Infection prevention and control and surveillance for coronavirus disease (COVID-19) in prisons in EU/EEA countries and the UK

ECDC published guidance on infection and control of COVID-19 in prisons.

This is a document that provides principles of surveillance, infection prevention and control (IPC) and management of COVID-19 infection in prisons in European Union (EU) and European Economic Area (EEA) countries and the United Kingdom (UK).

Read more – IPC-and-surveillance-for-coronavirus-disease-in-prisons

Global Prison Trends 2020

Penal Reform International released a document Global Prison Trends 2020.
Global Prison Trends 2020 documents the chronic issues that have led to this human rights and public health crisis and the challenges facing criminal justice systems in responding to the global pandemic.

The report documents a record 11 million people in prison worldwide, with over 124 prisons exceeding their maximum occupancy rate. Global Prison Trends shows how this increase in numbers is driven by a punitive approach to criminal justice where more costly prison sentences are favoured over non-custodial alternatives.
The overcrowding and underfunding of prisons, alongside the overuse of imprisonment, has resulted in poor health services and sanitary conditions for prisoners that make people in prison and prison staff acutely vulnerable to COVID-19.
The special focus of Global Prison Trends 2020 identifies the solution presented by increasing the use of alternatives to imprisonment and the challenges governments may face in implementing this. PRI advocates for an increase in the use of alternatives to detention as a solution to the global prison crisis and in the long-term to reduce reoffending rates, better protect human rights and tackle overcrowding.

Global Prison Trends 2020 explores the following subjects:
– Crime, justice and imprisonment
– Trends in the use of imprisonment, including the funding of penitentiary systems
– Prison populations such as women, children, older persons and minority groups
– Prison management including the provision of health services
– The role and use of technology in prison
– A special focus on alternatives to imprisonment

Read the document

Executive-Summary-GPT-English

EECA’s response to COVID-19. Prison health.

Evgeniy Yuldashev, peer consultant and social worker, AFEW Kyrgyzstan, about work with (ex) prisoners. 

For reference:

For three years, Evgeniy has been working as a peer consultant with people who are released from prisons and are getting ready for the release with AFEW Kyrgyzstan. His work is to provide support to (ex) prisoners, tell them how to adapt to the social environment and live a full life with HIV and any co-morbidities, such as tuberculosis or hepatitis C.

Changes due to COVID-19

Currently, Bishkek and other big cities of Kyrgyzstan live in the state of emergency. So far, there have been no cases registered in any correctional facilities. The penitentiary system implements a set of measures to avoid any outbreaks of COVID-19 in prisons. First of all, it means that all prisons are closed for visitors, including AFEW Kyrgyzstan staff members. Since 20 March 2020, our peer consultants have not been visiting any institutions.

Fortunately, some of our team members work as social workers in the correctional facilities. Besides, in each institution there are 2-3 volunteers (navigators) from among the prisoners. Thus, we are still able to remain in contact with the prisoners.

Innovations

Currently, one of our key priorities is prevention of the spread of coronavirus.

Prisoners are one of the populations most vulnerable to the new virus. The experience of other countries shows that in prisons the epidemic develops as a fire destroying everything on its way. It can be explained with the living conditions in prisons – overcrowded cells of the detention centers and cramped prison barracks do not allow for social distancing or self-isolation.

In fact, prison life has not really changed – inspections twice a day, waiting lines in the canteens and even long waiting lines in methadone dispensing sites…

From our side, we try to make our contribution to prevent any outbreaks in prisons. The first vital thing to be done is organizing awareness-raising activities. We started with our target group – prisoners who live with HIV. Through our project WhatsApp group and during our telephone calls, we regularly share information about coronavirus with the social workers which they can further share with the prisoners.

There is still a lack of studies on the virus, but the available data shows that HIV-positive people with suppressed viral load and high immunity status do not face a higher risk of infection than the general population. That is why our social workers and volunteers continue their efforts to enroll prisoners into the ART programs and ensure their adherence to treatment in close cooperation with the prison health workers.

As a peer consultant, I always stay in touch with the social workers and through them with the volunteers. We regularly organize phone calls and WhatsApp chats. As they say we are keeping our eyes on the ball. If prisoners have any questions, they can address them with our team through the social workers.

