This session identified a number of challenges in implementing effective HIV policies in relation to IDU and health care, within and outside jail.

The results of a prospective study of 1056 IDU in Tijuana, Mexico,  identified correlates of injection during incarceration. These included younger age, ever injecting a ‘speedball’, ever having sex with a man (among men) in jail; and ever having been arrested for needle or syringe possession. The latter is of particular concern as carrying injecting equipment without a prescription is not an offence in Mexico. Nonetheless,  31% of the sample had been arrested for carrying syringes. This highlights the deleterious effects on safe injecting behavior of poor implementation of policy on the part of arresting officers.  There is also an association between injecting in jail and subsequent unsafe ‘receptive’ injecting (ie using a syringe after another has used it) outside jail.

Other  presentations reflected the lack of equivalence in health care noted by Chuh (TUAX 01). A study of OST implementation in Portuguese prisons (Campos) found high levels of agreement among prison guards, HCW and inmates that introduction of OST had led to reduced violence and improved health of inmates. However, only one prison actively initiated OST and prison guards were reluctant to participate in the study and had generally poorer perceptions of improvements than HCW or inmates.  A study of access to ART in prisons in Ukraine identified prison guards’ attitudes and values as a barrier to timely access to ARV therapy for inmates, concluding that advocacy to address the shortfall in access to ARV for those who need it (117/200 in need, of 5074 HIV+ inmates nationally)and prison staff education were necessary to ensure adequate health care for HIV+ prisoners.