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Central Asia: HIV In Prisons Poses Threat To Public Health

A two-day conference on HIV/AIDS in Europe and Central Asia starts today in the Irish capital, Dublin. Some activists are using the opportunity to focus on HIV/AIDS in the region's prisons.

Prague, 23 February 2004 (RFE/RL) -- Few governments in the world have acted decisively to provide comprehensive HIV prevention, care, and treatment services for prisoners.

Since sexual relations and drug use in prisons are officially prohibited, condoms and sterile injecting equipment are generally unavailable.
In Central Asia, a primary hub of drug abuse and HIV infection is found behind prison walls. And every year, tens of thousands of prisoners are released from overcrowded and poorly funded jails, spreading the virus to the general populace.

In this way, the region's penal systems are functioning as incubators for HIV.

Observers say prevention programs are key if Central Asia is to avoid a full-blown AIDS epidemic. Rick Lines is the executive director of the Irish Penal Reform Trust in Dublin.

"Good prison health is good public health,” he says. “The health of people in prison is very much related to community health. Therefore, governments have more than an ethical responsibility to act in the best interests of prison health."

Lines and other activists have drafted the "Dublin Declaration on HIV/AIDS in Prisons in Europe and Central Asia," a framework for mounting an effective response to HIV/AIDS in the prisons of the region.

The document will be launched as representatives of 55 governments from Europe and Central Asia gather in Dublin today and tomorrow to discuss the fight against the HIV/AIDS epidemic in the region.

The declaration recommends the implementation of HIV prevention measures such as needle-exchange programs and providing condoms in prisons. It also stresses that prisoners have the right to receive HIV/AIDS treatment and care equivalent to that available outside the prison.

Burkhanov Mamasobir heads the addiction treatment clinic in the southern Kyrgyz city of Osh. He agrees that drug counseling and needle-exchange programs are very important in prisons.

"The biggest percentage of drug users are criminals who spend most of their time in prison, where they continue to use drugs. And they don't have the possibility to exchange needles. Many people use the same needle and there is a danger of quick HIV spread," Mamasobir said.

Half of Kyrgyzstan's registered HIV cases is located within the prison population.

Rudick Adamian, from the UNAIDS Central Asia office in Almaty, says pilot prevention programs in prisons are now operational in most of the region's republics. But antiretroviral drug treatment -- which slows the progression of HIV infection into full-blown AIDS -- is not yet available, because of a lack of resources.

"During the past couple of years most of the discriminative approach in HIV/AIDS prevention -- compulsory tests and [isolation] -- has shifted. Four [Central Asian] countries -- except Turkmenistan -- now have well-designed strategic programs. Based on their strategic programs, [the] four countries have obtained grants from [the] Global Fund [created to finance the fight against AIDS, tuberculosis, and malaria]. And it's already operational in three countries. Uzbekistan [will receive] funding in May-June this year," Adamian said.

Since sexual relations and drug use in prisons are officially prohibited, condoms and sterile injecting equipment are generally unavailable.

However, Adamian says significant efforts have been made in Kazakhstan to initiate disease prevention in all prisons, including educating prison staff and supplying condoms to prisoners.

Dmitrii Rechnov works for the AIDS Foundation East West, an international organization currently working in Kazakhstan, Kyrgyzstan, and Tajikistan. He says he believes the Kazakh leadership is politically ready to develop a good health care system for prisoners that will include access to substitution treatments for drug addicts like methadone.

In Kyrgyzstan and Tajikistan, the two poorest CIS states, progress has been slower. But Rechnov notes that needle-exchange programs have been introduced in the Kyrgyz penal system.

"Kyrgyzstan is the only [Central Asian] country where needle exchange really exists in all prison facilities. Also, policymakers and medical staff of the prison facilities are ready to start substitution therapies. But because of the lack of funding it's just a decision on paper," Rechnov said.

Tajikistan is a particular source of concern, as it shares a long border with Afghanistan, the world's top opium producer. The country is still recovering from a devastating five-year civil war in the 1990s.

In general, Rechnov notes, a lot of work needs to be done to improve the prisons' medical staffs. For instance, he says, his organization has counseled the medical team employed at a Tajik prison colony on how best to inform infected inmates that they are HIV-positive.

UNAIDS' Adamian says Central Asian states have used pilot projects to gain experience. But he stresses that experience must now be applied to widescale programs in order to halt the growing threat of an HIV epidemic.

"All countries now have better practice experiences with small-scale pilot projects among vulnerable groups. The issue today is using the Global Fund and resources from donors to expand this knowledge for a larger-scale intervention," Adamian said.

Central Asia has until recently reported relatively low numbers of people living with HIV/AIDS. But the number of new infections is beginning to grow rapidly, particularly among injecting drug users.

According to Adamian, 4,000 HIV cases have been documented in Kazakhstan, including more than 600 in prisons. There are 3,500 cases in Uzbekistan, 451 in Kyrgyzstan, and 120 in Tajikistan. Adamian stresses that real figures are likely to be much higher.

Turkmenistan has reported only two HIV cases so far. International health workers are denied access to Turkmen prisons.

(Ainura Asankojoeva of RFE/RL's Kyrgyz Service contributed to this report.)