In the 1990s a sharp increase of tuberculosis was seen in the Baltic Sea region. Recent studies confirmed that in parts of the region the tuberculosis incidence was rapidly increasing and that the worst hot spots for multi drug-resistant tuberculosis (MDR-TB) in the world were found in this region. The difficult situation in prison systems was thought to contribute to the increasing problem.
Sweden, in co-operation with Norway, organised an interdisciplinary expert meeting addressing the subject Tuberculosis among prisoners on the 4th - 6th of October 2000 in Sigtuna, Sweden. This expert meeting was a follow up of recommendations made during a previous meeting in Sigtuna (“Combating Infectious Diseases in the Baltic Sea and Barents Regions”) and decisions made at the CBSS Summit in Kolding in April 2000. At the summit, heads of government gave the issue of communicable disease control the highest priority, and established a Task Force of personal representatives to elaborate a joint plan to enhance disease control throughout the region.
The theme of the expert meeting was the prevention and control of tuberculosis, with special emphasis on prison systems. The aim was to increase interdisciplinary co-operation, nationally as well as internationally, and to form networks between institutions and a platform for future projects.
The Swedish organisers were the Ministry for Foreign Affairs, the Ministry of Justice, the Ministry of Health and Social Affairs, the Swedish Institute for Infectious Disease Control (SMI), the Swedish Prison and Probation Administration, the Swedish International Development Co-operation Agency (SIDA), the Swedish East Europe Committee of the Swedish Health Care Community, and the National Board of Health and Welfare.
Experts nominated by their governments participated in this meeting. Participants represented departments responsible for general tuberculosis control, health care in prisons, the judicial system, prison systems, and the social sector including experts on children’s social welfare from all countries of the Baltic Sea Region and Ukraine. In addition, representatives for national and international organisations and NGOs working with tuberculosis and/or prison projects participated.
The first part of the programme consisted of four keynote presentations, providing an up to date background to the increasing tuberculosis incidence (especially MDR TB), and the poor situation in the prisons in the region.
The second part of the meeting took the form of workshops focusing on three key issues: 1) how to prevent the introduction of tuberculosis into the prison system, 2) how to control tuberculosis within the prison system, and 3) how to prevent the spread of disease to other parts of the society outside the prison system. The children’s situation within this context was also discussed.
Groups representing Estonia, Latvia, Lithuania, Poland, the Russian Federation and Ukraine prepared written documents describing how, when and by whom counter actions towards the transmission of TB could be taken.
The country documents, as well as background documents, abstracts of the key note speeches, and the chairman’s summary have been compiled in a report from the meeting . The report has been forwarded to the Task Force on Communicable Disease Control in the Baltic Sea Region, where the considerations of the meeting will been taken into account in the elaboration of the joint plan to enhance disease control throughout the region.
The conclusions from the meeting can be divided into five main groups of issues.
1. The Need for an Integrated Approach for the control of TB in prisons
Within this context the meeting considered the need for effective TB treatment for prisoners that would involve:
Speedy and effective screening at point of entry to the prison
The capacity to isolate infectious cases
The need for continuous treatment through allocation and transfer
A gradual increase in the availability of treatment for MDR cases
2. The Need for Initiatives within the wider Criminal Justice Process
Within this context the meeting considered the need for governments to introduce measures to reduce the number of prisoners, especially juvenile prisoners, towards the European average through:
The establishment of alternative sanctions
3. The Need to Improve Prison Conditions
Within this context the meeting considered:
Projects that improve prisoners’ health by increasing their access to light and air
The need for improved nutrition and exercise
The special needs for women and young prisoners, especially juveniles
4. The Need for continuity of Health Care between Civil Society and Prisons
Within this context the meeting considered the need for:
Administrative reforms to facilitate co-operation between the ministries of health, social affairs, interior, justice and prosecutors
The need to ensure continuity of medical treatment for prisoners suffering from TB who have come to the end of their sentences and are to be released
The creation of programmes aimed at ensuring that released prisoners undergoing TB treatment have access to social help as well as medical treatment
5. The Need for International Co-operation
Within this context the meeting considered the need for:
Inter-state exchanges for all professional groups involved to enable them to study and learn from different approaches
The provision of a wide range of professional training programmes for prison medical staff at all levels
A follow-up meeting is planned for autumn 2001.
1. P. Lindkvist (ed). Tuberculosis among Prisoners – Interdisciplinary Expert Meeting on Prevention and Control. Report from an International Meeting, Swedish Institute for Infectious Disease Control, Solna, 2000