COVID-19 and prison health

On this page you can find helpful information and verified resources about COVID-19 and prison health.

The page is continuously updated

The International Corrections and Prisons Association (a verified resource)  

Worldwide Prison Health Research & Engagement Network (WEPHREN) (a verified resource)

Preparedness, prevention and control of COVID-19 in prisons and other places of detention. 

Source – WHO

Interim Guidance. COVID-19: Focus on persons deprived of their liberty.

Source – IASC – Inter-Agency Standing Committee

Position Paper COVID-19 preparedness and responses in prisons

SourceUNODC

COVID-19 pandemic: urgent steps are needed to protect the rights of prisoners in Europe. Statement by Commissioner Dunja Mijatović

SourceCouncil of Europe

Statement of principles relating to the treatment of persons deprived of their liberty

SourceCouncil of Europe

Coronavirus: Healthcare and human rights of people in prison

SourcePenal Reform International

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

COVID-19 in prison: the Council of Europe must lead on policies to address the Covid-19 challenges

SourceCouncil of Europe

COVID-19: Council of Europe anti-torture Committee issues “Statement of principles relating to the treatment of persons deprived of their liberty”

SourceCouncil of Europe

COVID-19 population management strategy for prisons

Source – www.gov.uk

UNODC, WHO, UNAIDS and OHCHR joint statement on COVID-19 in prisons and other closed settings

Source – UNAIDS

PRI educational posters for criminal justice practitioners to reduce the spread of COVID-19

Source:  penalreform.org

Understanding COVID-19 in secure settings 

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

COVID-19, Prisons and Drug Policy: Global Scan March-June 2020 

Source – https://www.hri.global/

ORGANISATION AND MANAGEMENT OF HEALTH CARE IN PRISON

Source – Council of Europe

 

Response of AFEW Kyrgyzstan to COVID-19

COVID-19 rapidly spreading around the world requires urgent and decisive actions. AFEW Kyrgyzstan quickly responded to the emerging threat and prepared the support measures, which can help the key populations in this challenging time. Natalia Shumskaya, director of AFEW Kyrgyzstan, told AFEW International about them.

Social bureau for women living with HIV

The social bureau for women living with HIV offering peer support services as well as consultations of psychologists and social workers continues its operation during the lockdown. Before the state of emergency was announced, most people living with HIV (PLWH) in the city received Antiretroviral therapy (ARVs) for up to three months. If people were not able to come and pick up their medications, the social worker brought them to their homes. However, PLWH still need ARVs, so every day a representative of our organization brings such medications to two or three addresses using an official vehicle of the AIDS centre.

Nutritional support

About one-third of PLWH in Kyrgyzstan live in poverty. People who used to earn money for their living with odd jobs are now left without any sources of income and have urgent needs in food products, hygiene items, diapers for their babies and mobile charge cards to stay connected. Every day, the psychologist from the AIDS Centre gives calls to women living with HIV and provides them with psychological support. If people need food, the psychologist gives them contact details of the Bishkek district headquarters for them to receive humanitarian aid. We have sent a request to the Red Crescent Society of Kyrgyzstan asking them to allocate food packages for 40 women living with HIV.

In community centres for women with substance abuse problems, there was also a need in masks, disinfectants and food packages, so we procured all the needed materials to comply with the infection control measures from our project budget.

Psychological support

Three psychologists of our organization continue providing psychological support over the phone and using WhatsApp. Mostly they are contacted by women with severe anxiety, panic attacks or those who faced domestic violence. Some women have relatives with mental health problems. Besides, we received phone calls from young people with drug abuse problems.

Young people help!

There is a volunteer headquarters launched in the youth centre together with the National Agency for Youth and Physical Culture. People working at the organization and other city residents make donations to a special account to procure food products for those in need. Our Champions for Life from the Dance4life programme signed up as volunteers and deliver the humanitarian aid.

For prisoners

We procured and provided to the National Law Enforcement Service two thousand masks, 850 kg of bleach, and 50 bottles of antiseptics for the prisoners.   Besides, we developed leaflets for prisoners and prisons staff. Soon brochures will be published and distributed among the prisons.

We are currently carrying out negotiations with different donors and I hope that in the nearest future we will be able to raise more funds to support the National Law Enforcement Service.   We are waiting for the response from the German Agency for International Cooperation (GIZ) concerning our project proposal on carrying out training sessions for prisoners and non-medical personnel working in prisons on COVID-19 and on procuring soap and laundry detergent for prisoners.

Due to the physical contact being impossible, our peer consultant (PLWH) provides support to the prisoners living with HIV remotely, through phone calls.