However, it will not be enough to inform people living with HIV to avoid any possible outbreaks. With support of our partners from the UNDP, we prepared a small information brochure, which will help people to learn more about COVID-19, its prevention, symptoms and treatment, and provided the published materials to the Prison Service.

Besides, we received a request for support from the prison administration to facilitate the procurement of personal protective equipment, disinfectants, etc. We submitted this request to our partners from ICAP, who will ensure the procurement of all the necessary supplies.

We are also looking for additional funding to roll out the response to the epidemic. Many prisoners complain about the lack of basic hygiene items. Today it is more important than ever to clean your hands and keep your towel clean. However, unfortunately such people do not always have access to a sufficient stock of such basic things as soap and laundry powder. We are in the process of negotiations with GIZ about the possibility to procure such materials and conduct large-scale awareness-raising activities covering not only prisoners but also prison staff as because of their work duties they are also at high risk of contracting the virus.

So we are keeping ourselves busy and make all the efforts to help our beneficiaries live through this challenging period of time.

 

AFEW International asks international organisations to take immediate action

AFEW International together with other European NGO asks international organisations to take immediate action and protect prisoners from coronavirus as soon as possible.

Text of the statement 

Appeal by European NGOs involved in the field of prison health and in the defence of the right to health protection for prisoners

The signatory organisations, which are involved on a daily basis in the protection of the right to health of prisoners, are alarmed at the unpreparedness of penitentiary administrations to deal with the spread of the coronavirus on the continent and, in most countries, the lack of consideration of the specific situation of prisons in national preparedness plans and systems for dealing with public health incidents. They recall that more than 1.5 million people are detained in prison facilities on the continent on any given day and that under international treaties, States are obliged to take the necessary measures to protect the life and health of those they detain.

The deficiencies observed pose a threat not only to prisoners and staff working in the institutions but also to the general population[1]. Prisons are generally considered to be amplifiers in the spread of infectious diseases[2].

Although levels of exposure to the health crisis vary greatly from one country to another, due to the great disparities in the characteristics of prison systems and the performance of national hospital systems, it appears that, overall, the prison issue is too largely ignored at European level, even though prisons are places with a high risk of transmission. Moreover, some states are tempted to adopt measures to isolate detainees from the rest of the population, in disregard of the rights of detainees and their relatives, and at the risk of preventing the population’s adherence to health instructions given by authorities.

Consequently, taking amount of the risk factors in the prison context, the signatory NGOs intend to alert the international organisations concerned, first and foremost WHO and the Council of Europe, to the serious shortcomings observed on the ground and urge them to put pressure on governments to take special health measures and reduce significantly the prison population as soon as possible.

Once again, the national contexts are highly contrasted and the picture drawn below should not be interpreted as reflecting a uniform situation. However, in view of the urgency of the situation, it is intended to underline the seriousness of the consequences that would result from failure to manage the coronavirus disease outbreak in prison and the imperative need for international organizations to act immediately to redirect national policies in this area.

  1. Prisons represent high-risk environments for the transmission of infectious diseases

1.1 Conditions of occupancy and organization of prison facilities. Prisoners are permanently in a situation of great promiscuity, whether in cells, production workshops, yards, etc. All aspects of prison life involve the movement of prisoners in groups, in more or less large numbers. The facilities are often poorly ventilated. In many European states, this situation is aggravated by regional or national situations of prison overcrowding[3]. From this point of view, the risks of spreading of the virus in the prison systems of post-soviet countries are particularly significant: i.) the prison population there is particularly large; ii.) remand prisons are often overcrowded and organised in collective cells, while correctional institutions are mostly organised in barracks housing 80-150 convicts, if not more; iii. ) once convicted, prisoners are transported for weeks or even months to their assigned correctional institutions; these transports take place in appalling hygienic conditions and involve repeated stops along the route.

1.2 A population at high risk of communicable disease and facing serious risk factor for coronavirus severity. In particular, the notification rates of tuberculosis in European prisons are up to 30 times higher than in the general population[4]. Prison populations in Europe are aging at an unprecedented rate[5]. Several countries in Europe, especially in Eastern Europe report HIV prevalence among prisoners at rates greater than 10 %[6]

1.2 A frequently failing medical system. Although the level of development of prison medicine varies greatly, the organisation of care in prisons is never designed to deal with a crisis situation. Even more critically, especially in Eastern Europe, services are very often under-equipped, understaffed and unable to cope adequately with the ordinary burden of common diseases. Moreover, they generally suffer from a very poor linkage with the general health system, leading to significant delays. Almost everywhere, the unavailability of escorts is a recurrent problem for the transfer of patients to the hospital.

