Prison health is public health. Only a small percentage of prisoners are incarcerated for life. Diseases are not stymied by prison walls. There is no distinct line between the health of prisoners and that of the general population. This article highlights a few projects that are working to address the underserved population of prisoners and ex-prisoners, particularly those who use drugs
by Corie Leifer*, MSc.
Project and Office Manager
Prison Health Article Number 2 Solutions
An article earlier this year concentrated on the epidemic of HIV, TB, and viral Hepatitis in prisons around the world and the potential contributing factors to this problem. A project review was conducted to find a few projects that are working to address the underserved population of prisoners and ex-prisoners, particularly those who use drugs. Alternatively, some of these projects serve people who use drugs, including those in prison. The information found in this article is mainly a result of internet research and email correspondence with project and program managers.
This high-level project initiated by the World Health Organization (WHO) seeks to guide and connect Ministries of Health, Justice and Interior to “help promote health and address health inequalities in prisons.” Every year for the last twenty years, the Health in Prisons Programme (HIPP) has organized regional conferences to facilitate communication and sharing of best practices between the different stakeholders working to improve health in prisons. Through HIPP, WHO member states are provided with technical assistance in creating prison health systems linked to the larger public health system. Also through this program, guidance is given on how to address all important issues of prison health like HIV/AIDS, viral hepatitis, tuberculosis, injecting drug use, and mental health. By encouraging partnerships between public health systems, international nongovernmental organizations and prison health systems, HIPP aims to solve the problem of prison health systems that are developed and maintained independent of the larger health system of a country. Furthermore, by incorporating prison health systems into the larger public health system, standards are established regarding human rights and medical ethics, and all prison health services.
USAID’s HIV React project works to reduce HIV transmission in Tajikistan, the Kyrgyz Republic, and Kazakhstan among key populations in detention and post-detention settings. The project provides technical assistance, training, transitional client management and prevention services to reduce HIV transmission among prisoners and post release inmates in these three countries and strengthen the quality of narcology services and their linkages with AIDS centers and legal and social support services for prisoners and ex-prisoners. This project is implemented by AIDS Foundation East-West (AFEW) and contributes to improving cooperation between the penitentiary system, NGOs and civil health services such as AIDS and Narcological Centers. Furthermore, through this project, trainings for prison-based health care workers in the field of narcology were offered, increasing the knowledge of these specialists. An updated version of AFEW’s “ START Plus: transitional client management program” offering HIV and TB prevention among prisoners and provision of comprehensive package of health and social services for pre and post-release prisoners in Tajikistan has been officially introduced by Head Administration of Penitentiary System of the Ministry of Justice of Tajikistan. One of the key components of this project is through-care, the methodology on which it is based. Through-care provides a support worker who helps the client navigate through the social system and helps him or her to access services from the time shortly before their release from prison until many months into the social re-integration process. Also, AFEW-Tajikistan has recently received official approval from the Ministry of Health and Social Protection to introduce VCT at their practice and practices of other Tajik NGOs. This will help increase the use of HIV counseling and rapid-testing service, as it is no longer only available in penal facilities and for key populations.
The SECRET project has been funded by the European Commission and the German Federal Ministry for Economic Cooperation and Development. It is implemented by the Institute for International Cooperation of the German Adult Education Association (DVV International) at the Female Prison in Nurek town and 4 cities. The two-year project (2014-2015) serves female prisoners and ex-prisoners of both genders in Tajikistan. The overall goal of this project is to “contribute to the realization of social, economic, and cultural rights” for these disadvantaged populations. The specific objective of this project is to provide them with and expand access to opportunities, including vocational skills development, civic education, and personal development programs. This project has helped approximately 600 ex-prisoners to reintegrate into society by providing professional orientation and psychological and legal support through social reintegration service desks. 150 female prisoners have received training and vocational facilities and courses, offering more possibilities for them to reintegrate into society after their release. Furthermore, through this project, prison staff has received trainings on “international standards of custodial supervision and penitentiary psychology.”
The African Prisons Project (APP) works in Uganda and Kenya to address the welfare, health, and education of detainees. In Uganda, as is the case in many places, prison health is not incorporated in the national health care system. The African Prisons Project aims to use the model of the national health care system within the prison system, utilizing a group of outreach workers known as Village Health Teams. The Prison Village Health Teams often work in prisons which house up to three times as many prisoners as their maximum capacity. In order to help resolve underlying causes of poor health conditions, APP is able to provide information and referrals to prisoners and to “empower prisoners, prisons’ staff and prison community members with relevant health knowledge.” Additionally, APP supports inmates living with HIV with nutritional supplements, which increases their adherence to Anti-Retroviral Treatment (ART) and helps mitigate its toxicity and side-effects. ART often causes a loss of appetite, mouth thrush, nausea and vomiting. The result is a lack of nutrition and a worsening of the condition. The additional proteins, vitamins, and minerals can improve the health of these patients and their quality of life.
In Chicago, Illinois, in the United States, the Safer Return project worked to help former prisoners to successfully re-enter society and to prevent re-incarceration. Working with the Urban Institute and the John D. and Catherine T. MacArthur Foundation, the Safer Foundation designed and implemented this project from 2008-2013 in a neighborhood known as Garfield Park on the west side of Chicago. The Safer Return project worked with various community-based organizations with different specialties to provide a wide range of supportive services to people returning to Garfield Park from prison. These services aimed to work on three aspects of re-integration:
- “Address the key needs of formerly incarcerated people and their families, such as job opportunities and stable housing.
- Introduce innovative system enhancements, such as neighborhood‐based parole officers and case management services that include family members.
- Remedy local conditions that hinder success by increasing access to social activities and role models.”
With a multitude of services to support former prisoners and their families provided by engaged community members and community-based organizations, the Safer Return project was able to “help returning prisoners shape better futures for themselves.” In the almost five years of the program, 727 former prisoners voluntarily enrolled to participate. There were many aspects of this project that contributed to its positive outcomes. Peer education and support, knowledgeable and accessible case managers, and job training and placement assistance were all crucial components of this project.
Prison health is public health. Only a small percentage of prisoners are incarcerated for life. Diseases are not stymied by prison walls. There is no distinct line between the health of prisoners and that of the general population. Prisoners come from the community and return to the community. It is important that prisoners receive equal rights to health and equal opportunities for success. These projects and many more like them are crucial to assisting in the transition from prison and re-integration into society.
*Corie Leifer (Office Manager since January 2013), was born in 1981 in Connecticut, USA. After earning a bachelor degree in communications and another in nursing in the United States, she moved to the Netherlands in 2011 to earn a Master of Health Science degree with a focus on International Public Health from Vrije Universiteit in Amsterdam. During this study, Corie completed her internship at AFEW and subsequently joined AFEW as Office Manager. As a research intern, she investigated the use of SMS campaigns to reduce the spread of HIV/AIDS. Corie has international marketing and communications experience, having worked at Operation Smile, Inc. and Trader Publishing Company prior to returning to school. Corie is also a Registered Nurse licensed in the Commonwealth of Virginia, USA.