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VIII. THE PENAL SYSTEM AND ISOLATION OF HIV-POSITIVE PRISONERS
Prisoners in Kazakhstan are at particular risk of contracting HIV/AIDS given generally overcrowded conditions, limited access to prevention services, unprotected sex and sexual abuse, and needle sharing in prison.246 Up until July 2002 it was national policy to conduct mandatory HIV testing of all persons in pretrial detention facilities. Those who tested positive and were convicted were isolated in separate wards in prison colonies in Karaganda province; HIV-positive prisoners with tuberculosis were further segregated in a separate ward.247 New HIV testing guidelines adopted by the Ministry of Health in June 2002 and subsequently adopted by the National AIDS Program have lifted the compulsory testing requirement of those in pretrial detention, and the government has announced that the segregation of HIV-positive prisoners will cease.248 As of this writing, however, the Ministry of the Interior, which oversees pretrial detention centers, had still not fully adopted the new policy, and many HIV-positive prisoners continued to be kept in isolation.249 In addition to the flagrant discrimination inherent in a policy that singles out HIV status, the isolation policy has created significant tensions among HIV- positive prisoners and prison personnel.250 The perception by HIV-positive prisoners of a contradiction between the policy to isolate them for medical reasons but not provide treatment has led to anger and frustration among them. Oleg Akhmetov expressed frustration on behalf of the prisoners: "At first they said we had to be isolated [because we were sick], now they say we're not sick, we're normal...they're demanding the impossible from us!"251 The prisoners' demands for treatment have in turn created a hostile attitude among prison personnel, who view and treat HIV-positive prisoners as a prison elite who are physically and psychologically aggressive, prone to exaggeration, and unreasonably demanding.252 Comments typical of those made to Human Rights Watch by officials who work with HIV-positive prisoners came from Tolgat Kiniskhanovich at the infectious diseases hospital of the prison system in Karaganda province: "We're all suffering from the isolation policy because the prisoners themselves are angry at being segregated . . . and they're aggressive, angry, and lie."253 Lyuba N., a nurse at Colony 159/17, described the excessive amount of energy required for staff working in the HIV wards when she declared, "They consider themselves elitist and special, and they have no regard for the other prisoners, plus, they're sucking the blood out of us!"254 Tensions have at time reached such a point that HIV-positive prisoners have reportedly smeared doorknobs with their blood, threatened to prick prison staff with syringes covered with their blood, and conducted hunger strikes to protest the inadequacy of their detention conditions.255 Furthermore, the isolation policy does not appear to have contributed to a reduction in risky behavior among those segregated.256 Tensions and misinformation created by the isolation policy also pose challenges for the transition to the integration with the regular prisoner population that would take place under the new policy. HIV-positive prisoners interviewed were overall hostile to the idea of integration in the regular prisoner population, as they felt that their already publicized status would only make them more vulnerable to discrimination and harassment. Some prisoners were also fearful that any new cases of HIV after integration would be blamed on them. HIV-negative prisoners were fearful of and opposed to the idea of integration, asserting that knowledge among prisoners of methods of HIV transmission was still insufficient and that overall poor state of detention conditions would only increase the possibility of contracting the virus.257 Prison staff are fearful of the new policy due to misinformation and a sufficient lack of understanding of HIV transmission,258 but officials are hopeful that integration with the regular prisoner population over time and increased information campaigns will overcome these obstacles.259 Conditions for HIV-positive prisoners in the segregated HIV-positive prisoners' wards viewed by Human Rights Watch did not appear to differ significantly from those for HIV-negative prisoners. HIV-positive prisoners interviewed indicated they received an adequate diet, including almost daily meat or fish, butter, oil, milk, bread, and dried fruits, approximately the same as for HIV-negative prisoners. HIV-positive prisoners are not fed a special diet unless they become sick with opportunistic infections,260 and they do not carry out demanding physical labor.261 Prisoners in the HIV wards were, in the presence of prison staff, physically at ease and unrestrained in their conversations with a Human Rights Watch representative. Kazakhstan's prisons are reported to suffer regular shortages of basic medicines and medical equipment, including rubber gloves and facial masks, concerns confirmed by HIV-positive prisoners and prison