The ABNF journal : official journal of the Association of Black Nursing Faculty in Higher Education, Inc
In the Caribbean AIDS has become the leading cause of death among those aged 15-45. The homeless ... more In the Caribbean AIDS has become the leading cause of death among those aged 15-45. The homeless are at high risk due to the nexus of mobility, psychiatric disorders and substance use, particularly crack. Seventy-four homeless, out-of-treatment drug users were recruited in Saint Lucia and Trinidad to assess risk behaviour and healthcare needs. Information was collected in several domains: medical, mental health, substance use, sexual risk, and barriers to care. Ninety-five percent of the sample reported crack cocaine use within the previous 30 days. Approximately 35% of the sample had ever been diagnosed with a sexually transmitted disease and 25% of the sample reported being HIV+. Approximately 40% had a history of trading sex for crack or money. Due to the range of needs in this population, interventions should be multimodal. A focus on the individual, community, and structural levels is warranted to improve chances of program effectiveness.
In St. Lucia (a small island in the British West Indies), our DOH was supporting the establishmen... more In St. Lucia (a small island in the British West Indies), our DOH was supporting the establishment of a drop-in center in Central Castries (the capital, the center is located in George the Fifth Park, commonly referred to as “the Gardens”), in an area frequented by dysfunctional, chaotic and mostly home-less crack users. In 2001 DOH director Uli Kohler instructed me to spend a good por-tion of my time getting the drop in center up and running. The Hook! Many of us have discussed what it takes to get crack users into a drop-in center. One ad-vantage programs working with injectors
The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overc... more The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centres a high risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return upon their release.
We reviewed the evidence regarding HIV prevalence, risk behaviours and transmission in prisons. We also reviewed evidence of the effectiveness of interventions and approaches to reduce the risk behaviours and, consequently, HIV transmission in prisons.
A large number of studies report high levels of risk behaviour in prisons, and HIV transmission has been documented. There is a large body of evidence from countries around the world of what prison systems can do to prevent HIV transmission. In particular, condom distribution programmes, accompanied by measures to prevent the occurrence of rape and other forms of non-consensual sex, needle and syringe programmes and opioid substitution therapies, have proven effective at reducing HIV risk behaviours in a wide range of prison environments without resulting in negative consequences for the health of prison staff or prisoners.
The introduction of these programmes in prisons is therefore warranted as part of comprehensive programmes to address HIV in prisons, including HIV education, voluntary HIV testing and counselling, and provision of antiretroviral treatment for HIV-positive prisoners. In addition, however, action to reduce overcrowding and improve conditions in detention is urgently needed.
About this book The Caribbean poses a significant drugs problem tor the UK and the US, as the rec... more About this book The Caribbean poses a significant drugs problem tor the UK and the US, as the recent phenomenon of yardie gangs in British cities graphically illustrates. But in the islands themselves ganja, crack cocaine and the policies to control them have become, as this ...
There are no interventions in the Caribbean or Saint Lucia that addresses the prevention, care an... more There are no interventions in the Caribbean or Saint Lucia that addresses the prevention, care and treatment (C&T) need of HIV+ homeless crack user. Our 2007 BSS of this population turned up high levels of HIV 7.5% for males and 11% for females compared to 1.2% for the nation. While ARV and clinic visits are free to all, barriers exist for homeless to access these services. Drug use coupled with poor hygiene, tattered clothes and lack of discretionary income for bus fare or to purchase a snack while waiting the long hours at the clinic serve to compound the stigma and discrimination (S&D) experienced by homeless HIV+ crack users from health care service provider and other clinic attendees. All this serves to keep homeless HIV+ crack users from accessing free services that are available to all.
This paper assesses compares and contrasts access to primary heath care, substance use and HIV
st... more This paper assesses compares and contrasts access to primary heath care, substance use and HIV status among a sample of urban street, out-of-treatment drug using populations in three Caribbean islands, St. Lucia, Trinidad and Jamaica. Demographic characteristics, substance use, self reported physical and mental health status and use and satisfaction with healthcare services were examined in anonymous and confidential interviews using structured questionnaires. The rate of self-reported HIV positive respondents was 12% in Saint Lucia 34% in Trinidad and 7% in Jamaica. A majority of respondents in all countries reported using the casualty department /emergency room at government hospitals as their first choice for their primary health care. A majority of respondents agreed that there were not enough services for drug users. Respondents within all samples agreed that drug users were not understood and that health care professionals had limited time to talk about their problems. Street out-of-treatment drug abusers are a high risk group for the acquisition and transmission of HIV/AIDS. A specialised primary health care service based on a ‘one stop shop’ approach, comprised of doctors, community public health and mental health nurses, counsellors, peer and outreach workers, is needed specifically for drug users to minimize the reaction to the drug-using stigma and address issues of exclusion and marginalization, thereby reducing the prejudice felt when using mainstream services.
