Kyrgyzstan: Bishkek Takes Lead In Fight Against TB, HIV In Prisons

Mycobacterium tuberculosis, blamed for most cases of tuberculosis (file photo) (Public domain) September 10, 2007 (RFE/RL) -- In the majority of Central Asia's prisons and colonies, inmate access to even basic medical care is severely limited.

Rights activists and former convicts say sick prisoners often get only one-half or even one-quarter of a pain-relief tablet, regardless of what illness they have.

Prison facilities are considered the epidemiological pump behind the high rate of infectious diseases there.

The rates of HIV/AIDS and tuberculosis (TB) are high among inmates.

The Brussels-based International Crisis Group reported last year that cases of TB among prisoners has more than doubled in Kazakhstan, tripled in Uzbekistan, and increased fivefold in Tajikistan since 1990.

Taking Steps

In Kyrgyzstan, the rates of TB among prison inmates are said to be 40 times higher than in the general population and mortality rates are some 60 times higher, the ICG reported.

In response to this alarming situation, Kyrgyz authorities seem to be taking steps to address the problem.

Valery Chernyavskiy of the Global Fund to Fight AIDS, Tuberculosis, and Malaria visited two prison colonies for men (Nos. 27 and 31) near the Kyrgyz capital of Bishkek last month.

Observers have said that TB -- particularly its drug-resistant strains -- is rampant in those colonies, two of the three prisons for men that have TB hospitals in Kyrgyzstan. (The women's and juveniles' colonies also house TB treatment centers.)

Positive Changes Reported

Speaking to RFE/RL from Geneva, Chernyavskiy says he saw positive changes to inmates' conditions in those two prisons.

He also says Kyrgyz authorities have demonstrated commitment and maturity in dealing with contagious diseases in the penal system.

"Like all other prisons in this region, the situation [in Kyrgyz prisons] and the conditions of sick [convicts] are very bad," Chernyavskiy says. "However, Kyrgyzstan does much more compared to other countries of the region in order to reduce the threat of the penitentiary system as a source of tuberculosis and HIV/AIDS. When I was there, I saw great progress."

Chernyavskiy says Kyrgyzstan was the first country in Central Asia to receive the Global Fund's financial aid to start treatment of people with multidrug-resistant tuberculosis.

"Kyrgyzstan does much more compared to other countries of the region in order to reduce the threat of the penitentiary system as a source of tuberculosis and HIV/AIDS. When I was there, I saw great progress." -- Valery Chernyavskiy, Global Fund to Fight AIDS, Tuberculosis, and Malaria Central Asian countries are situated on a transit route of narcotics from Afghanistan to Russia and on to Europe. All of them, including Kyrgyzstan, have seen a sharp increase in the number of drug addicts -- particularly heroin users -- in recent years. The trend has led to the rise of HIV/AIDS among the general population, as well as in prisons.

The use of intravenous drugs -- usually involving needle-sharing -- is widespread among inmates.

HIV/AIDS is also transmitted person-to-person through unprotected sex as well as tattooing, a common practice in prisons.

Distributing Disposable Syringes

One way of preventing HIV/AIDS epidemics in penal facilities is to distribute disposable syringes and needles to drug-addicted prisoners. This practice -- which is widely used in many countries around the world -- is rare in Central Asia.

Chernyavskiy says Kyrgyzstan is the only country in the region in which drug-addicted convicts receive disposable syringes from prison authorities.

"This is a very important element in virtually eliminating the risk of infection that exists because drug addicts in one prison cell usually share one syringe," he says. "[In Kyrgyzstan], they come every day to distribution centers where they leave the used syringes and receive new ones. Meanwhile, no one asks them how and from where they get the narcotics in the prisons."

Chernyavskiy says Kyrgyzstan has also taken the lead in Central Asia in introducing drug-substitution therapy.

Before the end of 2007, heroin addicts can start receiving methadone and buprenorphine as substitutes for heroine. Taken orally instead of using syringes, the practice should reduce the spread of HIV and other diseases among convicts, Chernyavskiy says.

He added that other Central Asians lag behind Kyrgyzstan.

"In Kazakhstan, there is not a single person [receiving drug-substitution therapy]. The government failed to make a decision to start substitution therapy even among the civil population," he says. "Uzbekistan has had 270 people who have received drug-substitution therapy. In Tajikistan, this issue has not been resolved, but it is currently being addressed."

Chernyavskiy's Global Fund has granted $15 million to Kyrgyzstan to fight HIV/AIDS, TB, and malaria among the general population as well as prison inmates since 2003.

The Incentive Of Aid

Some 1,500 of those who received medical assistance are convicts.

Kyrgyzstan will receive some $18 million through 2012.

Observers say international aid has been the major factor behind some progress in the fight against diseases like TB and HIV/AIDS in Kyrgyz prisons.

Those diseases have attracted great attention and received considerable aid investment.

However, other areas remain highly neglected. Basic conditions in prisons still remain very dismal, human rights activists say.

Despite the progress compared to other Central Asian countries, Kyrgyz Ombudsman Tursunbai Bakir-uulu has criticized the country's authorities for not taking enough measures to address the problem.

Speaking to RFE/RL's Kyrgyz Service on September 3, Bakir-uulu recalled his recent visit to a pretrial detention center in the eastern Kyrgyz town of Cholpon-Ata.

"Yesterday, when we visited it, there were 52 people in a place suited for only 30 people. Their conditions were hard. There was neither fresh air, nor natural light [in the cells]," he says. "Food was provided for 30 people; the other 22 people did not receive any."

In general, convicts lack basic medical care as well. Specialized services, like oncological, gynecological, mental, and dental services are virtually unavailable in most prisons in the region. Nutritious food -- a key in treating TB -- is also in very short supply.

Furthermore, prisoners who receive treatment for TB in prisons and who require further therapy do not receive follow-up care. Thus, they are likely to spread TB among the general population after their release from prison.