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Globally, 5 of the total population of the prisons consist of female prisoners. This proportion however is increasing, specifically in those countries that have a higher level of illicit substance use (International Centre for Prison Studies 2006). Although women represent a less proprtion of the prisons population, they present speciall challenges for correctional authorites nowadays. The background and the reasons of incarceration in the same situation is different from women and men prisoners (Coyle 2002). Sex workers and injecting drug users are overrepresented among the female prisoners. Not only their backgrounds are different, but also their social and health care and psychological needs are different once they are in prison.
It is to note here, that historically men have been accounted as the major proportion of the prison inhabitants and as a result, the facilities and services in the existing prisons are basically established for the men (UNAIDS/UNODC 2008: 1). In overcrowded and undestaffed prisons, women have, at best, limited access to facilities and services. Exisiting income generation and socialization programs reserved for women within the prisons are often menial or ineffective, and where opportunities do exist, women may be unable to take advantages of them. Women's basic needs, such as commodities for ensuring menstrual hygiene (sanitary napkins, clean sanitary cloths) are often not met. Because there are few prisons for women, women tend to be imprisoned far from home; the distance separating them from their children, families, and friends increases their isolation and can be a source of additional stress such as economic hardship and anxiety, for both the women concerned and their families. Upon release, the stigma of imprisonment weights more heavily on women than on men. In some countries, women are discriminated against and are unable to return to their communities once released from prison (UNAIDS/UNODC 2008: 3). Women have less access to health care services in prisons than imprisoned men (Yasunaga 2001). Reproductive health care may be limited or unavailable and health promotion materials, information and treatment are often limited in womes's prisons than in prisons for men. As a result in the absence of access to HIV prevention measures, the risk of HIV transmission is therefore higher in women's prisons (UNAIDS/UNODC 2008: 3) .
The experience of HIV/AIDS is sociallay and physically different among women and men. The HIV virus in women can be diagnosed later, they get the disease faster and they die because of it sooner in comparison to men (Ainslie/ Anderson. et al. 1992: 34). For example in the United States, in 2004, the overall HIV prevalence among imprisonment men was 1.7 percent compared to 2.4 percent among women. In some states however, such as New York, HIV prevalnece was 14.2 percent among women and 6.7% among men. Similarly in Moldova in 2006, HIV prevalnece among women in prison was 3 percent, compared to 2 percent among incarcerated men (Pintelei 2007 cited in UNAIDS/UNODC 2008: 2). Studies have shown that women are at least twice as likely as men to contract HIV through sex (European Study Group on Heterosexual Transmission of HIV 1992). The pre-existence of sexually transmitted infections (STI) can greatly increase the risk of contracting HIV. The proportion of women in prisons with an STI is relatively very high (Miranda A.E et al 2000: 494). For example, in the Russian Federation, a 2005 survey among juvenile detainees, homeless persons and women at a temporary detention center in Moscow, revealed that more than 50 percent of the female juvenile detainees had as STI, as did almost two third of the women at the temporary detention center and three quarters of homeless women. Among women at the detention center, 4 percent were HIV- positive, compared to 1.8 percent of the homeless women (Shakarishvili et al 2005).
Beside the above mentioned aspects that are contribute factors which increase the HIV prevalence rate among female prisoners, there are also some activities inside the prisons that are known as high risk activities for the transmission of HIV. These activities are as follow:
Sexual violence and high risk sexual behavior:
In the closed environment of prisons, women are especially vulnerable to sexual abuse, including rape, by both male staff and other male prisoners. There are countries, where women prisoners are held in small facilities adjacent to or within prisons for men. In some prison facilities, there are no separate quarters for women and they may be supervised by male prison staff. They are also susceptible to sexual exploitation and may engage in sex for exchange of goods such as food, drugs, cigarettes and toiletries (UNAIDS/UNODC 2008: 2).
Women to women sex risks are a common concern among women prisoners. The majority of women prisoners are not aware of the risks of this behaviour.
" In what I see and hear, I regret to say I don't think anyone takes care when having women to women sex-perhaps a handful- but most don't bother. Most don't think they can contract the virus from women, others who are aware that infection is a possibility still don't bother to take care. What needs to be doneâ€¦ is to have literature available all the time, have one-to-one talks, weekly group talks, and have access to 'dental dams' (cited in Walsh 1992: 702). As it was mentioned earlier, many women are in prison for drug related offences, that women have sex with other women in prison, and share needles, in and out of prison. They are therefore, potential carriers of the AIDS virus.