For reference

As of today, there are 144 confirmed cases of COVID-19 and one registered death in Kyrgyzstan.

Since March 25, the government declared the state of emergency. A curfew has been introduced, so people are not allowed to leave their homes after 8 p.m. In the daytime, there can be only three reasons to go outside: to a supermarket, pharmacy or to visit a doctor provided that the person has an itinerary sheet. Public transport and taxi services are closed.

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.

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.

AIDS 2018: Prison Corner and Harm Reduction Networking Zone Activities

More than 5 000 people, including famous actress Charlize Theron, visited the prison corner in Harm Reduction Networking Zone (HRNZ) located in the Global Village at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. During five days, visitors could stop by, have a delicious cup of coffee made by former prisoners and participate in a programme with interactive debates, interviews, and presentations. Prisoners are usually a forgotten group since very few organisations pay attention to this vulnerable group of people. Taking into consideration that in many countries the issue of HIV/AIDS in prison is very sensitive and that the implementation of programs in prisons can hibernate or even fail, a pragmatic step-by-step guide for prison authorities and civil sector actors is now being developed by European Monitoring Centre for Drugs and Drug Addiction and European Centre for Disease Prevention and Control.

The executive director of AFEW International Anke van Dam stressed on the necessity of working in prisons in Eastern Europe and Central Asia (EECA). Health protection in prisons is a serious public health issue. Even though international law recognises the right of everyone, including people deprived of their liberty, in practice, many prisoners receive healthcare of a lower standard to the one available outside of the prison, if they receive treatment at all. In Eastern Europe and Central Asia, the unbearable circumstances and lack of coherency within the penal systems of the regions exists. AFEW recognizes the importance of people living within prisons receiving the same healthcare and life opportunities during and after their stay in prison. Together with prison authorities, AFEW is in constantly implementing prison health projects that seek collaboration with organisations working in prison. To introduce the region where AFEW is actively represented, Anke van Dam gave a book Invisible Lives: HIV on the Fringes of Society to Monica Beg, Chief of HIV/AIDS Section and Global Coordinator for HIV/AIDS at United Nations. Stories from the representatives of key populations from Tajikistan and Ukraine are depicted in the book.

AFEW expresses a big gratitude to our prison corner partners: The Council of Europe Pompidou Group, Asian Harm Reduction Network, International Corrections & Prison Association, Health Through Walls and UNODC.

Ukrainian success with the monitoring instrument

During the session about engaging young people who use drugs in Ukraine in the HIV and human rights response, AFEW-Ukraine presented the developments achieved during ‘Bridging the Gaps: Health and Rights for Key Populations’ and PITCH projects, supported by the Ministry of Foreign Affairs of the Netherlands.

AFEW-Ukraine’s manager Irina Nerubayeva presented the instrument for monitoring violations of human rights of adolescents using drugs in Ukraine, that has been used for a year among the partners in four regions of Ukraine. ‘Bridging the Gaps’ project partner – social worker from Kharkiv NGO Blago Alina Khokhlova – told about challenges and results of using the instrument and emphasized the importance of her organisation in developing effective advocacy programs in the city. Youth activist Daria Kopyevskayskaya from Kropyvnitsky (NGO Return to Life) emphasized the role that young people play in delivering information to their peers about rights.

Legal expert Vita Musatenko presented the most typical cases that were identified in the process of monitoring and advised what social workers can do to provide adequate response and help to a young person. Evgenia Kuvshinova from NGO Convictus told about her work with young people who use drugs in Kyiv at the Street Power Club where young clients receive a range of services, including testing for HIV, sexually transmitted diseases, hepatitis. There they also engage in educational activities and are trained as leaders.

From harm reduction programmes to methadone therapy

The session on HIV prevention, treatment, and care in the countries of the former Soviet Union allowed to learn about challenges and achievements of prison programmes from various countries of the former Soviet Union and receive information from government officials and NGOs. The head of the Medical Department of Kyrgyz Penitentiary Service Nazgul Soltobekova told about the system of HIV prevention and treatment in Kyrgyz prisons. She also shared the country’s successful experience in providing comprehensive services for people who use drugs in penitentiary facilities – from harm reduction programmes to methadone substitution therapy.

