Is Moldova Leading the World on Harm Reduction in Prisons?

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Recently in Moldova visiting government officials, I was invited to visit the prison 15 in Cricovia which houses some 550 inmates.

A 30 minute ride from Chisinau, Moldova's capital, and set amongst gentle hills and vineyards, prison 15 was built by the Soviets in the fifties and is reasonably well kept, despite cracks in the walls. A small orthodox chapel opens up on to its courtyard.

My colleagues and I are greeted by Svetlana, a young and energetic woman who heads the national penitentiary health service. Passing through the iron gate to enter the prison is somewhat uneasy. The guards, wearing large high caps and in military uniform, greet us good morning while trying to work out just what it is that brings these new visitors to their prison.

Outside the temperature is around zero, and some snow still lines the prison's own mini courtyard. I notice t-shirts and towels are suspended to dry on lines hooked between the two-three story buildings surrounding the courtyard.

Escorted by the guards, we reach the office of the prison doctor, Constantin. Constantin manages the small pharmacy which stocks methadone, needles, syringes and condoms. His office is small -- a simple wooden desk, paper files and a sofa. He greets us with tea.

A general practitioner in his early forties, Constantin is the sole medical staff member serving some 550 inmates. His role is broad: He deals with routine everyday medicines and emergencies as they arise; he supervises a nicely carpeted small ward with three beds, and is also a confidant and trusted advisor to many inmates.

While there is a two per cent prevalence of HIV among the inmates, HIV and Hep C testing are not mandatory, neither at entry nor during initial detention. Rather, it is the voluntary counseling and testing provided by Constantin that has successfully engaged the inmates. An NGO funded rapid saliva test is available. Moldova's harm reduction program in prisons is unique in the region, and a remarkable model, not only there, but globally. Begun in the early 2000s, following pioneering work by the Open Society Foundations (OSF), responsibility for managing the program underwent by all accounts, a smooth transition to the public health staff working in the penitentiary system.

Methadone is available for anyone Constantin decides to prescribe it to, and those inmates on substitution treatment take it each day in the pharmacy after signing a register. Although I am told that there are not many methadone clinics outside the capital city, at the same time, I didn't hear any strong complaints about the lack of availability of services for people after they leave prison.

Methadone and needle exchange are also available, I was told, in prisons in Transnistria, the secessionist Eastern part of the country, under strong Russian influence.

I believe one of the most fascinating achievements in the delivery of this harm reduction program I observed in the prison was the way in which needles, syringes and condoms were distributed.

Needles and syringes are stocked in distribution points under the supervision of volunteer inmates who keep them in a small wooden cupboard in their cell. I saw two of these distribution points, one in a long term inmate's well-kept and tidy individual cell. The other was a cupboard in a corner of a crowded dormitory of about sixty inmates.

Moldova's harm reduction system is exemplary. There are not many countries worldwide that implement needle exchange and OST in prisons, as well as providing condoms, and even fewer -- if any -- that run a smooth system such as the one I saw in Moldova.

Moldova is showing the way by prioritizing the health of its prison population. The proof is in the pudding -- Constantin and Svetlana make a point of telling me that they do not know of any cases of overdose (there have been overdose reductions).

We must remind ourselves, though, of the reality in which harm reduction programs like this exist and continue to function. As is the case throughout the Eastern European and Central Asia region, the funding for harm reduction in prisons remains entirely dependent on external funds -- in most cases supplied by the Global Fund To Fight AIDS, Tuberculosis and Malaria.

In the present climate we need to deal head on with the very real risks that the gains made in programs of this kind face in maintaining funding, and thereby contributing to strengthening the achieved sustainability of a country's AIDS response. The evidence, such as the kind we witness in Moldova, is staring policy makers and donors in the face.

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