Women prisoners may also be at risk because their husbands, de facto husbands or boyfriends may have spent time in prison. While in prison these men may have been exposed to the AIDS virus through intravenous drug use, consensual sex or rape. The male to male sex does take place and is seen often as a sexual act not necessarily with the stigma so often attached to homosexual sex. Male to male rape also occurs and is often hidden by the victim because of feelings of shame, guilt, hurt and denial. Female partners would not necessarily be told of any of these experiences by either established or future partners. In addition, a survey conducted that women did not believe that their partners would engage in consensual sex while in prison, or rape another prisoner. The women prisoners believed that their risks of contacting HIV are minimal if their partner is not as intravenous drug user (Walsh 1992: 702).
Drug use/Drug injecting/needle sharing
In many jurisdictions, a larger proportion of women than men are in prison for drug related offences. Many of these women will continue using and injecting drugs in prisons, while women who have never used drugs may begin to do so while in prison (Dolan/ Kit et al 2007). in the absence of sterile njecting equipment, women like men will inject with used needles or with home-made syringes (Elwood et al 2005). Women who inject drugs are more likely to become infected with HIV than men who inject drugs, as they have limited access to information, health services and safe injecting equipment (UNAIDS/UNODC 2008: 2). HIV transmission risk in women's prisons is needle sharing. A participant of one Prisoners's AIDS Committee in a maximum security prison has indicated that:
"[Wanting] the drug is compounded by 'secrecy of everything' and this often means that sterilising goes out the window. Women are depressed, they have little self-esteem and feel worthless. They often come from 'crisis' situations and intense peer pressure especially for younger women, means responsibility is lost, as are the educational messages. Only a handful bother to go through the two times water, two times bleach, two times water method and usually the same fit (needle) is used throughout; so God knows!" (Cited in Walsh 1992: 270).
Like men women also get tatooed in prison (Doll 1988). Prison tatoo artists manufacture and use a variety of tools, including knives, guitar strings, sewing needles, writing ink or empty plastic casings from pens. One methof of tattoing, the "pluck method", involves inserting nk with a single shared needle, which is not sterilized. In the absence of proper precautions and access to safe eqipments, tatooing can be a high risk activity for the transmission of HIV (UNAIDS/UNODC 2008: 3).
One of the most problems to indicate is that typically, women in prison are young and many are mothers whose childeren either live n prison with them or are cared for by others outside. They may also be pregnant or become pregennt during imprisonment, some give birth while in prison. Often, very limited reproductive and post natal care services are available for women in prisons. In addition, antiretrovial therapy is often not availale to prisoners ans as consequense neither to HIV positive pregnant women to prevent mother to child transmission. Children born in prison, especially to HIV positive mothers, need particular care and attention. Prison diets often fail to provide the level of nutrition required by pregnentor breastfeeding mothers (UNAIDS/UNODC 2008: 3).
As illustrated the women prisoners are vulnerable to HIV/AIDS, which has effects on their childeren and the society. Based on that, WHO has published an action guidance and checklists on the Women's health in prison (2011: 4). According to these guidelines the serives that should be provided for the women intimates should include the following:
comprehensive and detailed screening for women on first admission to prison and regularly throughout their stay, covering their socioeconomic and educational background, health and trauma histories, current health status and an assessment of skills held or required;
an individualized care, treatment and development plan, to be prepared jointly by the different health care providers and all other staff likely to be involved in a woman's care and custody, and in consultation with the women themselves;
primary health care services provided in the prison, which are outlined to the woman during the important induction period; her rights to access, including emergency access, to confidentiality, to privacy and to health information and promotion activities should be made clear, preferably in an easily understandable pamphlet;
specialist health care, which is readily provided and adjusted to meet the needs of women, such as for mental health, including help with a legacy of abuse and posttraumatic stress disorder; chronic health conditions, HIV and AIDS (including counselling and support), hepatitis, tuberculosis (TB) and other infectious diseases; drug and alcohol dependence; learning disabilities; and reproductive health, with access to specialist health care being explained to the woman in prison when discussing her individual care plan;
pre-release preparations that are adequately planned and provided so as to ensure continuity of care and access to health and other services after release: health and social care cannot be provided in isolation from community services - just as health and nursing staff must maintain professional contacts with their peer groups, so must all services within prisons have good links to the equivalent services in the community.