Two weeks ago, the Baltic nation of Lithuania had just 361 registered cases of HIV infection. That number, however, recently shot up to over 500, when it was revealed that 162 inmates at Lithuania's Alytus penitentiary are infected with the virus that causes AIDS. Prison screenings elsewhere in the country have seen no such rise. What is causing the Alytus outbreak, and what are Lithuanian authorities doing to contain it?
Prague, 28 May 2002 (RFE/RL) -- In Lithuania, a country with a relatively low rate of HIV infection, the national AIDS center is reporting a disturbing trend: Some 162 inmates at the Alytus penitentiary have tested positive for the virus that causes AIDS. It is a surprisingly high figure for a country where just two weeks ago the official number of cases of HIV infection stood at 361 in a nation of 3.5 million. Furthermore, the number of infections may rise again as screening continues at Alytus, where some 750 of the prison's nearly 2,000 inmates remain untested.
Alytus is the first prison in Lithuania to see such a startling jump in the rate of HIV infection. Viktor Buiko, deputy director of Lithuania's department of prisons, tells RFE/RL he has no idea how HIV was first introduced to Alytus: "Every person who is jailed is tested for HIV, and it is practically impossible to have the disease in the penitentiary. I really have no idea [how the Alytus outbreak began]. But they say this disease has an incubation period that lasts for three or four months, during which it is impossible to detect the virus."
Buiko says new inmates with HIV may have been incarcerated when their infection was in the incubation period, thus explaining the penitentiary's failure to detect the virus. The prison official also says inmates are allowed occasional conjugal visits, and may have contracted the virus from their wives.
But officials from the Lithuanian AIDS Center, which is conducting the screening at Alytus, say intravenous drug use is to blame for the rapid spread of HIV in the prison. Buiko admits that many prisoners use drugs -- more than 12 percent of Lithuania's nearly 12,000 prison inmates are officially considered drug addicts, and many more may use drugs sporadically. Homosexual relations are also prevalent in Lithuania's prisons and may also contribute to the spread of HIV.
Buiko says Lithuania's prison administrations are doing everything possible to prevent people from carrying drugs into the facilities. He says prison officials routinely confiscate drugs and lecture inmates on the dangers of drug abuse. However, he admits, these steps have had little result. The country's under-funded prison system, he says, needs better, more modern equipment to detect drugs more efficiently. Moreover, Buiko says, many inmates may refuse to be re-tested for HIV while they are serving their sentence, making it even more difficult to control the spread of the virus.
"It is very hard to deal with this problem and not violate human rights. If [an inmate] doesn't want to be tested, we can do nothing to force him to give his blood for tests or to isolate him."
Julija Rakickiene, a doctor working in the Lithuanian AIDS Center, has a different view of the problem. She tells RFE/RL the prison authorities themselves are very much to blame for the Alytus HIV outbreak, as well as any further outbreaks that may be detected in other Lithuanian prisons. "One of the reasons why the outbreak took place is that the [prison administrations] have stopped informing inmates about the dangers of being infected, and have stopped all preventive measures. I'm talking about booklets and posters with information about safe sex and safe drug use. On the whole, no information about the way this disease spreads is available in the prisons."
Rakickiene says the state stopped financing such educational measures in 1999 and likewise neglected the problem of drug use in Lithuanian prisons. There are no needle-exchange programs in Lithuanian penitentiaries. Rakickiene says the fight against HIV in Alytus penitentiary will not be successful without giving inmates access to clean needles.
Funds are so low that the AIDS Center will have to limit how many inmates they can screen for HIV. Rakickiene says that testing for HIV/AIDS is already under way in a number of Lithuanian prisons but that a lack of money will likely put a halt to it. "One way or another, we would need approximately 100,000 litas ($25,000) to test all the inmates a single time. And to test them fully -- [three times] -- we would need about 350,000 litas ($95,000). The entire budget of the AIDS Center is only 300,000 litas ($80,000) this year."
The average sentence for inmates at Alytus penitentiary is five to eight years. Is there any way of preventing the spread of the virus once they leave prison?
Rakickiene says it is difficult for former inmates, many of whom suffer the stigma of drug addiction in addition to their prison records, to return to normal society, and that many -- failing to integrate or find work -- fall back on crime as a way of life. Now, she says, the situation is even worse. The HIV outbreak at Alytus has been widely publicized in the country, with Lithuanian newspapers carrying front-page articles about the problem. Now, inmates at Alytus will have to live with the stigma of being a potential HIV carrier whether they are infected or not.
Rakickiene says doctors from the Lithuanian AIDS Center talk to every inmate who is infected and try to help him accept the fact that he is carrying the HIV virus. She says a lot depends on the good will of those infected and the limited funds the AIDS Center has. "If we aren't given any more money," says Rakickiene, "the only thing we can do is just pray."
Martin Mckee works with the World Health Organization's European Observatory in Britain. He says he believes the official statistics indicating a relatively low incidence of HIV/AIDS in Lithuania are correct. But he warns that the situation might change very quickly. "The rate of growth of AIDS in the countries of the former Soviet Union is extremely fast. It is, in fact, the fastest anywhere in the world at present. It may well be that some countries like Lithuania currently have relatively low rates. But that could change rapidly. And the challenge is that we must have policies in place to prevent that happening."
McKee says everything must be done to stop the Alytus infection from spreading -- from introducing a needle-exchange program to reducing the use of drugs. However, he says, the main aim of Lithuanian officials should be to reduce the root causes of the problem -- the alienation and marginalization of people with HIV.