HEALTH CARE, DRUG USE AND EPIDEMIOLOGY OF INFECTIOUS DISEASES IN PRISONS SYSTEM OF LITHUANIA BIRUTE SEMENAITE, VLADAS RIMGAUDAS KASPERUNAS, MEDICAL DIVISION OF THE PRISON DEPARTMENT AT THE MINISTRY OF JUSTICE OF LITHUANIA 14 February, Oslo

LITHUANIAN PRISONS. BACKGROUND: 14 INSTITUTIONS IN LITHUANIA (ONE FOR PRISONERS WITH ACTIVE TUBERCULOSIS) AND CENTRAL HOSPITAL WITH A UNIT FOR PATIENS WITH TUBERCULOSIS AND CONSULTING-ROOM FOR HIV/AIDS PROPHYLAXIS AND TREATMENT. PRISON POPULATION ON WAS 8 137; OVERAGE NUMBER OF PRISONERS IN 2005 WAS THE INCIDENCE OF INFECTIOUS DISEASES IN THE PENITENTIARY SYSTEM REFLECTS THE OVERAL SITUATION IN LITHUANIA.

NUMBER OF PRISONERS ( )

DRUG USE IN PRISONS SYSTEM OF LITHUANIA

NUMBER OF DRUG USERS IN PRISONS OF LITHUANIA (abs. No.)

DRUG USE IN PRISONS OF LITHUANIA (%)

Drug use among prisoners (%) 2000 m.2001 m.2002 m.2003 m.2004 m.2005 m. Opiates (F11)8179,975,666,757,142,0 Cannabis (F12)0,90,71,00,81,62,6 Tranquilizers (F13) 3,31,83,26,23,91,5 Cocaine (F14)0,2 0,1 0,2 Stimulants (F15)2,83,42,64,59,711,9 Haliucinogenes (F16) -0,1 0 0,2 Inhalators (F18) 1,52,13,03,62,42,0 Several drugs (F19)10,211,414,418,125,039,6

Decrease of drug supply in prison Prison staff certification and selection Enhanced control of prison staff Improved guard of prison perimeter and implementation of other measures jointly with Police Department Stricter control of items in parcels delivered by mail and handed in as well as their screening by technical and electronic equipment Installation of outer and inner observation posts

Decrease of drug supply in prison For illegal circulation of drugs: 2001 – 7 criminal cases 2002 – 49 criminal cases 2003 – 20 criminal cases and 75 pre-trial investigations 2004 – 161 pre-trial investigation 2005 – 201 pre-trial investigation Withdrawal of drugs and psychotropic substances: 2001 – 427 grams 2002 – 486 grams 2003 – 591 grams 2004 – 679,97 grams 2005 – 2078,2 grams

Decrease of drug supply in prison Withdrawal of mobile phones: 2004 – 1281 items 2005 – 2162 items

Decrease of drug supply in prison Foundation of drug rehabilitation and prevention centers in all correction houses Cooperation with state institutions and NGOs Availability of education for prison staff and inmates Individual counseling of inmates

SURVEY OF HIV INFECTION IN PRISONS OF LITHUANIA LITHUANIA

NEW HIV CASES AMONG LITHUANIAN POPULATION BY YEAR

EPIDEMIOLOGY OF INFECTIONS DISEASES: DETECTION OF HIV IN PRISONS SYSTEM OF LITHUANIA

1992 – the first HIV infected person 1997 – several persons with HIV positive. Problem of their accommodation during their term of imprisonment opening of the Local Zone 2002 – HIV outbreak in Alytus 2003 – Local Zone cancelled CHRONOLOGY OF HIV AND MEASURES TAKEN IN PRISONS OF LITHUANIA 2003 May – HIV/AIDS Counseling Center established in Central Prison Hospital

EPIDEMIOLOGY OF INFECTIONS DISEASES: NUMBER OF HIV INFECTED PRISONERS About 66 per cent HIV infected persons served their term in prison

1 May 2003 Establishment of HIV/AIDS Prophylaxis and Treatment Center in Central Prison Hospital Its functions: Health care of persons with HIV/AIDS Counseling before and after testing for HIV Educational activities Implementation of prevention measures in prison Follow-up care of HIV infected and persons with AIDS

One of the main legal acts regulating the control of infections in penitentiary institutions is the Procedure on Preventive Examination for Infections Qualified as Risky and of High Risk of Persons Held in the Institutions Subordinate to the Prison Department under the Ministry of Justice approved by the Joint Order No 343/191 of the Minister of Health Care of the Republic of Lithuania and the Minister of Justice of the Republic of Lithuania of 2 July 2002.

