ice-breaking) helps • Prisoners: quite positive attitudes also before start • Prison staff: quite conservative/negative attitudes before, changed after 1 months (neutral/positive) • No major problems during first weeks of implementation, threats of prison staff not confirmed • Condom distribution works, machines are preferred

References • • European Centre for Disease Prevention and Control. (2015). Thematic report: Prisoners. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2014 progress report. Stockholm: ECDC. European Monitoring Centre for Drugs and Drug Addiction. (2017). Statistical Bulletin EMCDDA 2017 Fazel, S. , Yoon, I. A. , & Hayes, A. J. (2017). Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction, 112(10), 1725 -1739. doi: 10. 1111/add. 13877 Kamarulzaman, A. , Reid, S. E. , Schwitters, A. , Wiessing, L. , El-Bassel, N. , Dolan, K. , . . . Altice, F. L. (2016). Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners. Lancet, 388(10049), 1115 -1126. doi: 10. 1016/s 0140 -6736(16)30769 -3 Mravčík, V. , Chomynová, P. , Grohmannová, K. , Janíková, B. , Tion Leštinová, Z. , Rous, Z. , . . . Vopravil, J. (2017). Výroční zpráva o stavu ve věcech drog v České republice v roce 2016. Praha: Úřad vlády České republiky. UNODC, ILO, UNDP, WHO, & UNAIDS. (2013). HIV prevention, treatment and care in prisons and other closed settings: A comprehensive package of interventions. Vienna: UNODC. WHO. (2014). Prisons and Health. Copenhagen: WHO Retrieved from http: //www. euro. who. int/__data/assets/pdf_file/0005/249188/Prisons-and. Health. pdf

Thank you for your attention! mravcik. viktor@vlada. cz www. drogy-info. cz/en/ www. hareact. eu/en This meeting is part of the joint action ‘ 677085 / HA-REACT, ’ which has received funding from the European Union’s Health Programme (2014 -2020).