  1. WHO guidance against COVID-19 spread are hardly implemented in prison.

WHO has provided States with guidance for public health measures that can slow the transmission and spread of COVID-19[6]. Accordingly, many States have taken measures to prohibit gatherings, to close down most public places and impose quarantine on the population to ensure social distance. However, although all countries are not on an equal footing in this respect, most measures recommended by the WHO are not, for the most part, implemented in prisons[7].

2.1 The reduction of prisoners’ contact with their relatives: mostly adopted response by prison administrations. Domestic authorities have generally limited themselves to providing information about the virus and drastically limiting prisoners’ contact with the outside world[8]. Some, like France, have suppressed collective activities within the prisons. However, these measures do not appear to be of such a nature as to adequately prevent the risks of contamination, which may be caused by new entrants, extractions of prisoners to the courts, staff working in the prison, etc. These measures can have perverse effects: prisons are particularly vulnerable to fake information/myths that may circulate by word-of-mouth or online. The increasing isolation of the prison environment accentuates the impact of rumours[9].

2.2 The maintenance of recurrent situations of regrouping of people: a favourable environment for the spreading of the virus. At present, detainees are generally still faced with multiple and routine gathering situations, for roll call, work, showers, etc.. Prison staff are in daily contact with a large number of detainees, conduct body and cell searches.

2.3 Failure to implement the required prevention interventions. From this point of view also, authorities do not seem to consider the risks of internal propagation within the prison. Detainees are frequently not in a position to observe hand hygiene instructions[10]. Masks for symptomatic individuals or health staff are not available[11]. Environmental cleaning is done under usual conditions.

  1. COVID-19 case management

The laconism of the prison preparedness and response plans disseminated, or even the absence of any public information on the subject, indicates that prison medical services have not, at this stage, been prepared for an influx of COVID-19 cases. In view of the serious failures of the services concerned in the management of common pathologies in ordinary times, the lack of preparedness suggests an improvised and therefore potentially chaotic management of COVID-19 cases.

3.1 Intervention protocol and articulation with civil medicine. In most of the countries, no information was available on the intervention protocols defining the division of roles between prison medicine and civil medicine.

3.2 Capacities of penitentiary medical facilities. Apart from exceptions[12], the available information does not show any reinforcement of the medical units in terms of personnel and equipment, particularly respiratory equipment. It does not appear that guidance to health providers for COVID-19 and severe acute respiratory infections has been disseminated.

3.3 Conveyance and stay of detained patients in hospital. No increase in the number of medical personnel was reported, nor were escorts provided to transport patients with Covid-19 to civilian hospitals. No legal measures to ease the transfer and hospital stay appear to have been envisaged.

  1. Measures liable to infringe fundamental rights.

Several countries have taken, or are about to take, drastic measures to limit the prison population’s contact with the rest of the world. Some countries have decided to completely suspend family visits[13], others have imposed severe restrictions in this area. Some States have provided for compensatory measures, such as increased telephone[14] or video conferencing facilities[15].

Several UN experts[16] and the Council of Europe have urged States to avoid overreach of security measures in their response to the coronavirus outbreak. When it comes to prison, the NGO Penal Reform International has recalled the requirements of necessity and proportionality of measures limiting visiting rights in this context[17].

While limitations on contact with the outside world may be justified where they are proportionate to the risk and accompanied by adequate compensatory measures, it must be stressed that closing prisons on themselves increases the risk of ill-treatment, especially in crisis and panic situations. Limitations on visits and activities will inevitably lead to situations of great tension[18]. Prison administrations will face unprecedented pressure. If relief measures are not taken swiftly, particularly in terms of the number of detainees, they may find themselves facing situations that are very difficult to manage.

Furthermore, it is essential that NPMs retain their right of access to prisons and that detainees have the possibility of contacting them by telephone, under appropriate conditions of confidentiality.