COUNSELING AND TESTING OF PRISONERS FOR HIV Testing for HIV in prison: for prisoners (detainees/sentenced) upon their arrival to places of detention and imprisonment, also to Central Prison Hospital from police arrest houses; 3 months after their arrival to remand prisons and correction houses; 3 months before their release from correction houses; 3 months after their long-term visits or vacations; once per year – all inmates in correction houses; according epidemiological or medical indications.

Prospects growing number of persons with HIV growing number of persons with AIDS growing expenditures for personal healthcare of these patients growing expenditures for treatment of diseases accompanying AIDS expenditures for treatment of AIDS increase of mortality in prison

SURVEY OF TUBERCULOSIS IN PRISONS OF LITHUANIA LITHUANIA

NUMBER OF NEW CASES OF TUBERCULOSIS REGISTERED IN LITHUANIA BY YEAR

RATE OF INCIDENCE OF TUBERCULOSIS IN LITHUANIA PER POPULATION

RATE OF INCIDENCE OF TUBERCULOSIS IN PENITENTIARY INSTITUTIONS OF LITHUANIA PER PRISONERS

EPIDEMIOLOGY OF INFECTIONS DISEASES: NUMBER OF NEW CASES OF TUBERCULOSIS REGISTERED IN PRISONS OF LITHUANIA BY YEAR

RATE OF INCIDENCE OF TUBERCULOSIS AMONG DETAINEES AND CONVICTS (%)

PULMONARY AND EXTRAPULMONARY TUBERCULOSIS (%) IN PENITENTIARY INSTITUTIONS OF LITHUANIA

INCIDENCE OF PULMONARY TUBERCULOSIS IN PRISONS OF LITHUANIA (new cases, abs.n.)

PRIMARY DRUG RESISTANCE (% )

RESULTS OF TREATMENT OF PULMONARY TUBERCULOSIS IN PENITENTIARY INSTITUTIONS OF LITHUANIA IN 2004

CONCLUSIONS (1) THE INCIDENCE OF TUBERCULOSIS IN PRISONS OF LITHUANIA WAS STABILIZED AND THERE IS A TENDENCY OF DECREASE IN THE LAST YEAR. THOUGH THE PROBLEM IS STILL VERY ACCUTE. THE RATE OF INCIDENCE OF TUBERCULOSIS IN PRISONS IS A REFLECTION OF TUBERCULOSIS INCIDENCE RATE WITHIN THE COMMUNITY OUTSIDE PRISON. THE BEST PREVENTION OF TUBERCULOSIS IS EARLY DETECTION OF CASES AND PROPER TREATMENT ACCORDING TO DOTS.

COMMUNITY REMAND PRISONS LUKISKES RP REMAND PRISONS LUKISKES RP CENTRAL PRISON HOSPITAL PRAVIENISKES CH (men) PANEVEZYS CH (women) PRAVIENISKES CH (men) PANEVEZYS CH (women)

CONCLUSION (2) IT IS NECESSARY TO ESTABLISH CLOSER RELATIONSHIP BETWEEN PRISONS AND THE PUBLIC HEALTH SYSTEM IN ORDER TO ACHIEVE BETTER RESULTS IN THE TUBERCULOSIS TREATMENT AND TO DECREASE THE INCIDENCE OF TUBERCULOSIS ASWELL AS THE SECONDARY DRUG RESISTANCE IN THE CASES OF THE INTERRUPTED TREATMENT

CONCLUSIONS (3) TUBERCULOSIS CONTROL IN THE FACE OF THE SPREADING OF HIV INFECTION REQUIRES THE FOLLOWING RESPONSE: - IMPROVEMENT OF CO-ORDINATION AND COOPERATION BETWEEN TUBERCULOSIS CONTROL SERVICES AND HIV/AIDS SERVICES - STRENGTHENING OF TUBERCULOSIS CONTROL SERVICES:THE NEED TO FOCUS ON THE IDENTIFICATION AND CURE OF INFECTIOUS TUBERCULOSIS PATIENTS.