A Study of the Health Care Provision, Existing Drug Services and Strategies Operating in Prisons in Ten Countries from Central and Eastern Europe

Abstract

The ten countries involved in the research were Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia. The field visits to all the countries apart from the Czech Republic, Poland and Slovenia were carried out by the author of this report. The overall aims of the research were to: - undertake a review of the services/ initiatives operating in the area of health within two sample prisons in each of the countries; - provide a report of the provision of services for drug-dependent prisoners in the ten countries; - relate the provision of services to current Council of Europe and World Health Organisation guidelines and to the national strategies operating in each country; - promote awareness of the initiatives operating within the sample prisons and facilitate the sharing of best practice on the national and international level. The research involved visiting at least two prisons and key non-governmental organizations (NGOs) working in the area of drug addiction in each of the ten countries. A qualitative case study design was chosen as the most appropriate methodology in order to provide an in-depth analysis of the processes involved in the development of prisons’ drugs policy in the ten sample countries. In a study such as this, quantitative research models are of limited use whereas qualitative approaches offer distinct advantages (Pollitt et al., 1992; Koester, 1993). For example, although quantitative measures can give rise to important descriptive data, they do not provide information or access to meanings and choices in the development and implementation of policy. The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) sets out guidelines for treating problematic drug and alcohol users, both of which are at greater risk of contracting HIV and other infectious diseases. Often, as a result of drugs misuse prior to incarceration, inmates are already carrying infectious diseases. However, the implementation of services to treat HIV/AIDS and drugs misuse both within prisons and in the community varies and is subject to a country’s socio-economic circumstances, cultural attitudes towards HIV and drugs and existing resources. Prevention and treatment initiatives must overcome many cultural barriers relating to attitudes towards sex, especially homosexual activity, as well as providing enough resources to deal effectively with the problem.This may determine whether or not preventative measures (e.g. clean needles, condoms) are in place and to what extent they, along with sexual activity and tattooing, will impact on the risk levels of spreading infectious diseases. The prevalence of sexual activity in prisons needs to be acknowledged and addressed in order to prevent further infection within prisons and subsequently in the wider community.