 

  1. An indispensable intervention at the international level

The Signatories urge international governmental organizations to take full account of both the major health risk associated with the spread of COVID-19 in prisons and the inertia shown by States, and consequently to take measures to ensure that States act effectively and with full respect for the fundamental rights of detained persons.

5.1 Health measures of prevention, early detection and control of COVID-19. International organizations must act swiftly to get States to develop the required prevention and response plans. WHO must play its leading role in this area and provide support to authorities for preparation and response. However, the technical support approach is not enough, and WHO and the relevant United Nations and Council of Europe bodies must use all their influence to bring States to meet their international obligations to protect the life and health of detained persons.

5.2 Avoid the spread of COVID-19 by significantly reducing the prison population. Whatever measures may be taken by the prison authorities to adapt to life in detention, the configuration of the premises and the organization of the prisons do not allow for the implementation of preventive measures, and in particular of social distance. Unless there is a clear reduction in the number of detainees, the virus will spread rapidly within the facilities and the prison and medical services will be overwhelmed. The national authorities must take urgent measures to seriously reduce the number of prisoners. In this respect, Council of Europe bodies, and in particular the Committee of Ministers, the General Secretary, the Committee for the Prevention of Torture (CPT) and the Commissioner for Human Rights, which play an important role in guiding penal and prison policies, must rapidly adopt recommendations to bring states to take these decisive steps. States have at their disposal a wide range of measures that can produce rapid effects, from penal policy guidelines provided to prosecutors’ offices to exceptional measures of pardon and amnesty. It is essential that an impetus be given very quickly at European level to steer national policies in this way.

5.3 Monitor respect for fundamental rights. The mechanisms for monitoring respect for fundamental rights should take exceptional organisational measures in order to be able to fully play their role. First, the ECtHR should strengthen its capacity to deal with requests for interim measures under Rule 39. In ordinary times, these are already very often necessary in some countries, such as Russia or Ukraine, in order to obtain acts of care which are essential for the protection of life. It is likely that the number of well-founded requests will increase significantly. Moreover, for legal or practical reasons, prisoners’ access to their lawyer or to NGOs will become acute. The Court should adopt practical instructions adapting the formal requirements resulting from Article 47. The other relevant bodies of the Council of Europe and the United Nations should organise the monitoring of the measures taken by states to combat the pandemic.

A PDF version of the document

On 18.03.2020

First signatories :

European Prison Litigation Network – EPLN

Eurasian Network of People who use Drugs – ENPUD

Helsinki Foundation for Human Rights (Poland)

Altro Diritto (Italy)

PromoLex (Republic of Moldova)

Antigone (Italy)

Belgian Bar (French and German speakers bars) – Avocats.be (Belgium)

Kharkiv Human Rights Protection Group – KHPG (Ukraine)

Ukrainian Human Rights Institute (Ukraine)

Bulgarian Helsinki Committee (Bulgaria)

Public Verdict Foundation (Russia)

Russia Behind Bars (Russia)

Ban Public (France)

Observatoire International des Prisons – Section Française (France)

Prison Archive/Strafvollzugsarchiv e.V. (Germany)

Legal Basis (Russia)

Agora International Human Rights Group (Russia)

Zona Prava (Russia)

Association for Human Rights of Andalusia (Spain)

Iridia – Center for the Defense of Human Rights (Spain)

Centre de la protection internationale (France/Russia)

Siberia Without Torture (Russia)

Man and the Law (Russia)

Ural Human Rights Group (Russia)

Civil Activists (Russia)

Tatort Zukunft (Germany)

Kosova Rehabilitation Centre for Torture Victims – KRCT (Kosovo)

Avocats sans Frontières – ASF (Belgium)

La Ligue des Droits de l’Homme – Section belge (Belgium)

Alliance of Ukrainian Unity (Ukraine)

HPLGBT (Ukraine)

«New Life » (Russia)

«All-Ukrainian League «Lеgalife» (Ukraine)

Zahid Chance (Ukraine)

Initiative Group PULS (Moldova)

Citizen N. (Russia)

Forum PUD (Russia)

Ukrainian Helsinki Human Rights Union (Ukraine)

AFEW International (Netherlands) 

