1. SITUATION WITH TUBERCULOSIS AND OTHER INFECTIOUS DISEASES IN LATVIAN PRISONS PROGNOSIS AND CHALLENGES
Riga, 29 – 30 May 2008

2. TB incidence in Latvia 1971 - 2006
per inhabitants

3. Prisons are the mirror of the society.
All problems of the society exist also in prisons;
however, in prisons the problem level is 10 to 100 times higher.
It refers also to the health problems of prisoners.
It refers also to the prevalence rate of diseases in prison population
because most part of prisoners come from lower socio-economic strata of society,
(unemployed, homeless persons, alcoholics, drug addicts)
those health problem level is much higher than those of other people.

4. Situation with TB in Latvian prisons
TUBERCULOSIS
1999
2000
2001
2002
2003
2004
2005
2006
2007
Tuberkuloze (TB)
gada laikā/year prevalence
745
562
518
491
344
278
249
149
118
uz 31.decembri /point prevalance
361
301
265
222
168
135
112 73 47
AIDS + TB uz 31.decembri /point prevalence 5 16 24 11 19 13 9
In 1998 – 1999 TB prevalence in prison population was 25 times higher than in general population.
At present, the situation has improved considerably

5. Prisons are not totally closed institutions.
People are entering prisons from the community with their problems including health problems and after some period of time they are returning into the community.
The community should be interested to receive people released from prisons in good health, without serious health problems which would endanger the community.

6. Medical activities on TB in the Latvian prison system
Prisoners examination for TB on entry and during the detention
TB patients isolation
All new TB cases and relapses are treated in the Latvian Prison Hospital
DOTS and DOTS plus in-patient treatment is carried out in the hospital and outpatient treatment is carried out in isolated units/cells.
All new TB patients and MDR TB patients are consulted in State Agency of Tuberculosis and Lung Diseases (SATLD)
All TB patients are registered in the National TB Register
High level prison administration officials, guards and medical staff are educated about TB
Good information exchange system is organized between Prison Medical Service and SATLD. Prison medical staff notifies the local community TB out-patient medical centres about the persons who are being released from prisons and are in need to continue the treatment
Organizational and technical management (the isolated out-patient units or cells are created in 7 prisons)

7. Collaboration between MoJ and SATLD
Since 1996 – 1997 the Medical Department of Latvian Prison Administration and the State Agency of Tuberculosis and Lung Diseases is being in the close collaboration on:
- assessment of TB situation in prison system
- professional training of LPA specialists:
- prison administration
- primary care physicians
phthisiopulmonologists
nurses
laboratory specialists
- consultation of TB cases
- information exchange
- providing prisons with specific medicines
- ensuring prisons with specific examinations and manipulations

8. Due to good collaboration between LPA and SATLD that eventually was good collaboration between MoJ and MoH the TB situation in prisons considerably improved.
incidence
prevalence on 31 Dec
year prevalence
1999
279
361
745
2007 31 47
118

9. In 2007 a new challenge emerged in Latvian prisons
- restrictions of TB preventive measures caused by closing of X-ray rooms almost in all prisons.
In 2006 in 10 prisons X-ray rooms were closed because the X-ray equipment there were old and did not meet the modern standards and the new Rules of Cabinet of Ministers.
Currently MoJ and Latvian Prison Administration are working to improve the situation.
MoJ alloted money for 3 x-ray in 2008.

10. Previous years in order to decrease and normalize TB prevalence
the main WHO principles
were implemented in Latvian prisons:
- prisoners health care should be equivalent to that available in the outside community;
- prison medicine integration into the public medicine.

11. This work was carried out under the guidance of WHO (Latvia).
The Medical Department of the Latvian Prison Administration participated in the creation of the Draft of the National TB Control Programme 2008 – 2012.
This work was carried out under the guidance of WHO (Latvia).

12. The example with TB incidence and prevalence in Latvian prisons demonstrates that only with joint efforts (prison medicine + public medicine) it is possible to improve and normalize the situation with infectious diseases in prisons.

13. In 2007, with the initiative and help of WHO Health in Prisons Project (WHO HIPP) coordinator L. Moller, the „Status Paper on Prisons and Tuberculosis” was translated and distributed in Latvia. In June, 2007, for the first time in 15 years, on WHO HIPP initiative, the meeting of two Ministries was organized. High ranke officials from Ministry of Justice and Ministry of Health, and also the leading specialists from Latvian medical centres participated in the meeting.

14. In prison population the proportion of HIV infected persons is higher than in the general population. Proportion of HIV infected persons: - in prisons 6%; - in society 0,17%.

15. The HIV positive cases are diagnosed when prisoners enter prisons, therefore the incidence: - in prisons 2%; - in society 0,2%. It means, that people from marginal groups of the society, who constitute the major part of prison population, while in freedom, did not meet the necessary medical and educational services, so many activities in prisons for providing these services and preventing the spread of drug addiction and HIV/AIDS should be done.

16. There is a large number of drug users in the prisons of Latvia
There is a large number of drug users in the prisons of Latvia. According to the research, made by Latvian University in 2003: - 65% of prisoners had been using drugs during their lifetime; - 31% of prisoners use drugs in imprisonment; - 5% of prisoners started to use drugs in imprisonment.

17. 90% of HIV infected prisoners used injective drugs
during their lifetime
11-20% of prisoners are injective opiate users
(data from MoH Public Health Agency)

18. INFECTIOUS DISEASES PREVALENCE IN LATVIAN PRISONS
1999
2000
2001
2002
2003
2004
2005
2006
2007
HIV inficētie
gada laikā/year prevalence
290
544
766
803
700
585
613
570
uz 31.decembri /point prevalance 96
197
358
522
468
454
410
401
400
% no visiem ieslodzītajiem /point
2,15
4,32
6,15
5,7
5,9
5,88
6,12
6,1
AIDS 2 10 23 59 51 72 81 97
% from all HIV cases 2= 1% 5 19 32 30 45
59 =
14,7%
74=
18,5
AIDS + TB uz 31.decembri /point 16 24 11 13 9
Syphilis
102 56 36 38 27 20 18
Gonorhoea 6 4 7 1
VHC
uz 31.decembri /point prevalence
487
503
584
629

19. The Medical Department of Latvian Prison Administration established good collaboration with National AIDS Prevention Centre and with Latvian Infectology Centre implementing activities on HIV/AIDS in prisons. However, inadequate financing can worsen the situation.
So, actually there are no activities on VHC in prisons and it is only by cause of inadequate financing.

20. Goals of Latvian Prison Medical Service:
- to stop increase of TB cases
- to continue activities on HIV/AIDS
- to begin activities on VHC and VHB
- to begin activities on drug addiction

21. MoJ and Latvian Prison Administration will be able to reach these goals only in good collaboration with MoH

22. Thank you for attention