At the end of 1998, 33,4 million people world-wide were infected with

HIV - which represents an increase of 10% compared to 1997 (according to

figures of UN/WHO). The prison population, among them a high percentage of

drug users, seems to be more affected by the epidemic than other groups.

Anonymous studies of more than 3.300 prisoners, carried out by independent

researchers in seven EU-countries showed that around one third of the

inmates were injecting drug users (IDUs). Nearly half of these IDUs had

also injected while imprisoned; one in eight was HIV positive and one in

two carried the Hepatitis C virus. Clear evidence was found for ongoing

risk behaviour in prison, and it was concluded that there is an urgent need

for prevention strategies in prison.

Recent developments of the HIV epidemic show a stabilisation or even

decline in prevalence in western countries (though incidence is

unchanged!), and increased prevalence in Eastern Europe and Africa. If one

considers the possible effects of legal changes in central and eastern

Europe (which might bring more drug users behind bars), it seems likely

that prisons in central and eastern European countries will become

"high-risk areas" for the transmission of HIV and viral Hepatitis.

Scientific information about drug use and related risk behaviour in

prisons in central and eastern Europe is still very limited. It can

however be said that HR policies for prisons are - in general - not in

place in the region.

Discussions at the Seminar confirmed the topic as a relevant choice

for experts from the region. From the point of view of the sub-regional

project team, the Seminar could only be a starting point in a long process

of policy advocacy and expert training and much more efforts have to be

made in the future to prevent drug-related harm - inside and outside

prisons.

Besides achieving the two objectives set by the sub-regional team,

the TS also made an important contribution to the overall objectives of the

Phare TA to DDR project. It offered opportunities for network strengthening

between participants from all Phare partner countries and gave input to

policy and strategy development by making relevant information on HR in

prison available. It also contributed to capacity building among all

participants with regard to various aspects of drug use in prison.

Follow-up on national level is already planned in the three

cluster-countries of the HR project. The discussion about confidentiality

of medical information of prisoners, which emerged during the TS will be

followed up by the Slovenian National Team through further meetings and

activities. In the Czech Republic the full documentation of the Seminar

will be distributed to key-experts and policy-makers during a special

event.

The sub-regional team of the HR project makes the following follow-up

proposals for the regional level:

Information provided by participants upon registration (see Chapter 4

of this report) and the discussions during the Seminar showed that there is

some interest among participants to join a regional network on the issue of

Harm Reduction in Prison. It is proposed to follow this up through the

creation of an informal expert-network, composed by those participants who

re-confirm their interest upon receiving this Seminar. The network should

contribute to an exchange of experiences and disseminate up-to-date

information. However, as the resources within the ongoing sub-regional

project on HR (until October 1999) are limited and already allocated to

other activities, a regional network could only be realised at a later

stage.

Several participants also expressed their interest in themes within

the wider issue of "Drug Users and/or Drug Use in Prison". In particular,

participants' interest in the two workshop-topics that were chosen

spontaneously by participants during the Seminar (drug-free units and

confidentiality of medical information of prisoners) should be re-evaluated

at a later stage.

Other topics, like research into prevalence of drug use by prisoners,

and into risk behaviour of IDU prisoners, as well as training of prison

staff who work with drug users might be further topics to be considered

when the Phare TA to DDR continues after October 1999.