[1] WHO, Prison and Health, Genève, 2014
[2] The Lancet, HIV and related infections in prisoners, Sep 10, 2016 Volume 388Number 10049p1025-1128, e2-e3
[3] Prison population brief. See also CoE, White Paper on Prison Overcrowding, CM(2016)121-add3
[4] WHO Europe, Good practices in the prevention and care of tuberculosis and drug-resistant tuberculosis in correctional facilities (2018)
[5] For instance, a report by Public Health England (PHE) showed that the proportion of people in prison aged 50 or older has increased by 150 per cent between 2002 and 2017.
[6] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
[7] In France, the National Preventive Mechanism stated on 16 March that the safety of persons in remand detention centres was no longer guaranteed and that the administration will therefore fail in its obligation to protect the persons under its control if it does not take the necessary measures as a matter of urgency. It called for a reduction in the prison population by encouraging prison exits and limiting entries.
[8] In addition to visitations restrictions, the Irish Prison Service planned on a number of contingency measures to reduce the number of people in custody in a controlled manner.
[9] In Italy the lack of medical information and miscommunication resulted in panic and false myth.
[10] For instance, hydroalcoholic gel is prohibited for detainees.
[11] In Italy, according to the NGO l’Altro Diritto, ombudsmen have expressed high concerns for the lack of masks, gloves or sanitizer. In Belgium, the guidelines for the management of suspected or actual cases of contamination recall the shortage of means of protection (masks, disinfectant gel) and recommend their use only when necessary.
[12] In Moldova, the texts dated 12 March foresee the supply of equipment stocks (protective masks, multifunctional electronic thermometers, etc.), medicines, biodistructive preparations, etc.;
[13] Including Belgium, Spain, Italy, France, Russia, Ukraine, Moldova, Bulgaria
[14] Belgium has granted a 20 euro telephony credit to all detainees.
[15] On 8 and 9 March, the Italian authorities authorised wide access to video calls to offset the effects of the suspension of visits. However, these instructions were unevenly applied, contributing to the outbreak of trouble.
[16] COVID-19: States should not abuse emergency measures to suppress human rights – UN experts, GENEVA (16 March 2020)
[17] Penal Reform International, Coronavirus: Healthcare and human rights of people in prison, briefing paper, 16 March 2020.
[18] Riots or protests have been taking place in 27 prisons throughout Italy. In this context, 13 prisoners died on 7 March 2020.

Coronavirus: Healthcare and human rights of people in prison

Where widespread community transmission of COVID-19 is occurring, there are legitimate concerns of this spreading to prisons. The outbreak of any communicable disease presents particular risks for prisons due to the vulnerability of the prison population and not least because of the difficulties in containing a large outbreak in such a setting. People detained are vulnerable for several reasons, but especially due to the proximity of living (or working) so closely to others – in many cases in overcrowded, cramped conditions with little fresh air.

People in detention also have common demographic characteristics with generally poorer health than the rest of the population, often with underlying health conditions. Hygiene standards are often below that found in the community and sometimes security or infrastructural factors reduce opportunities to wash hands or access to hand sanitizer.

Any coronavirus outbreak in prisons should – in principle – not take prison management by surprise, as contingency plans for the management of outbreaks of communicable diseases should be in place. This is an essential part of the obligation of the state to ensure the health care of people in prison required by international human rights law.

Organization Penal Reform International assessed the current situation of COVID-19 outbreaks and prevention measures in prisons and wider impacts of responses to governments on people in criminal justice systems. In a briefing note the organization argues for action to be taken now and immediately, given the risk people in prison are exposed to, including prison staff.

Read the Briefing 

Source

Women in prison: mental health and well-being – a guide for prison staff

People in prison have a disproportionately high rate of poor mental health, and research shows these rates are even higher for women in prison. While primary care remains the responsibility of healthcare professionals, frontline prison staff play an important role in protecting and addressing mental health needs of women in prison.

Penal Reform International (PRI), in partnership with the Prison Reform Trust (PRT), has published a guide for prison and probation staff to help them understand how prison life can affect a person’s mental health, with a focus on women. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.

This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. It also includes a checklist based on international human rights standards aimed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.

Published with the support of Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.

Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.