The Caribbean region has the second highest burden of HIV/AIDS in the world, after sub Saharan Af... more The Caribbean region has the second highest burden of HIV/AIDS in the world, after sub Saharan Africa As such CARICOM Countries have high rates of HIV infection in the general population. This infection rate is driven primarily by unsafe heterosexual sex. In these countries, high rates of HIV infection among prisoners are related to high rates of HIV infection in population as a whole.
The continued spread of HIV within the prisons in these countries is related more to sexual contact than either unsafe medical practices or injecting drug use (IDU). Injecting drug use is rare to non-existent in the CARICOM Caribbean, contribute to the spread of HIV in CARICOM prisons.
Despite this situation, no CARICOM country has yet to implement a comprehensive HIV prevention programme in its prisons. There exist no written policies or protocols for dealing with HIV transmission in any of the prison systems of the 4 countries covered by this assessment. In fact when polled by the author, the prison governors attending the recent conference of Caribbean Superintendents of Prisons in Saint Vincent in May 2007 admitted that they had not implemented the HIV and infectious disease protocols presented to them at the previous conference in Grenada in 2006. Those protocols are attached as Appendix F.
In the past three decades, the HIV epidemic has rapidly emerged to become one of the most complex... more In the past three decades, the HIV epidemic has rapidly emerged to become one of the most complex problems facing the Americas. While Latin America generally has a low prevalence of HIV, the Caribbean as a region has the 2nd highest prevalence of HIV in the world. This belies that fact that regardless of national prevalence rates, HIV prevalence in certain most at risk populations can be 10 times or more the national rate. This assessment addresses one such population – drug users – and more specifically injecting drug users, as well as non-injecting drug users, particularly those who smoke or snort cocaine, populations for whom research has shown to be at high risk for contracting HIV.
The regional prevalence of HIV has declined from 2.2% in 2001 to less than 1% in 2012. Correspo... more The regional prevalence of HIV has declined from 2.2% in 2001 to less than 1% in 2012. Correspondingly the most recent UNAIDS publication updating the status of the epidemic in the Caribbean, Keeping the Score (2012) states that “AIDS-related mortality has declined by 50% from 2001 to an estimated 10,000 people in 2011 . Using that figure we can calculate that in 2001, an estimated 20,000 people died of AIDS related illnesses in the Caribbean. During this same period, HIV incidence in the Caribbean has decreased by about 10% between 2001 and 2011, with 13,000 new infections reported in 2011 . This steady decline in deaths and a corresponding decline in new infections can be directly attributed to the increase in antiretroviral treatment from 5% coverage in 2001 to 67% of the eligible population in 2011. The data is clear that as a result of the introduction and expansion of coverage of ART there was an accompanying decline in deaths from AIDS related illnesses.
The aim of this paper is to examine the contextual factors associated with the initiation of and
... more The aim of this paper is to examine the contextual factors associated with the initiation of and attitudes toward crack cocaine use from a sample of out-of-treatment male and female users from three islands in the English-speaking Caribbean. Data from 111 persons who reported using crack cocaine in the previous 30 days are analyzed.
The judiciary systems in most Caribbean countries
have some system of non-custodial treatments
wh... more The judiciary systems in most Caribbean countries have some system of non-custodial treatments whether enshrined in legislation or informally implemented by magistrates who understand that incarceration is not always the best solution in dealing with offenders. However, these measures have not been widely implemented owing to a variety of issues that vary from jurisdiction to jurisdiction, leaving unresolved the excessive overcrowding in Caribbean prisons. This manual aims to discuss the issues that hamper the wider implementation of non-custodial treatment in the Caribbean and to suggest some possible solutions, which may contribute to easing this overcrowding. It is envisaged that the resulting decreases in inmate numbers would enable the correctional systems to function more effectively.
