THE LITHUANIAN PRISONS SYSTTEM BIRUTE SEMENAITE, MEDICAL DIVISION OF PRISON DEPARTMENT AT THE MINISTRY OF JUSTICE OF THE REPUBLIC OF LITHUANIA Vilnius, 9 February 2009

LITHUANIAN PRISON SYSTEM. HISTORICAL BACKGROUND: Prison Department of Lithuania was stablished on 11 February 1919. During the period of Soviet occupation the penal enforcement system of Lithuania was an integral part of the Soviet Union’s overall system under the jurisdiction of the Ministry of Interior. Prison Department was renamed: first, Board of Corrective Labor Institutions, later, Board of Correction Affairs.

LITHUANIAN PRISON SYSTEM. HISTORICAL BACKGROUND: After the restoration of independence in 1990 the Board of Correction Affairs was reorganized into the Department of Correction Affairs.   On 1 September 2000 in the course of the reform of the legal system, the penal enforcement system was transferred from the jurisdiction of the Ministry of Interior to the Ministry of Justice. The Department of Correction Affairs regained the name it had during the interwar period of independent Lithuania - at present it bears the official name of the Prison Department under the Ministry of Justice of the Republic of Lithuania.

LITHUANIAN PRISONS. BACKGROUND: There are 15 penal institutions subordinate to the Prison Department enforcing pre-trial detention sanctions and custodial sentences imposed by court. 48 territorial correction inspections that are responsible for the execution of sentences alternatives to imprisonment and supervision of persons released on parole. The training Center of the Prison Department organizes the training of the newly hired staff of the institutions subordinate to the Prison Department.

LITHUANIAN PRISONS. BACKGROUND: During the service of their term sentenced prisoners are employed at the state enterprises subordinate to the Prison Department that are operating at four penal institutions. The enterprises produce furniture, electric fittings, various metal mouldings, door and window bindings. They also make bedclothes, coveralls, footwear and repair vehicles. The produce manufactured by inmates is of the identical quality as that produced by ordinary enterprises, though less expensive, in the majority of cases.

LITHUANIAN PRISONS. BACKGROUND: 15 PENITENTIARY INSTITUTIONS OF LITHUANIA: - 3 REMAND PRISONS FOR ADULT PRISONERS (including 1 institution combining a remand prison and a closed prison); - 9 CORRECTION HOUSES FOR ADULT SENTENCED MEN (including 1 correction house for patients with active TB); - 1 CORRECTION HOUSE FOR SENTENCED WOMEN; - 1 CORRECTION HOUSE- REMAND PRISON FOR JUVENILES; - 1 CENTRAL PRISON HOSPITAL. PRISON POPULATION – 8, 000 (as of 01-01-2009) AVERAGE NUMBER OF PRISONERS – 7, 787 (in 2008)

NUMBER OF PRISON POPULATION (1999-2009)

COMPOSITION OF PRISON POPULATION 01-01-2008 01-09-2009 TOTAL NUMBER OF PRISONERS 7 866 8 000 of them: SENTENCED 6 911 7 022 of them: women 255 259 adult prisoners 6 804 6 904 sentenced whom the court process has not been concluded 361 393 REMAND PRISONERS 955 978 72 76 861 877 WOMEN TOTAL 327 335 ADULT PRISONERS TOTAL 7 665 7 781

LEGISLATIVE BASIS FOR DRUG USE AND INFECTIUOS DISEASES CONTROL (1) NATIONAL PROGRAM OF DRUG CONTROL AND DRUG USE PREVENTION FOR 2004 – 2008 LITHUANIAN STATE PROGRAM OF HIV/AIDS PREVENTION AND CONTROL FOR 2003 – 2008

LEGISLATIVE BASIS FOR DRUG USE AND INFECTIUOS DISEASES CONTROL (2) STATE PROGRAM OF PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED DISEASES FOR 2006 – 2009 STATE PROGRAM OF PREVENTION AND CONTROL OF TUBERCULOSIS FOR 2007 – 2010

LEGISLATIVE BASIS FOR DRUG USE AND INFECTIUOS DISEASES CONTROL (3) 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 REBUBLIC OF LITHUANIA AND THE MINISTER OF JUSTICE OF THE REPUBLIC OF LITHUANIA OF 2 July 2002.

LEGISLATIVE BASIS FOR DRUG USE AND INFECTIUOS DISEASES CONTROL (4) REGULATIONS FOR ASSESSMENT OF INEBRIETY OR INTOXICATION OF DRUNK - DRIVING AND OTHER PERSONS APPROVED BY RESOLUTION OF THE GOVERNMENT OF THE REPUBLIC OF LITHUANIA No. 452 DATED 12-05-2006

LEGISLATIVE BASIS FOR DRUG USE AND INFECTIUOS DISEASES CONTROL (5) METHODOLOGY OF MEDICAL EXAMINATION PERFORMANCE FOR ASSESSMENT OF INEBRIETY OR INTOXICATION BY PSYCHOTROPIC SUBSTANCES APPROVED BY THE WRITTEN ORDER OF MINISTER OF HEALTH CARE No. V-505 DATED 20-06-2006

