Nelwan Erni Juwita, Diana Aly, van Crevel Reinout, Alam Nisaa Nur, Alisjahbana Bachti, Pohan Herdiman T, van der Ven Andre, Djaya Ilham
Department of Internal Medicine, University of Indonesia - Cipto Mangunkusumo Hospital. Jl. Diponegoro no. 71. Jakarta 10430, Indonesia.
Acta Med Indones. 2009 Jul;41 Suppl 1:52-6.
Around the world, HIV-prevalence rates among prisoners are high compared to the general population. This is due to overrepresentation of injecting drug users (IDUs) in prison and possible HIV-transmission inside prison. Limited health services in penitentiary institutes, stigma, policy issues, and budgetary constraints may hamper delivery of appropriate services for HIV in prison. Prisons may, on the other hand, enable the access to a high risk population for HIV-prevention and -care. IDUs are namely hard to reach outside prisons, while in prison targeted interventions for IDUs can be used repeatedly and economically. Also, harm reduction and HIV-treatment can be supervised and monitored carefully. This paper reviews HIV-prevention and care in prison, and describes the experience in one particular prison in West Java, Indonesia. Based on the literature and local experience, one can conclude that effective and widespread HIV-testing and treatment can be established in prisons if there is commitment from prison authorities, endorsement of services by prison staff and inmates, and collaboration with health care providers from outside prison. Essential components of HIV-services in prison include appropriate health care services, a suitable environment for HIV-counseling and -testing and tailored services for injecting drug use. By partner counseling and linking HIV-services in prison with continued care afterwards, prisons may contribute significantly to HIV-control in the general population, especially in settings where HIV is often due to injecting drug use.
在全球范围内，与普通人群相比，囚犯中的艾滋病毒流行率较高。这是由于监狱中注射吸毒者（IDU）的比例过高以及监狱内可能发生的艾滋病毒传播。监狱机构的卫生服务有限、耻辱感、政策问题和预算限制可能会妨碍为监狱中的艾滋病毒感染者提供适当的服务。另一方面，监狱可以为艾滋病毒预防和护理提供接触高危人群的途径。因为注射吸毒者在监狱外很难接触到，而在监狱里针对注射吸毒者的有针对性的干预措施可以反复且经济地使用。此外，减少伤害和艾滋病毒治疗可以得到仔细的监督和监测。本文回顾了监狱中的艾滋病毒预防和护理情况，并描述了印度尼西亚西爪哇一所特定监狱的经验。根据文献和当地经验，可以得出结论，如果监狱当局有决心、监狱工作人员和囚犯认可服务，并且与监狱外的医疗保健提供者合作，就可以在监狱中建立有效且广泛的艾滋病毒检测和治疗。监狱中艾滋病毒服务的基本组成部分包括适当的医疗保健服务、适合艾滋病毒咨询和检测的环境以及针对注射吸毒的量身定制服务。通过同伴咨询以及将监狱中的艾滋病毒服务与后续的持续护理联系起来，监狱可以为普通人群中的艾滋病毒控制做出重大贡献，特别是在艾滋病毒通常由注射吸毒引起的环境中。