The ABNF journal : official journal of the Association of Black Nursing Faculty in Higher Education, Inc
In the Caribbean AIDS has become the leading cause of death among those aged 15-45. The homeless ... more In the Caribbean AIDS has become the leading cause of death among those aged 15-45. The homeless are at high risk due to the nexus of mobility, psychiatric disorders and substance use, particularly crack. Seventy-four homeless, out-of-treatment drug users were recruited in Saint Lucia and Trinidad to assess risk behaviour and healthcare needs. Information was collected in several domains: medical, mental health, substance use, sexual risk, and barriers to care. Ninety-five percent of the sample reported crack cocaine use within the previous 30 days. Approximately 35% of the sample had ever been diagnosed with a sexually transmitted disease and 25% of the sample reported being HIV+. Approximately 40% had a history of trading sex for crack or money. Due to the range of needs in this population, interventions should be multimodal. A focus on the individual, community, and structural levels is warranted to improve chances of program effectiveness.
In St. Lucia (a small island in the British West Indies), our DOH was supporting the establishmen... more In St. Lucia (a small island in the British West Indies), our DOH was supporting the establishment of a drop-in center in Central Castries (the capital, the center is located in George the Fifth Park, commonly referred to as “the Gardens”), in an area frequented by dysfunctional, chaotic and mostly home-less crack users. In 2001 DOH director Uli Kohler instructed me to spend a good por-tion of my time getting the drop in center up and running. The Hook! Many of us have discussed what it takes to get crack users into a drop-in center. One ad-vantage programs working with injectors
The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overc... more The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centres a high risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return upon their release.
We reviewed the evidence regarding HIV prevalence, risk behaviours and transmission in prisons. We also reviewed evidence of the effectiveness of interventions and approaches to reduce the risk behaviours and, consequently, HIV transmission in prisons.
A large number of studies report high levels of risk behaviour in prisons, and HIV transmission has been documented. There is a large body of evidence from countries around the world of what prison systems can do to prevent HIV transmission. In particular, condom distribution programmes, accompanied by measures to prevent the occurrence of rape and other forms of non-consensual sex, needle and syringe programmes and opioid substitution therapies, have proven effective at reducing HIV risk behaviours in a wide range of prison environments without resulting in negative consequences for the health of prison staff or prisoners.
The introduction of these programmes in prisons is therefore warranted as part of comprehensive programmes to address HIV in prisons, including HIV education, voluntary HIV testing and counselling, and provision of antiretroviral treatment for HIV-positive prisoners. In addition, however, action to reduce overcrowding and improve conditions in detention is urgently needed.
About this book The Caribbean poses a significant drugs problem tor the UK and the US, as the rec... more About this book The Caribbean poses a significant drugs problem tor the UK and the US, as the recent phenomenon of yardie gangs in British cities graphically illustrates. But in the islands themselves ganja, crack cocaine and the policies to control them have become, as this ...
There are no interventions in the Caribbean or Saint Lucia that addresses the prevention, care an... more There are no interventions in the Caribbean or Saint Lucia that addresses the prevention, care and treatment (C&T) need of HIV+ homeless crack user. Our 2007 BSS of this population turned up high levels of HIV 7.5% for males and 11% for females compared to 1.2% for the nation. While ARV and clinic visits are free to all, barriers exist for homeless to access these services. Drug use coupled with poor hygiene, tattered clothes and lack of discretionary income for bus fare or to purchase a snack while waiting the long hours at the clinic serve to compound the stigma and discrimination (S&D) experienced by homeless HIV+ crack users from health care service provider and other clinic attendees. All this serves to keep homeless HIV+ crack users from accessing free services that are available to all.
This paper assesses compares and contrasts access to primary heath care, substance use and HIV
st... more This paper assesses compares and contrasts access to primary heath care, substance use and HIV status among a sample of urban street, out-of-treatment drug using populations in three Caribbean islands, St. Lucia, Trinidad and Jamaica. Demographic characteristics, substance use, self reported physical and mental health status and use and satisfaction with healthcare services were examined in anonymous and confidential interviews using structured questionnaires. The rate of self-reported HIV positive respondents was 12% in Saint Lucia 34% in Trinidad and 7% in Jamaica. A majority of respondents in all countries reported using the casualty department /emergency room at government hospitals as their first choice for their primary health care. A majority of respondents agreed that there were not enough services for drug users. Respondents within all samples agreed that drug users were not understood and that health care professionals had limited time to talk about their problems. Street out-of-treatment drug abusers are a high risk group for the acquisition and transmission of HIV/AIDS. A specialised primary health care service based on a ‘one stop shop’ approach, comprised of doctors, community public health and mental health nurses, counsellors, peer and outreach workers, is needed specifically for drug users to minimize the reaction to the drug-using stigma and address issues of exclusion and marginalization, thereby reducing the prejudice felt when using mainstream services.