medical personnel interviewed by Human Rights Watch.262 This situation raises particular concerns for persons living with AIDS, who require specialized medical care and treatment. Medical prescriptions for HIV-positive prisoners are written in close collaboration with the Karaganda AIDS Center.263 Officials and representatives of international NGOs working in Kazakhstan's prisons indicated an overall shortage of medication to treat opportunistic infections.264 In particular, a shortage of drugs for treatment of tuberculosis, which leads the list of diseases contributing to AIDS mortality in Kazakhstan, highlights problems of insufficient medication for HIV-positive prisoners.265 Of additional concern is the view encountered among many medical prison personnel that it was not useful to offer HIV-positive prisoners antiretroviral treatment. Medical staff at colonies with HIV-positive prisoners, for example, said they knew cases of HIV-positive patients at the Karaganda AIDS Center who had refused treatment in the belief that it was too difficult to follow or simply ineffective.266 Some medical staff simply that the lack of antiretroviral medicines was the main impediment to offering them in prison.267 Not surprisingly, many HIV-positive prisoners exhibited a general lack of knowledge about the use and effects of antiretroviral treatment.268 A UNDP-sponsored pilot harm reduction project in prisons which includes provision of condoms, sterilization equipment, information on HIV/AIDS and sexual and drug injecting practices currently covers prisons in Karaganda province, Almaty, Astana and Pavlodar. Attempts by the Ministry of Justice to establish harm reduction services in prisons not included in the UNDP-sponsored project program are currently underway.269 Limited supplies of condoms and disinfectant materials were available in the HIV-positive persons' wards as well as in a regular prison colony visited by Human Rights Watch in September 2002 in Karaganda and Pavlodar provinces, while posters and information about HIV transmission were in prominent view.270 A psychological service was ostensibly available to incarcerated HIV-positive persons, although HIV-positive prisoners in Colony 159/18 complained that the service was ineffective or unavailable.271 HIV-positive prisoners are released on humanitarian grounds if their medical condition reaches a critical stage.272 According to prison medical staff at Colony 159/17, four HIV-positive prisoners with tuberculosis had been released from the colony since the beginning of 2002.273 They were unaware of what eventually became of these persons. 246 UNAIDS/IPU, Handbook for Legislators on HIV/AIDS, Law and Human Rights: Action to Combat HIV/AIDS in View of its Devastating Human, Economic and Social Impact (Geneva: UNAIDS, 1999), p. 61; U.N., Support to National Strategic Plan Against HIV/AIDS, STIs and Injecting Drug Use, p. 2; and U.S. Department of State, Country Reports on Human Rights Practices. 247 These prisons are Colony 159/18, Colony 159/17 and 159/9. In September 2002, there were approximately 500 HIV-positive prisoners held in isolation in these colonies and approximately fifty in pre-trial detention in Karaganda province. This number varies frequently due to releases and new convictions. As of publication date, HIV-positive prisoners with tuberculosis continued to be isolated from HIV-negative prisoners. Human Rights Watch interviews with Pyotr N. Posmakov, Astana, September 4, 2002; Dr. Vagif Aliev, Karaganda, August 17, 2002; and Marat Akhmetov, head, Medical Department, Criminal-Executive System, Ministry of Justice, Almaty, August 16, 2002.
248 Dr. Isidora Erasilova, remarks, press conference organized by the National AIDS Program, Almaty, August 15, 2002; and Human Rights Watch interview with Pyotr N. Posmakov, Astana, September 4, 2002. 249 The Ministry of Justice assumed control of the country's prisons in January 2002, while pre-trial detention centers and police stations remained under the control of the Ministry of the Interior. Notably, numerous and widespread due process violations occur during the first twenty-four hours of detention, making the imperative for the transfer of pretrial detention centers to the Ministry of Justice even stronger. Penal Reform International, informal report received by Human Rights Watch in August 2001; "Sobludenie prav cheloveka politsiei pri zaderzhanii po podozreniu...," p. 49. 250 A guidebook for those working with HIV/AIDS law co-authored by UNAIDS and the Inter-Parliamentary Union points out several negative effects that can result from a policy to segregate HIV-positive prisoners: "...Segregation per se reveals HIV status to other prisoners and warders, providing an excuse for abuse and threats, which can enhance stigma and isolation even after release to the community. Mandatory testing and unauthorized disclosure of HIV status in prisons should be prohibited. Both mandatory testing and segregation lead to a false sense of security. Segregation is stigmatizing and implies that casual contact with people living with HIV is unsafe, as well as having no impact on violent or dangerous behaviour which is unrelated to HIV status." UNAIDS/IPU, Handbook for Legislators on HIV/AIDS, Law and Human Rights, p. 62. 