AFEW International and ICAP at Columbia University to improve HIV services in prisons in Kyrgyzstan and Tajikistan

In 2020, AFEW and ICAP at Columbia University will partner to implement «Technical Assistance to Central Asian National HIV Programs to Achieve and Sustain HIV Epidemic Control under the President’s Emergency Plan for AIDS Relief (PEPFAR)» in Kyrgyzstan and Tajikistan, a project funded by PEPFAR through the US Centers for Disease Control and Prevention (CDC). In Kyrgyzstan the project will be implemented by AFEW Kyrgyzstan; in Tajikistan, by NGO SPIN Plus with technical support of AFEW Kazakhstan.

With this project, the partners will strive to reach two important goals:

1) improving the 90-90-90 targets for people who inject drugs (PWID) and people living with HIV (PLHIV) in prisons in Kyrgyzstan and Tajikistan, using new technologies and services;

2) facilitating and improving collaboration between general public health care facilities and health care services within the penitentiary system, ensuring continuity of HIV-related services to people being released from prisons.

AFEW International will be the lead agency working with its in-country AFEW partners and local partners to implement this project in Kyrgyzstan and Tajikistan,” said Daria Alekseeva, Program Director of AFEW International. “We have a proven track record and evidence that working as a regional EECA network has encouraged the exchange of context-specific approaches that help to find appropriate local solutions and models of best practice. We combine local Central Asian knowledge and expertise, exchanging this within the wider EECA region, as well as the added advantage of an international, Netherlands-based Secretariat, contributing to international expertise and innovation. AFEW International – together with AFEW Kyrgyzstan and AFEW Kazakhstan, which will provide technical support to activities in Tajikistan – will aggregate lessons learned from ICAP’s previous work in Kazakhstan and combine those lessons with the methodological approach gained through the past experience of working in prisons in Central Asia to produce practical guidelines and training modules. AFEW International will look for possibilities to pilot this model in Kyrgyzstan and Tajikistan, where political and technical conditions may allow.”

“People living with HIV in prisons are less likely to be on antiretroviral therapy (ART) when compared to general population. They are also less likely to adhere to the prescribed treatment regimen and, therefore, are often viremic,” said Anna Deryabina, ICAP Regional Director for Central Asia. “Lower ART initiation and viral load suppression rates among prisoners are due to many factors, including structural factors, such as lack of trained health care personnel in prisons and limited adherence support and treatment monitoring. Also, lack of coordination between general and prison-based health care services and fragmented service delivery systems lead to many people living with HIV being lost to follow-up and discontinuing treatment after being released from prisons. ICAP has been very effective in improving the quality of HIV services provided to people living with HIV treatment facilities outside of prisons. We really hope that AFEW’s deep knowledge and understanding of subcultures and norms inside the prisons, as well as their experience working with the prison-based health care systems will allow this project to effectively improve the quality of services and HIV outcomes for people living with HIV in prisons.”

“AFEW-Kyrgyzstan is pleased to launch this joint project with ICAP. Under the Project, our organization will be responsible for the implementation of the component to achieve the 90-90-90 goal in the penitentiary system,” said Dina Masalimova, AFEW-Kyrgyzstan Programs Manager. “We plan to work in almost all large prisons in Chui Oblast. Our activities will be aimed at expanding HIV testing coverage with the provision of quality pre- and post-test peer counseling, motivation to start therapy, and adherence development. In addition, we will focus on ensuring that people do not stop their treatment even after release.”

This project is very important to maintaining an effective response to the HIV infection in the country, as 5-10% of all PLHIV in the country are in the prison system. With the high turnover of the prison population, this number can be easily multiplied by half per year.

“We are happy to work in a team with such a highly professional organization as ICAP,” said Masalimova. “It is planned that ICAP specialists will be responsible for medical aspects of providing assistance to PLHIV, and our organization will take over the community element and peer-to-peer support.”

In Kyrgyzstan, AFEW-KG will recruit and train a team of peer navigators representing each layer of the prison sub-population (with a special focus on prison outcasts and pre-release prisoners) in order to identify those who practice risky behaviors and haven’t been tested for HIV in the past six months. AFEW-KG will work with newly identified PLHIV to motivate them to start antiretroviral therapy and take all of the necessary tests. The peer consultants will work as liaisons between patients and prison doctors to ensure that patients are prescribed ART, are adherent to treatment, and that relationships between prison doctors and patients are built on mutual trust.