The Caribbean region has the second highest burden of HIV/AIDS in the world, after sub Saharan Af... more The Caribbean region has the second highest burden of HIV/AIDS in the world, after sub Saharan Africa As such CARICOM Countries have high rates of HIV infection in the general population. This infection rate is driven primarily by unsafe heterosexual sex. In these countries, high rates of HIV infection among prisoners are related to high rates of HIV infection in population as a whole.
The continued spread of HIV within the prisons in these countries is related more to sexual contact than either unsafe medical practices or injecting drug use (IDU). Injecting drug use is rare to non-existent in the CARICOM Caribbean, contribute to the spread of HIV in CARICOM prisons.
Despite this situation, no CARICOM country has yet to implement a comprehensive HIV prevention programme in its prisons. There exist no written policies or protocols for dealing with HIV transmission in any of the prison systems of the 4 countries covered by this assessment. In fact when polled by the author, the prison governors attending the recent conference of Caribbean Superintendents of Prisons in Saint Vincent in May 2007 admitted that they had not implemented the HIV and infectious disease protocols presented to them at the previous conference in Grenada in 2006. Those protocols are attached as Appendix F.
In the past three decades, the HIV epidemic has rapidly emerged to become one of the most complex... more In the past three decades, the HIV epidemic has rapidly emerged to become one of the most complex problems facing the Americas. While Latin America generally has a low prevalence of HIV, the Caribbean as a region has the 2nd highest prevalence of HIV in the world. This belies that fact that regardless of national prevalence rates, HIV prevalence in certain most at risk populations can be 10 times or more the national rate. This assessment addresses one such population – drug users – and more specifically injecting drug users, as well as non-injecting drug users, particularly those who smoke or snort cocaine, populations for whom research has shown to be at high risk for contracting HIV.
The regional prevalence of HIV has declined from 2.2% in 2001 to less than 1% in 2012. Correspo... more The regional prevalence of HIV has declined from 2.2% in 2001 to less than 1% in 2012. Correspondingly the most recent UNAIDS publication updating the status of the epidemic in the Caribbean, Keeping the Score (2012) states that “AIDS-related mortality has declined by 50% from 2001 to an estimated 10,000 people in 2011 . Using that figure we can calculate that in 2001, an estimated 20,000 people died of AIDS related illnesses in the Caribbean. During this same period, HIV incidence in the Caribbean has decreased by about 10% between 2001 and 2011, with 13,000 new infections reported in 2011 . This steady decline in deaths and a corresponding decline in new infections can be directly attributed to the increase in antiretroviral treatment from 5% coverage in 2001 to 67% of the eligible population in 2011. The data is clear that as a result of the introduction and expansion of coverage of ART there was an accompanying decline in deaths from AIDS related illnesses.
The aim of this paper is to examine the contextual factors associated with the initiation of and
... more The aim of this paper is to examine the contextual factors associated with the initiation of and attitudes toward crack cocaine use from a sample of out-of-treatment male and female users from three islands in the English-speaking Caribbean. Data from 111 persons who reported using crack cocaine in the previous 30 days are analyzed.
The judiciary systems in most Caribbean countries
have some system of non-custodial treatments
wh... more The judiciary systems in most Caribbean countries have some system of non-custodial treatments whether enshrined in legislation or informally implemented by magistrates who understand that incarceration is not always the best solution in dealing with offenders. However, these measures have not been widely implemented owing to a variety of issues that vary from jurisdiction to jurisdiction, leaving unresolved the excessive overcrowding in Caribbean prisons. This manual aims to discuss the issues that hamper the wider implementation of non-custodial treatment in the Caribbean and to suggest some possible solutions, which may contribute to easing this overcrowding. It is envisaged that the resulting decreases in inmate numbers would enable the correctional systems to function more effectively.
When researching this article on non-communicable diseases (NCDs) and the Small States of the Com... more When researching this article on non-communicable diseases (NCDs) and the Small States of the Commonwealth, I was shocked at learning of two aspects of what has quickly become a global epidemic.