251 Human Rights Watch interview with Oleg Akhmetov, HIV ward, Colony 159/17, Karaganda province, September 6, 2002. 252 Human Rights Watch interviews with Dr. Vagif Aliev, Karaganda, September 5, 2002; doctors and nurses, HIV ward, Colony 159/17, Karaganda province, September 6, 2002; Tolgat Kiniskhanovich, head, Infectious Diseases Hospital, Criminal-Executive System, Karaganda province, September 7, 2002; Svetlana Turevna, head, Medical Department, Colony 159/18, Karaganda province, September 7, 2002; and Nurtai Abilmazhanov, deputy head, medical department, Ministry of Justice of the Republic of Kazakhstan Committee of Criminal-Executive System, Karaganda, September 5, 2002. 253 Human Rights Watch interview with Tolgat Kiniskhanovich, Karaganda province, September 7, 2002. 254 Human Rights Watch interview with Lyuba N., nurse, HIV ward, Colony 159/17, September 6, 2002. Prison personnel only at Human Rights Watch's repeated insistence allowed a representative to view part of the HIV ward in Colony 159/18, stating that it was too dangerous due to the "tense and difficult situation between HIV-positive and regular prisoners." Human Rights Watch interview with Svetlana Turevna, Colony 159/18, Karaganda province, September 7, 2002. 255 Marat Kairbekov, "Turma vnutri turmi," ("A Prison Within a Prison") Yuridicheskaya gazeta (The Jurisprudence Newspaper), April 17, 2002; Human Rights Watch interviews with Volodya S., Karaganda AIDS Center, August 19, 2002; Nurtai Abilmazhanov, Karaganda, September 6, 2002; and Sergei Znaiko, HIV ward, Colony 159/18, September 7, 2002. 256 Kossukhin, "HIV/AIDS in Central Asia." HIV-positive persons are at risk of reinfection with HIV, which can speed the progression of AIDS disease. 257 Human Rights Watch interviews with HIV-positive and HIV-negative prisoners, Colony 159/18, Karaganda Province, September 7, 2002. 258 Human Rights Watch interviews with Marat Akhmetov, Almaty, August 16, 2002; prison doctors and nurses at Colony 159/17 tuberculosis hospital and Colony 159/17, Karaganda province, September 6, 2002; and Dr. Vagif Aliev, Karaganda, September 5, 2002. 259 Human Rights Watch interviews with Dr. Vagif Aliev, Karaganda, September 5, 2002; Nurtai Abilmazhanov, Karaganda, September 6, 2002; and with Pyotr N. Posmakov, Astana, September 4, 2002. 260 Human Rights Watch interview with Marat Akhmetov, Almaty, August 16, 2002. 261 Human Rights Watch interview with Tolgat Kiniskhanovich, Karaganda province, September 7, 2002. 262 Ibid.; Human Rights Watch interviews with Nurtai Abilmazhanov, Karaganda, September 6, 2002; nurses, doctors and HIV-positive prisoners at Colony 159/17, Karaganda province, September 6, 2002; with HIV-positive prisoners, Colony 159/18; and persons living with AIDS at the Karaganda AIDS Center, August 19, 2002. 263 Human Rights Watch interviews with nurse and doctors, Colony 159/17, Karaganda province, September 6, 2002. 264 Human Rights Watch interviews with Dr. Vagif Aliev, Karaganda, August 17, 2002; Svetlana Pak, Penal Reform International (PRI), Almaty, August 16, 2002; Project Hope officials, Karaganda, September 6, 2002; and Nurtai Abilmazhanov, Karaganda province, September 6, 2002. 265 Project Hope, "Kazakhstan: Tuberculosis Management," [online] http://www.projecthope.org/kazakhstantb.htm (retrieved January 15, 2003); Jay Dobkin, "Assessing and Responding to the AIDS Threat in Central Asia," Eurasia Insight, March 1, 2001, [online], http://www.eurasianet.org/policy_forum/dobkin030101.shtml (retrieved January 15, 2003). 266 Human Rights Watch interviews with nurses and doctors, HIV ward, Colony 159/17, Karaganda province, September 6, 2002. 267 Ibid. 268 Human Rights Watch interviews with HIV-positive prisoners at Colonies 159/17 and 159/18, September 6 and 7, respectively. 269 Human Rights Watch interviews with Dr. Vagif Aliev, Karaganda, August 17, 2002; and with Marat Akhmetov, Almaty, August 16, 2002. A U.N.-sponsored harm reduction project started up in Temirtau, Karaganda province, in 1997. 270 The prison visited in Pavlodar province was Colony 162/2. 271 Human Rights Watch interviews with Denis Monatyrov, Dyma Kosov and Albert Zhitbaev, HIV ward, Colony 159/18, Karaganda province, September 7, 2002. 272 Human Rights Watch interviews with Marat Akhmetov, Almaty, August 16, 2002, and with Pyotr N. Posmakov, Astana, September 4, 2002. A prison medical commission with representation from the Karaganda AIDS Center is responsible for determination of humanitarian release. Human Rights Watch interview with Svetlana Nikolaevna, doctor, Colony 159/17, Karaganda province, September 6, 2002. Dr. Gulsara R. Suleimanova at the Almaty AIDS Center also reported that juvenile HIV-positive prisoners are released on humanitarian grounds if their medical condition reaches a critical stage. Human Rights Watch interview, Almaty, September 12, 2002. 273 Human Rights Watch interview with Svetlana Nikolaevna, doctor, Colony 159/17, Karaganda province, September 6, 2002.
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