In addition, AFEW-KG will provide a series of counseling sessions for at least 200 prisoners who are PWID on the benefits of starting methadone-assisted treatment (MAT) and dispelling the myths related to the therapy.

“We believe that this collaboration will yield excellent results and that by the end of 2020 we will be able to see tangible progress on each of the 90-90-90 goals in prisons,” said Masalimova.

 

Status report on prison health in the WHO European Region

WHO HIPP has launched the Status report on prison health in the WHO European Region.

This report presents an analysis of data collected on the health status of people in prison and prison health systems for 39 countries in the WHO European Region. The Health in Prisons European Database (HIPED) survey collected data from Member States between 2016 and 2017 to enable monitoring and surveillance of health in prisons. The aim of this report is to provide an indication of the current status of prison health in the European Region and highlight areas of prison health policy that should better be aligned to WHO guidance.

The document presents data and recommendations under the following headings: prison population statistics, prison health-care systems, prison environment, risk factors for ill health, disease screening on admission, prevention of infection, treatment and mortality. These data, alongside WHO guidance on health in prison, will help to inform and influence policy-makers to improve the health outcomes of people in prison.

The report is now live on the WHO website: http://www.euro.who.int/en/status-report-on-prison-health.

Prison Health Infographic ENG

Health in prisons: fact sheets for 38 European countries (2019)

 

 

HIV in prison is not a death sentence

Nowadays Kyrgyzstan is recognized as one of the most advanced countries in the world in regards to delivery of the harm reduction and HIV care and treatment programs in prisons (details here).

At the moment here, in the penitentiaries, there are 5 active programs: syringe exchange program, methadone maintenance treatment program, rehabilitation program “Atlantis”, Center for Rehabilitation and Social Adaptation “Clean zone” and “Start Plus” program.

Dina Masalimova, AFEW-Kyrgyzstan program manager, explained what kind of work is done in this field in the country, and which significant results have already been achieved.

Dina, could you please describe the programs for inmates? What do they look like?

A pilot program on needle and syringe exchange was introduced in Kyrgyzstan in 2002, in one of the prisons with a modest reach of 50 people. A year later the program was expanded to 3 prisons, and then several more. Today there are 14 syringe exchange stations (SES) in the penitentiary system. They work in all the prisons except for the facility for underage convicts. Also, syringe exchange services are provided in the 2 largest detention centers. An actual number of SES clients in 2018 amounted to over 1300 people. They received syringes either in person, or through a secondary exchange conducted by volunteers. Aside from the sterile injection equipment you can also find other protection items at the stations – alcohol wipes, condoms; and HIV blood tests are done here too. Those clients that would like to decrease or fully stop the injecting drug use are forwarded to the methadone maintenance treatment stations.

The methadone maintenance treatment program was started in the country’s prisons over 10 years ago – in 2008.  Today there are already 9 stations in the penitentiaries, and the number of clients is over 350. These programs are conducted by the State Penitentiary Service with the support of the Global Fund To Fight Aids, Tuberculosis And Malaria, as well as Center for Disease Control (CDC).

Aside from the harm reduction programs there is a program aimed at the full withdrawal from drug use in prisons. In a number of places the  “Atlantis” program based on the famous model “12 steps” is active. The program graduates can serve their remaining sentence time in the Center for Rehabilitation and Social Adaptation “Clean zone”. “Clean” means that it’s free from drugs. There is a full-scale program of rehabilitation and preparation for sober life outside of prison there.

Over the past 5 years we also were active in delivering services directly to inmates. For instance, our consultants have supported prisons’ health system by providing peer-to-peer consultations and HIV testing, as well as supported inmates before and after their release from prison. For a long time this program has been implemented with the support of USAID. Soon it will be continued thanks to the financial and technical support of ICAP (international program by Columbia University’s Mailman School of Public Health).

How are these programs created, and who delivers them?

As a rule, these programs are created based on the actual needs of the most vulnerable groups of prisoners – people living with HIV and/or using drugs. And these programs are also delivered by the representatives of these communities.