The first was the extent of the problem: I was astounded that up to 80% of the worlds deaths were caused by diseases that were only recently been amalgamated into the category “NCDs”.
The second thought I had was: “If this is so huge, why is it just now that we are hearing about it? The whole concept of the cumulative impact NCDs seems to have only appeared on the global stage since the turn of the century.
Despite their obvious and growing significance, the lack of amalgamating the component diseases as “NCDs” has had the effect of keeping the impact of the aggregate hidden, misunderstood and under-recorded. NCDs were not even mentioned in the Millennium Development Goals, which, by focusing attention on HIV/AIDS, tuberculosis, malaria, and maternal, child and reproductive health, may have caused this growing public health concern to o unrecognized at the global level until recently.
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Papers by Marcus Day
We reviewed the evidence regarding HIV prevalence, risk behaviours and transmission in prisons. We also reviewed evidence of the effectiveness of interventions and approaches to reduce the risk behaviours and, consequently, HIV transmission in prisons.
A large number of studies report high levels of risk behaviour in prisons, and HIV transmission has been documented. There is a large body of evidence from countries around the world of what prison systems can do to prevent HIV transmission. In particular, condom distribution programmes, accompanied by measures to prevent the occurrence of rape and other forms of non-consensual sex, needle and syringe programmes and opioid substitution therapies, have proven effective at reducing HIV risk behaviours in a wide range of prison environments without resulting in negative consequences for the health of prison staff or prisoners.
The introduction of these programmes in prisons is therefore warranted as part of comprehensive programmes to address HIV in prisons, including HIV education, voluntary HIV testing and counselling, and provision of antiretroviral treatment for HIV-positive prisoners. In addition, however, action to reduce overcrowding and improve conditions in detention is urgently needed.
status among a sample of urban street, out-of-treatment drug using populations in three Caribbean islands,
St. Lucia, Trinidad and Jamaica. Demographic characteristics, substance use, self reported physical and
mental health status and use and satisfaction with healthcare services were examined in anonymous and
confidential interviews using structured questionnaires. The rate of self-reported HIV positive respondents
was 12% in Saint Lucia 34% in Trinidad and 7% in Jamaica. A majority of respondents in all countries
reported using the casualty department /emergency room at government hospitals as their first choice for
their primary health care. A majority of respondents agreed that there were not enough services for drug
users. Respondents within all samples agreed that drug users were not understood and that health care
professionals had limited time to talk about their problems. Street out-of-treatment drug abusers are a high
risk group for the acquisition and transmission of HIV/AIDS. A specialised primary health care service
based on a ‘one stop shop’ approach, comprised of doctors, community public health and mental health
nurses, counsellors, peer and outreach workers, is needed specifically for drug users to minimize the
reaction to the drug-using stigma and address issues of exclusion and marginalization, thereby reducing the
prejudice felt when using mainstream services.
The continued spread of HIV within the prisons in these countries is related more to sexual contact than either unsafe medical practices or injecting drug use (IDU). Injecting drug use is rare to non-existent in the CARICOM Caribbean, contribute to the spread of HIV in CARICOM prisons.
Despite this situation, no CARICOM country has yet to implement a comprehensive HIV prevention programme in its prisons. There exist no written policies or protocols for dealing with HIV transmission in any of the prison systems of the 4 countries covered by this assessment. In fact when polled by the author, the prison governors attending the recent conference of Caribbean Superintendents of Prisons in Saint Vincent in May 2007 admitted that they had not implemented the HIV and infectious disease protocols presented to them at the previous conference in Grenada in 2006. Those protocols are attached as Appendix F.
attitudes toward crack cocaine use from a sample of out-of-treatment male and female users from
three islands in the English-speaking Caribbean. Data from 111 persons who reported using
crack cocaine in the previous 30 days are analyzed.
have some system of non-custodial treatments
whether enshrined in legislation or informally
implemented by magistrates who understand that
incarceration is not always the best solution in
dealing with offenders. However, these measures
have not been widely implemented owing to a
variety of issues that vary from jurisdiction to
jurisdiction, leaving unresolved the excessive
overcrowding in Caribbean prisons. This manual
aims to discuss the issues that hamper the wider
implementation of non-custodial treatment in the
Caribbean and to suggest some possible solutions,
which may contribute to easing this overcrowding. It
is envisaged that the resulting decreases in inmate
numbers would enable the correctional systems to
function more effectively.
