1. Jana Feldmane Ministry of Health of Latvia Public Health Department Health care overview in prisons

2. General Information 11 prisons total capacity of 6000 persons approximately 4500 inmates yearly 1 correctional institution for juveniles 4 closed prisons 2 investigation prisons 2 semi- closed prisons 1 open prison 1 Prison Hospital (with closed department for treatment of active TB) 1 centre for treatment of addictions (social rehabilitation programmes) is opening on 05.10.2016. 2

3. 3 Legislative framework: Prisons Health System o The Medical Treatment Law - every prisoner has the right to receive the same health care as each citizen of Latvia o Regulation of the Cabinet of Ministers - on how arrested and convicted persons receive health care services - sets framework of health care services for inmates o Regulation of the Cabinet of Ministers - The procedures for organising and financing health care - shared responsibility of both - Ministry of Health and Ministry of Justice

4. 44 Prisons’ Health Care Structure Prison hospital: o with capacity of 200 inmates o well equipped, but provide limited services o lack of specialists o external specialists (psychiatrist, gynaecologist, dentist*) o treatment of active TB *dentist - prisoners must pay for dental care themselves, with the exception of emergencies Each prison has a medical unit and provides health check upon arrival (medical examination, mandatory screening for TB (chest x-ray), voluntary HIV test)

5. 5 HIV o HIV testing is voluntary o In case of clinical symptoms HIV test is recommended o Inmate, who refuses the test, has to certify this by signature o During health check upon arrival approx.98% of all inmates are being tested o In 2015, 47 new HIV cases were registered in prison settings o Incidence of HIV is 50 times higher as in general population o HIV transmission mainly attributes to injection drug use o The medical doctor in prison hospital has the primary responsibility for HIV infected inmate. The medical treatment of this inmate is shared with the Infectology Centre in Riga

6. 6 HIV in figures Year Number of new cases Incidence per 100 000 inhabitants/inmates 2011201220132014201520112012201320142015 HIV in general population 29933934034739314,416,716,917,419,9 HIV in prison settings 67594356471004,4930,7763,11132,01027,0

7. 7 Hepatitis B and C o Hepatitis B and C tests are only offered to inmates with HIV, clinical symptoms, or upon inmate’s request o In 2015, only 27 new cases of hepatitis C were registered in prison settings o Hepatitis transmission mainly attributes to injection drug use o The medical treatment of hepatitis is shared with the Infectology Centre in Riga o Treatment of hepatitis C as well as interferon-free therapy is covered by health care budget o The barrier for hepatitis C diagnosis and treatment in prisons is that diagnostics of hepatitis takes place outside the prison

8. 8 Hepatitis B and C in figures Year Hepatitis BHepatitis C Total number of new cases Per 100 000 inhabit. In prison settings Per 100 000 inmates 2015 Total number of new cases Per 100 000 inhabit. In prison settings Per 100 000 inmates 2015 200755326,1345,5168077,910151,7 200855525,7229,8146667,3574,5 200945821,4343,1135663,67100,5 201031615,1114,5111253,0343,4 201131515,300,0133664,97104,9 201233016,2115,8141069,3231,6 201332916,3117,7127463,3588,7 201430115,0120,2176488,127545,6 201538819,6490,7185993,9461043,3

9. 999 Tuberculosis o Mandatory TB screening is provided for all persons entering the prison o 29 new cases of TB are registered in prison settings in 2015 o There are well established DOTS therapy

10. 10 Tuberculosis in figures Year Total number of new cases New cases in prison settings Risk factors Alcohol useDrug useHIV positive 20117884316 10128805028 23 101377645131913 20146374462420 20156212911187

11. 11 Treatment of the Addictions o Recent study of CDPC Latvia indicated that 66,1% of the prison population had ever used drugs, and 31,8% of inmates reported that they had continued to use of drugs while in prison o Collaboration with Riga Narcology centre in order to ensure treatment of addictions o OST is not initiated in the prison settings but is continued for inmates who used to receive OST before they were admitted o Methadone is not available through the prison pharmacies and is purchased from external providers o Anonymous meetings in prisons o Minnesota and other social rehabilitation programmes will be available at the Olaine prison from 05.10.2016.

12. 12 o Health care records are paper-based o Well established data collection system in all prisons, which includes diagnose and care o The health records of prisoners are updated every three months and include information about treatment (OST, ARV, DOTS etc.) o Central registry - qualification of medical staff Prisoners' Health Care Records

13. 13 o To improve HIV and hepatitis B and C testing in order to ensure that each inmate knows his status o To improve access to hepatitis C treatment o To ensure sustainability of inmate’s health after release Challenges

14. 14 Thank you for your attention