Konstantine Turashvili from the medical department of the Ministry of Corrections of Georgia told about HIV programmes in Georgian prisons and the country’s successes in hepatitis elimination programmes. Both speakers emphasized the importance of cooperation with community-based organisations that provide effective counseling services for inmates and help to ensure continuity of care of those released from detention facilities. This topic was further followed by Natalia Rudokvas from Kazakh NGO “Answer” who shared the experience of her NGO’s work with HIV positive inmates. Ikrom Ibragimov from AFEW-Tajikistan shared his experience of cooperation with the penitentiary system and told how NGO can build the capacity of prison staff in HIV, TB, and other related issues.

Being an expert in prison health, AFEW will continue advocating for HIV, TB and hepatitis C prevention and treatment programs for prisoners in EECA. We are promoting essential elements like harm reduction, including needle and syringe programmes, and opioid substitution therapy. Transitional client management that prepares prisoners for release and ensures linkage to follow-up after release is a valuable variant of client management that meets many of (ex)prisoners’ needs.

‘Bridging the Gaps’ in Georgian Provinces

Gocha lives in a small town of Telavi

Author: Irma Kakhurashvili, Georgia

Gocha and Nikoloz are clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Georgia.

Art therapy works

Gocha lives in the hottest region of Georgia – Kakheti – in a small town of Telavi. He is a client of a Rehabilitation Centre in Gremi village. There he receives support to overcome his alcohol and substance use problems.

The Rehabilitation Centre for drug users run by Tanadgoma is the first and only stationary rehabilitation centre in the country offering free services to its clients. Since it was founded, over 25 clients received help free of charge there. In the Centre, clients can get social, psychological and health services. The Centre applies twelve-step recovery programme. Besides, it offers art therapy classes and even runs a ceramic workshop. The instructors working in the Centre were trained in a Ukraine-based rehab.

As many of his friends, Gocha used to smoke “harmless weed” since he was a schoolboy. Soon enough, he found himself among people who were eager to use other drugs as well. At first, he was curious to experiment with substances, but during the heroin boom in Georgia – when it could be purchased even in the Kakheti villages – the situation changed. If Gocha was lacking money to buy drugs, he had enough to get some alcohol. Gocha’s family knew about his problems. His parents told him that he would find himself in a trouble, but it did not help. After the government introduced stricter rules for drug dealers and users, Gocha switched to the homemade drugs.

He first came to the Tanadgoma Rehabilitation Centre two years ago. Gocha took part in the twelve-step recovery programme, attended counselling sessions and art therapy classes. Currently, the man is in remission, but sometimes he comes back to the Centre seeking services. He says that sometimes he drinks alcohol. Georgia is the motherland of wine, so it is hard to quit alcohol.

“I do not know what would happen to me if not for this project. Now working with clay and ceramics is the biggest joy for me. There is a radio set in the workshop and I can work all night long, listening to music. I have a lot of creative insights and the process of work is very important for me. When I draw sketches, I think of nothing else. My negative thoughts go away,” he tells.

Gocha does not know if he will be able to quit drugs and alcohol for good. There are no guarantees, but at least now he understands how to reduce the harm he does to his health. Gocha finds his support in knowing that if he goes home and has a relapse again, he can always come back to the Centre or contact harm reduction programmes.

Sometimes small tours are organized for the clients of the Centre. This region of Georgia is famous for its historical sights and beautiful nature.

“Sounds of the river calm me down. There I can think about my life. I spent 11 years behind the bars and I have many regrets… Now there are a lot of pharmacy drugs in Georgia, many people need psychosocial support… I do not understand why the government does not want to implement rehabilitation and employment programmes instead of the repressive drug policies. It does not want to be responsible for such people as me. So far, the Centre is the only place where someone cares about my mental health,” says Gocha.

He has two dreams: to equip the Rehabilitation Centre with exercise equipment for its clients to stay fit so that they are able to start a family.

“I want my empty house in Telavi to be full of child laughter and hope. I want to live a normal life,” says Gocha.

Drug use changed my life

Nikoloz is a former police officer

Nikoloz is 45 years old. He is a former police officer. His professional career ended up when he was arrested for drug use and sentenced to seven years of imprisonment. Before that day, he had no problems.

“I was 18 when my friend and I tried drugs for the first time. Little by little, I got used to drugs. My brother also did drugs, but I was afraid to tell him. I felt uncomfortable to talk about it with my family. Then I studied law, started working in police and that is when I got really “hooked.” I had powerful relatives, so I felt safe, but after eight years of active drug use I was locked up,” remembers Nikoloz.

Seven years in prison were a dreadful, lost period of his life. Then it was easy to get drugs in closed settings and Nikoloz used this opportunity. However, one case of severe overdose, when he almost died, made him rethink this situation. After he got back home, all his social connections were lost.