We reviewed the evidence regarding HIV prevalence, risk behaviours and transmission in prisons. We also reviewed evidence of the effectiveness of interventions and approaches to reduce the risk behaviours and, consequently, HIV transmission in prisons.
A large number of studies report high levels of risk behaviour in prisons, and HIV transmission has been documented. There is a large body of evidence from countries around the world of what prison systems can do to prevent HIV transmission. In particular, condom distribution programmes, accompanied by measures to prevent the occurrence of rape and other forms of non-consensual sex, needle and syringe programmes and opioid substitution therapies, have proven effective at reducing HIV risk behaviours in a wide range of prison environments without resulting in negative consequences for the health of prison staff or prisoners.
The introduction of these programmes in prisons is therefore warranted as part of comprehensive programmes to address HIV in prisons, including HIV education, voluntary HIV testing and counselling, and provision of antiretroviral treatment for HIV-positive prisoners. In addition, however, action to reduce overcrowding and improve conditions in detention is urgently needed.
status among a sample of urban street, out-of-treatment drug using populations in three Caribbean islands,
St. Lucia, Trinidad and Jamaica. Demographic characteristics, substance use, self reported physical and
mental health status and use and satisfaction with healthcare services were examined in anonymous and
confidential interviews using structured questionnaires. The rate of self-reported HIV positive respondents
was 12% in Saint Lucia 34% in Trinidad and 7% in Jamaica. A majority of respondents in all countries
reported using the casualty department /emergency room at government hospitals as their first choice for
their primary health care. A majority of respondents agreed that there were not enough services for drug
users. Respondents within all samples agreed that drug users were not understood and that health care
professionals had limited time to talk about their problems. Street out-of-treatment drug abusers are a high
risk group for the acquisition and transmission of HIV/AIDS. A specialised primary health care service
based on a ‘one stop shop’ approach, comprised of doctors, community public health and mental health
nurses, counsellors, peer and outreach workers, is needed specifically for drug users to minimize the
reaction to the drug-using stigma and address issues of exclusion and marginalization, thereby reducing the
prejudice felt when using mainstream services.
The continued spread of HIV within the prisons in these countries is related more to sexual contact than either unsafe medical practices or injecting drug use (IDU). Injecting drug use is rare to non-existent in the CARICOM Caribbean, contribute to the spread of HIV in CARICOM prisons.
Despite this situation, no CARICOM country has yet to implement a comprehensive HIV prevention programme in its prisons. There exist no written policies or protocols for dealing with HIV transmission in any of the prison systems of the 4 countries covered by this assessment. In fact when polled by the author, the prison governors attending the recent conference of Caribbean Superintendents of Prisons in Saint Vincent in May 2007 admitted that they had not implemented the HIV and infectious disease protocols presented to them at the previous conference in Grenada in 2006. Those protocols are attached as Appendix F.
attitudes toward crack cocaine use from a sample of out-of-treatment male and female users from
three islands in the English-speaking Caribbean. Data from 111 persons who reported using
crack cocaine in the previous 30 days are analyzed.
have some system of non-custodial treatments
whether enshrined in legislation or informally
implemented by magistrates who understand that
incarceration is not always the best solution in
dealing with offenders. However, these measures
have not been widely implemented owing to a
variety of issues that vary from jurisdiction to
jurisdiction, leaving unresolved the excessive
overcrowding in Caribbean prisons. This manual
aims to discuss the issues that hamper the wider
implementation of non-custodial treatment in the
Caribbean and to suggest some possible solutions,
which may contribute to easing this overcrowding. It
is envisaged that the resulting decreases in inmate
numbers would enable the correctional systems to
function more effectively.
The first was the extent of the problem: I was astounded that up to 80% of the worlds deaths were caused by diseases that were only recently been amalgamated into the category “NCDs”.
The second thought I had was: “If this is so huge, why is it just now that we are hearing about it? The whole concept of the cumulative impact NCDs seems to have only appeared on the global stage since the turn of the century.
Despite their obvious and growing significance, the lack of amalgamating the component diseases as “NCDs” has had the effect of keeping the impact of the aggregate hidden, misunderstood and under-recorded. NCDs were not even mentioned in the Millennium Development Goals, which, by focusing attention on HIV/AIDS, tuberculosis, malaria, and maternal, child and reproductive health, may have caused this growing public health concern to o unrecognized at the global level until recently.