LEGISLATIVE BASIS FOR DRUG USE AND INFECTIUOS DISEASES CONTROL (6) PROCEDURE OF DETERMINATION OF INEBRIETY OR INTOXICATION WITH PSYCHOTROPIC SUBSTANCES OF PERSONS HELD AS INMATES AT CUSTODIAL INSTITUTIONS APPROVED BY THE WRITTEN ORDER OF DIRECTOR GENERAL OF THE PRISON DEPARTMENT AT THE MINISTRY OF JUSTICE OF THE REPUBLIC OF LITHUANIA No. V-20 (issued on 28 January 2008)

DRUG USE IN PRISON SYSTEM OF LITHUANIA

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

DRUG USE IN PRISONS OF LITHUANIA (%)

DRUG USE AMONG PRISONERS (%) 2000 2001 2002 2003 2004 2005 2006 Opiates (F11) 81 79,9 75,6 66,7 57,1 42,0 36,0 Cannabis (F12) 0,9 0,7 1,0 0,8 1,6 2,6 4,4 Tranquilizers (F13) 3,3 1,8 3,2 6,2 3,9 1,5 Cocaine (F14) 0,2 0,1 0,3 Stimulants (F15) 2,8 3,4 4,5 9,7 11,9 8,7 Haliucinogenes (F16) - 0,5 Inhalators (F18) 2,1 3,0 3,6 2,4 2,0 Several drugs (F19) 10,2 11,4 14,4 18,1 25,0 39,6 47,0 2007 44,2 3,4 1,1 0,1 8,1 0,2 1,2 41,7

DRUG USE IN LITHUANIAN PRISONS ACCORDING TO THE WAY OF DRUG USE 2008

SERVICES RENDERED TO DRUG USERS (1) Psychological counselling and psychological programmes: work with inmates having dependence on narcotic substances is aimed their social and psychological rehabilitation.

SERVICES RENDERED TO DRUG USERS (2) In 4 penitentiary institutions there are rehabilitations centres functioning. They accommodate inmates participating in various rehabilitation programmes. Day Centre functioning in one of the penitentiary institutions serves the same purpose.

SERVICES RENDERED TO DRUG USERS (3) Groups of Alcoholics Anonymous and Drug Users Anonymous are functioning in 7 penitentiary institutions. The activities of these groups are based on 12 Step Minnesota Programme. Individual work is also being carried out with inmates having dependence on narcotic substances. The programme applied there is called Behaviour-Conversation-Change (BCC). Individual psychological counselling is done in all (15) penitentiary institutions.

SERVICES RENDERED TO DRUG USERS (4) Detoxication is also available in all (15) penitentiary institutions.

IMPORTANT ACTIONS FOR FUTURE Establishment 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

EPIDEMIOLOGICAL SITUATION HIV/AIDS EPIDEMIOLOGICAL SITUATION IN PRISON SYSTEM OF LITHUANIA

DETECTION OF HIV IN PRISON SYSTEM OF LITHUANIA BY YEAR

CHRONOLOGY OF HIV AND MEASURES TAKEN IN PRISONS OF LITHUANIA 2003 May – HIV/AIDS Counseling Center established in Central Prison Hospital 2003 – Local Zone cancelled 2002 – HIV outbreak in Alytus 1998 - opening of the Local Zone 1997 – several persons with HIV positive. Problem of their accommodation during their term of imprisonment 1992 – the first HIV infected person

EPIDEMIOLOGY OF INFECTIONS DISEASES: NUMBER OF HIV INFECTED PRISONERS About 65 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

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

INCIDENCE OF ACUTE VIRAL HEPATITIS IN PRISON SYSTEM OF LITHUANIA

NUMBER OF ACUTE VIRAL HEPATITIS IN PRISONS OF LITHUANIA

EPIDEMIOLOGY OF TUBERCULOSIS IN PRISON SYSTEM OF LITHUANIA

INCIDENCE OF TUBERCULOSIS IN LITHUANIA PER 100 000 POPULATION

INCIDENCE OF TUBERCULOSIS IN PRISONS SYSTEM PER 100 000 POPULATION

REGISTERED CASES OF TUBERCULOSIS IN PRISON SYSTEM

INCIDENCE OF TUBERCULOSIS OF INVESTIGATED PERSONS AND CONVICTS (%)

PRIMARY DRUG RESISTANCE

RESULTS OF TB TREATMENT 2006

CURRENT PROBLEMS 1. The level of TB morbidity in penitentiary institutions fluctuates either up or down, but the trend that 60-70 percent of morbidity if viewed on the morbidity structural chart is comprised of “TB brought in from the outside”, i.e., a disease which is revealed only during preventive medical examination upon an offender‘s entrance to a remand prison, remains.

CURRENT PROBLEMS 2. Patients' succession is a pending problem (inter-institutional cooperation (MoJ, MoH, MoSSandL) – possible joint programs or other measures) – patients released from penitentiary institutions without accomplishing the complete course of treatment usually fail to continue the treatment outside. The problem gets deeper every year as more and more offenders are released without accomplishing their treatment due to a shorter period of sentencing.

CURRENT PROBLEMS 4. The problem of inter-institutional cooperation (Moj and MoI) on the issue of continuous anti-tuberculosis treatment for detainees and prisoners convoyed to the arrest houses of the police commissariats has not yet been settled.

CURRENT PROBLEMS 3. The problem of multidrug-resistant tuberculosis in penitentiary institutions increases year by year. More offenders keep returning to penitentiary institutions with previously diagnosed tuberculosis and having terminated the treatment that ensues multidrug-resistance.