“Then I thought that it was enough, I had to stop. Even now, I hate drugs with all my heart. I fight them and fight myself. Last year I had a relapse. Therefore, I had to enrol into a substitution therapy programme and receive treatment in a clinic,” confesses Nikoloz.

He feels sorry because drugs changed his life but says that if years ago he had access to harm reduction programmes, he would definitely enrol in them. Back then, he knew little about reducing the risks of drug use.

“I had no strength or desire to quit drugs, but I would surely use them in a safer way, for example decreasing the frequency of injections. I would be able to control my life and health and would avoid overdose and hepatitis C. Drugs will always be there. Non-medical use of drugs is bad for everybody – the individual and the society – so protection of public health requires protection of drug users’ health. For that purpose, drug users should be integrated into the society and not isolated,” says Nikoloz.

In jail, Nikoloz got acquainted with people working for Tanadgoma, who offered different services to the inmates, in particular, psychological support, which was very important for him.

After Nikoloz was released, he went to a social bureau in Tbilisi. Tea Chakhrakia, working for Tanadgoma, helped him to re-issue his documents. Besides, people from Tanadgoma helped him to get a job with Akhali Gza NGO providing harm reduction services to people who use drugs. Since then, Nikoloz has been working as a social worker there. For him, his job is not only his responsibility, but also his real family, where he is loved and respected, and such love and respect are mutual.

Nikoloz is convinced that harm reduction services are more effective than incarceration. The best approach to resolve drug-related problems is to work with people who use drugs and not punish them.

“In our country, drug policy is based on some Utopian ideas because the government thinks that the drug use may be eradicated. In Georgia, criminal justice is the only method to solve the problems of injecting drug use. Drug use is treated as a criminal offence, though there is a strong evidence proving that repressive drug policies are ineffective and prevent access of people who use drugs to health services,” says Nikoloz.

Nikoloz is happy to share his experience with junior outreach workers. He works with clients, motivating them to get tested, helps them to prepare all the required documents, develops support plans, and tells people about safer drug use methods.

“I am really grateful to the project for the job that I have, which helps me feel that people need me. I received help one day, and now I can help others, sharing my experience with them. My clients are people who use drugs. Many of them use drugs only to overcome their withdrawal syndrome. They are the ones who really need support. I want them to understand what is waiting for them ahead,” he says.

Nikoloz says that with support of harm reduction experts many good things may be done for people who have already lost any hope. That is why it is important to implement the projects, which meet the specific needs of vulnerable populations.

“I am glad that in prison I met people who saw my potential and believed in me,” he says.

About the project

Bridging the Gaps: Health and Rights for Key Populations‘ is an international project implemented in 16 countries of the world to improve the health and protect the rights of vulnerable populations. In Georgia, the project was launched in September 2012. Its main goal is protecting human rights of drug users by changing social attitudes and government policies and improving the quality of services delivered and access to them.

In Georgia, the project is implemented by Bemoni Public Union and Tanadgoma Centre for Information and Counselling on Reproductive Health. Bemoni provides services in the social bureau based in Telavi (Kakheti), and Tanadgoma – in the social bureau based in Tbilisi. Besides, in 2015 Tanadgoma opened a Rehabilitation Centre for people who use drugs in the Gremi village, Kakheti.

In 2012-2017, over four thousand people who use drugs received 17,321 medical, psychological, social and legal services within the project.

The Latest Global Prison Trends Publication Launched

Source: www.russellwebster.com

Last week, on 15 May 2018, Penal Reform International launched its annual flagship publication, Global Prison Trends 2018, at the UN Commission on Crime Prevention and Criminal Justice.

This is the fourth edition in their annual Global Prison Trends series and explores:

  • Trends in the use of imprisonment, including the use of pre-trial detention as an automatic response to suspects; the ongoing challenge of prison overcrowding; and the steady growth in the number of life-sentenced prisoners around the world.
  • Prison populations, such as the specific needs of women, children and LGBTI prisoners.
  • Developments and challenges in prison management, including record levels of prisoner violence in a number of prison systems; healthcare challenges and shortages of qualified healthcare staff; and the need to address violent extremism and prevent radicalisation in the prison system.
  • The role of technology in criminal justice and prison systems, such as the use of ‘telemedicine’ to provide mental healthcare and treatment, and the rise in access to online education and training.
  • The expansion of prison alternatives, including community service orders and electronic monitoring, and a growing trend in the use of restorative justice.

A Special Focus section looks at the rehabilitation and reintegration of offenders in the era of sustainable development.

Here you can find ten key facts that are of particular interest about the report.

Source: www.russellwebster.com