We approach the program in a flexible way and always try to improve it so that it remains relevant. For example, one of our recent additions to the program is working with the convicts that were rejected by the prison subculture. Due to the unspoken prison rules this group of prisoners has the lowest level of access to medical and social support and faces a high level of stigma and discrimination from the other convicts, and often also from the prison staff.

Could you share some results of these programs?

All the programs currently active in the country are aimed at reaching the ambitious goal 90-90-90.  Now almost all inmates in prison are being tested for HIV “at the entrance”, and a vast majority of people living with HIV are formally in treatment. Why “formally”? The viral load indicators show that quite a few of inmates don’t use it. In prisons there are a lot of myths about HIV and antiretroviral therapy, and during in-person conversations many patients admit that they simply throw medicines away. Because of that, the main goal of our project is to increase the number of convicts who live with HIV with undetectable virus load.
Over the years we achieved great results. For instance, in prison #31 the number of people who are adherent and have a suppressed virus load has grown from 15% to 68%, and in prison #16 – from 33% to 66% in the past three years. We are especially proud of two prisons – #2 and #47, where we’ve already reached the second and third “90”.

All these programs are mainly targeting male convicts. Are there any special programs for female inmates, for pregnant women?

In Kyrgyz prisons there are only 10 female inmates living with HIV. However, it is also important to consider their needs while planning measures in response to HIV-epidemic. We approach work in female prisons quite reverently and are trying to make sure our programs are gender-sensitive.  In one prison there was a women self-help group focusing on gender violence prevention. Also we partner with NGO “Asteria”, which runs a women’s center supported by AFEW-Kyrgyzstan and open for women released from prison. Many of the center’s clients are former inmates, and the help and support program includes temporary lodging, provision of food and hygiene packages, peer consulting on HIV, sexual and reproductive health and rights (SRHR) and opioid substitution treatment (OST), as well as provides access to gynecological services.

What is the prisoners’ attitude towards such programs?

Inmates perceive this program in a very positive way. Slowly but surely our team managed to win their trust and involve them into the dialogue about their health. It’s important to understand that health is far from the first priority for a person in prison. Unfortunately, current conditions of prisons make basic survival the main priority, and HIV is perceived as a far removed problem for many of them. Our peer consultants have their own experience of living with HIV in a prison, so they can show by their own example how one could solve upcoming problems.

Could you name the main current problem for prisoners with HIV in Kyrgyzstan?

One of the main problems is the lack of medical staff in the penitentiary system. In a number of large prisons in the country there are no doctors with higher medical degree. All the work on supporting prisoners’ health is put on the shoulders of a small team of paramedics. Of course, very often they have no time or knowledge needed to perform quality work on supporting inmates with HIV. We also try to help in such cases. For example, in prison #16 there was no doctor for a whole year, and our organization set up weekly visits of a doctor from the Republican AIDS center in order to support the patients.

It is often said that many prisoners don’t trust prison staff, including health workers…

Yes, it’s a separate and quite serious problem, and the consequence of it is the unwillingness of prison inmates to follow doctors’ recommendations. Our consultants serve as a certain “bridge”, which helps to build trust-based relationships between doctors and patients. For instance, with the patients’ agreement they take the results of viral load and cd-4 tests and thoroughly explain their meaning to the patients, e.g. the influence of the therapy on those indicators etc. We try to find individual approach to everyone. For many people the possibility to have a family and healthy children when they reach undetectable viral load becomes the best motivation for treatment.

It seems that peer-to-peer consulting is a really life-saving tool when it comes to fighting for the health of prisoners living with HIV, isn’t it?

Александр Certainly! We have so many stories that prove it. For instance, the story of Alexander. He learned about his positive HIV-status in 2013. His prison mates gave him a clear verdict that he would die soon. Needless to say, he was in great shock. He didn’t have any access to information, and doctors didn’t explain much. On the verge of desperation he started to use more drugs. He looked at the people with positive HIV-status around him, and they were dying one after another. He also waited for his turn.
In 2016 peer consultants from the Action against HIV project started to come to the prison. One of them – Evgeniy – really impressed him. He was living with HIV himself, but he didn’t look like he was dying at all, quite the contrary. During one conversation with a peer consultant Alexander got more information than in the previous 3 years of his life with positive HIV-status. At that moment he told himself: “Enough. I choose life”. He started treatment and quite soon reached undetectable viral load.