30 The Bangkok Rules needs are not adequately understood or treated, symptoms are addressed rather than the underlying reasons that lead to mental health problems. Too often women are prescribed medication to overcome their distress or depression, rather then being provided with psycho-social support, based on individual assessments. While counselling and treatment should be offered whether a woman is in pre-trial detention or sentenced, depending on the average length of time spent in pre-trial detention in each jurisdiction, long term treatment programmes may begin only if a woman is sentenced and therefore expects to stay a longer period of time in prison. Where possible and appropriate, treatment in the community, with adequate security measures, should be considered for such women, taking account of the negative impact of imprisonment on mental health. Rule 13 Women are particularly susceptible to mental distress and depression at certain times, for example on admission to prison, due to separation or loss, upon receiving negative information from home, following the delivery of a child, following the experience of any act of victimization or violence, during menopause, after separation from a child previously in the prison with her and prior to release. Thus the rule encourages the adoption of an institutional policy to ensure staff awareness and training to recognize symptoms of mental distress and to respond to needs in an appropriate manner, by responding to the women’s need with understanding and referring them to specialised support, as necessary (e.g. pscycho-social support services, including those provided by specialised organisations of civil society, non-governmental organisations, etc). Rules 14 Women have a particular physical vulnerability to HIV. Studies have shown that women are at least twice as likely as men to contract HIV through sex. The pre existence of sexually transmitted diseases (STD) can greatly increase the risk of contracting HIV.47 Due to the typical background of women prisoners, which can include injecting drug use, sexual abuse, violence, sex work and unsafe sexual practices, a significant number of women are infected with STD, including HIV and hepatitis, at the time they enter prison. Thus, the proportion of women in prison with an STD is relatively very high.48 As such, HIV prevention, treatment and care in women’s prisons, covered by these rules, are vital to protect women from HIV/AIDS and prevent the spread of the disease. Peer education has proven to be particularly successful in a number of jurisdictions. Rule 15 A large number of women prisoners worldwide are in need of treatment for substance addiction, though only a minority has access to treatment programmes, and especially to programmes designed for women offenders. When drug addiction is untreated in prison, the likelihood of re-offending is high, either on drugs charges or due to theft or illegal sex acts, often to finance the addiction. In most countries, women experience social, cultural and personal barriers to treatment entry in the community. These include the significant stigma and shame associated with substance use and related problems among women, such as fear of losing custody of children, lack of partner and other family support to undertake treatment and lack of confidence about treatment. There is significant evidence that substance abuse is tied to both past histories of violence and trauma as well as mental health conditions.49 In addition, it is increasingly recognized that women have distinctive needs in relation to substance abuse treatment, though few programmes offer specialized services for them. There is now increased knowledge and awareness that gender differences in substance use and related problems require different treatment approaches.50 ___________ Women and HIV in Prison Settings, HIV/AIDS Unit, UNODC, p. 3 www.unodc.org/unodc/en/drug_demand_hiv_aids.html. Ibid., p. 3. 49 Bloom B., Owen, B. Owen & S. Covington, Gender Responsive Strategies: Research Practice & Guiding Principles for Female Offenders. National Institute of Justice, US Dept. of Justice, USA, 2003. 50 UNODC Drug Abuse Treatment Toolkit, Substance abuse treatment and care for women: Case studies and lessons learned, United Nations, New York, 2004, p. 23. 47 48