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Speech by Mr. Antonius Broek, UNDP Resident Representative, at the 4th International Scientific and Practical Conference "Challenges of the Penitentiary Medicine. Tuberculosis and other socially important diseases in prisons"

Dear Mr. Deputy Minister of Health, Dear Mr. Deputy Chief of the Penal Committee, Dear prison directors and doctors, guests, colleagues of the UN, ladies and gentlemen,

I am very pleased to participate in the opening ceremony of this important conference.

On any day worldwide about 10 million people are incarcerated, in prisons, remand centres, police stations, jails, detention centres for asylum seekers, penal colonies, and prisoner of war camps. In Belarus, there are about 50 thousand prisoners.

There is an increasing recognition that the high risk of tuberculosis in these settings poses a problem for those imprisoned and for the wider society. The issue now is what to do about what was until very recently “a forgotten plague” – tuberculosis.

Here are a few important statements on which the whole of WHO, “Stop TB strategy” in prisons is based and I would like to repeat them here.

  • Prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former inmates. TB does not respect prison walls.
  • Improving TB control in prisons benefits the community at large. Community TB control efforts cannot afford to ignore prison TB.
  • Prisoners have the right to at least the same level of medical care as that of the general community. Catching TB is not part of a prisoner’s sentence.
  • Drawing attention and resources to the problem of TB in prisons is likely to lead to an overall improvement in prison conditions, the health of inmates and human rights.

What is the solution?

  • The priority strategy must be the widespread implementation of the Stop TB Strategy, particularly addressing TB/HIV co–infection and MDR–TB, in the incarcerated population. Every prisoner should have unrestricted access to the correct diagnosis and treatment of TB.
  • Delays in the detection and treatment of TB cases must be minimised to reduce further transmission of infection and pressures to self–treat TB.
  • Unregulated, erratic treatment of TB in prisons should cease.
  • Urgent action is needed to integrate prison and civilian TB services to ensure treatment completion for prisoners released during treatment.
  • Measures to reduce overcrowding and to improve living conditions for all prisoners should be implemented to reduce transmission of TB.

UNDP in Belarus has been a long standing partner of the Belarus penal system since 2003 in implementing HIV and TB prevention and treatment programmes in prisons. All of you prison directors and prisons doctors sitting in this room have contributed to the introduction of treatment for both HIV and TB, dissemination of information on how to protect oneself form the diseases, development of new guidelines and setting up resource and treatment centres in prisons. Let me take this opportunity to thank you for the important work you are responsible for.

One could argue that there is not much to do in Belarussian prisons any more, all major issues have been tackled, and Belarus indeed has been a pioneer in many new ideas in prisons. But of course much can still be done.

We may look at the innovative ideas implemented in other countries, including Lithuania and Latvia as the countries bordering Belarus and trying to implement them here.

For instance, infection control in prisons still remains a concern to all of us and the source of multi–drug resistant TB spread. There is no single prison which complies with WHO infection control guidelines.

The human rights based approach can be further strengthened in our joint work. For instance, surveys on violence or sexual abuse have not been organised in Belarus, but surveys in the Russian Federation proved that more than 40% of all prisoners have been sexually abused, and this seems to be a problem in many other countries also.

Many prisons worldwide have condom vending machines where each prisoner can freely purchase condoms. After release from prison an inmate who has HIV or TB has to be followed up to the new place of residence and it has to be ensured that treatment and care in the civilian sector continue. These are just a few ideas that could be explored in our future cooperation.

As many of you know, Belarus will be receiving additional funding for another six years within the grants of the Global Fund. Work with the penitentiary system will continue for both diseases: HIV and TB. The success of the prison components of the current grants is mainly attributed to the commitment and hard work of the Belarusian prison personnel and I would like to thank all of you present here for your active engagement in the HIV and TB prevention and treatment. Wishing you good luck in your hard work!

Thank you!

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