Health situation remains grim in prisons

Health conditions in Kyrgyzstan's burgeoning prison system remain a source of concern for health officials in the mountainous Central Asian state. "I was 16 years old when I tried drugs for the first time. I played around with drugs and than I went down. In hospital, where I was treated for drug addiction, doctors took blood from me for an HIV test. I don't know where I could have caught it! Probably while sharing a syringe with other inmates in the prison," one former convict told IRIN in the capital, Bishkek. Such stories are not unusual among former prisoners in the country. According to the National AIDS Centre of Kyrgyzstan, the main mode of HIV/AIDS transmission is injecting drug usage. The official number of HIV-infected people in the country was 543 by June 2004, of which 82 percent were injecting drug users and some 100 infected were inmates serving their terms. In 2003, there were 83 infected prisoners. As of 1 January 2004, there were 17,000 prisoners in the country - 350 per 100,000 people. Besides HIV/AIDS, many prisoners in Kyrgyzstan are infected with TB, hepatitis and sexually transmitted diseases (STDs). Research by various government bodies, international and nongovernmental organisations (NGOs), including the Kyrgyz Ministry of Justice, Department of Corrections, Penal Reform International (PRI), the Kyrgyz National AIDS Centre and the Inter Demilge NGO, who directly monitor the penal facilities, endorse this. According to them, the most widespread diseases among the prisoners are HIV/AIDS and TB. "The problem is that in our country we undergo, so to speak, triple 'infection': drug addiction, which leads to AIDS, and AIDS which in turn leads to TB. Thus, 95 percent of AIDS patients die from TB," Boris Shapiro, head of the National AIDS Centre, told IRIN in the capital, Bishkek. The main reasons for the growth in these diseases in the prisons are inadequate sanitation and hygiene conditions, insufficient nutrition and, of course, a shortage of necessary medicines and the absence of modern medical equipment in hospitals run by the Department of Corrections. "Overcrowded facilities, deterioration of conditions and prisoners' nutrition, low awareness and antisocial conduct - all these create conditions for an increased level of TB in the corrective establishments and prisons. [Also] there is a danger of a fast spread of the HIV infection and drug addiction," Jakshylyk Toktosunov, head of the Corrections Department's central hospital, told IRIN in Bishkek. Almost 870 people contracted TB in the correctional facilities in 2002, while according to the Justice Ministry's estimates, 2,000 out of 17,000 prisoners serving their terms were infected with an "open" (easily contractible) form of TB in 2003. Experts say that the growth of convicts with TB is partly fuelled by an increase in the number of infected people arriving in detention facilities. Some 740 patients with TB were registered in detention institutions in 1999, while in 2001 that figure almost doubled, reaching 1,311 patients. The situation is aggravated by a lack of funds and equipment in the health institutions of the prison system. "Medical equipment in the corrective facilities have not been updated since the 1990s. It is already outdated. Today, it is difficult for us to work, it is difficult to detect HIV infections rate since HIV tests are very expensive. We do not have mobile fluorography-sets to detect TB patients and suffer a severe shortage of medicines," Akylbek Muratov, head of the Corrections Department's health service, told IRIN. There have, however, been some changes since 1998 when TB-infected convicts were included in the national programme for treatment of TB patients based on the DOTs strategy. "Certainly, everything is not that bad. Reforms have being carried out in the prison system for almost a year. Due to the reforms, much has been done: repair work has been done in the prisons, beds and bedclothes have been purchased, nutrition has been improved. If earlier we spent some 45 cents per prisoner, and there were also times when a mere 20 cents was spent, now we spend about 60 cents per a prisoner [per day]." This being the case, the Global Fund to fight AIDS, TB and malaria has paid special attention to Kyrgyzstan and other Central Asian countries. Although Kyrgyzstan is a low HIV/AIDS prevalence county, the international body allocated two grants to strengthen the former Soviet republic's struggle against HIV/AIDS and TB. Commenting on how this assistance was to be used, Shapiro said the most important activity was awareness raising campaigns. "People should know as much as possible about HIV/AIDS and how to fight it. We try and teach people to protect themselves against AIDS, to live in such a way so that they can avoid a threat of getting infected. It is more important for us to prevent rather than to treat this disease," he said, adding that no one in the world had been cured of the disease yet. Meanwhile, Kyrgyzstan's experience in the prevention of HIV/AIDS, STD, hepatitis and TB in corrective facilities, which started in 1998, is the first precedent in Central Asia. Specialists from China and Tajikistan are interested in Kyrgyzstan's experience in preventive measures against HIV/AIDS in correctional facilities, Raushan Abdildaeva, a senior inspector for the department for reforming and developing the criminal-executive system at the Justice Ministry, told IRIN. In the beginning, there were a few pilot projects on the basis of one or two facilities. The work included information-educational seminars on HIV/AIDS prevention among the staff of facilities as well as inmates. Inter Demilge, a local NGO, has implemented a pilot project on the prevention of HIV/AIDS, STD, hepatitis and TB in two prisons since July 2003. Abdildaeva explained that these seminars produced big results - the level of knowledge among prisoners on infectious diseases had increased remarkably by the end of the project. Implementation of other important projects is now planned, such as syringe exchanges and a methadone substitution programme. The latter will be exclusively targeted at patients who have been HIV-infected for many years.