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Description
According to the United Nations, one of the key components for protecting the fundamental right of people in prisons to health care is the unhindered access to diagnosis/treatment and the confidentiality of their personal medical files. During the interventions of “Prometheus” and “Positive Voice” in 11 prison settings, it was noticed that the access of prisoners in diagnostic examinations and treatment is hindered by restrictions, while the leakage of their medical data leads to stigma and discrimination.
The purpose of the project is to officially register those restrictions, in 5 prison settings at the Greek periphery, with a population of 2,500 and strengthen advocacy towards state institutions, in order to bring policy change, regarding prisoners’ rights (electronic medical records, Social Security Number issuance, telemedicine, medical data confidentiality and prisons’ decongestion). At the same time, through training and awareness initiatives, we aim to eliminate stigma, discrimination and exclusion of prisoners with infectious diseases, such as hepatitis and HIV.
The project activities are the following:
• Scientific Committee establishment (defining methodology, data analysis, policy brief, project supervision)
• Research for human rights’ violations/restrictions
• 5 seminars in prisons: “Viral hepatitis and HIV Myth busters”
• Training of 15 “human rights ambassadors” in prisons
• One-day conference on Human Rights of Prisoners with Health Problems
• Cooperation with 3 media for reporting news stories
The ultimate goal of the project is to benefit all people in prisons with health problems, who face barriers in accessing diagnostic and treatment services, as well as medical data breach.
Summary of project results
In accordance with the United Nations (UN), the fundamental components to protect the basic right of detainees to health included uninterrupted access to diagnosis/treatment and the confidentiality of personal medical data. During the interventions of the "Prometheus" and "Positive Voice" projects in 11 correctional facilities, limitations were observed that hindered detainees'' connection to diagnostic examinations and treatment. Furthermore, the leakage of medical data led to phenomena of stigma and discrimination.
The project aimed to officially record the limitations in 5 correctional facilities in the region with 2,500 detainees and, based on this, strengthen advocacy in state institutions for the implementation of changes related to detainees'' rights (electronic health record, issuance of social security numbers, telemedicine, ensuring confidentiality, and prison decongestion). Simultaneously, through education and awareness initiatives, the project aimed to eliminate stigma, discrimination, and the exclusion of detainees with infectious diseases such as hepatitis and HIV.
The ultimate goal of the project was to benefit all detainees with health problems facing obstacles to access diagnosis/treatment and issues of medical data leakage. The implementing body was responsible for project management, supervision, and coordination, while all individual actions were implemented jointly with the partner organization, given both organizations'' experience with vulnerable populations such as detainees.
The aim of this project was to educate both prisoners and prison officers on viral hepatitis and HIV, while also examining prisoners'' access to health services, service quality, confidentiality, and incidents of discrimination and marginalization. Within the project framework, successful training seminars titled "Myths and Truths about Viral Hepatitis and HIV" were conducted in five prisons. Additionally, information leaflets on prevention and transmission were sent and distributed to prisoners, and some were trained as "human rights ambassadors." A survey was conducted in five prisons (Trikala, Chania, Malandrino Korydallos I, Chios) focusing on health, medical confidentiality, privacy, marginalization, and the stigma associated with prisoners with viral hepatitis or HIV.
The survey covered areas such as health, medical privacy, data protection, marginalization, and stigma. Key findings included that 25% of prisoners may face difficulty accessing healthcare services, 32% used drugs within detention facilities, and 45% felt their health issues were not kept confidential. Moreover, high percentages reported incidents of marginalization and stigmatization due to HIV or Hepatitis C diagnosis, such as exclusion from certain areas and negative comments.
Based on the research results, key policy recommendations included the universal implementation of an electronic health record for prisoners, increased numbers of health professionals, prison decongestion, adoption of harm reduction policies, and the assignment of a Temporary Social Security Number for Prisoners, as mandated by new legislation to be implemented after the adoption of the corresponding ministerial decision (17/05/2023).
The "Health Without Barriers" project was founded on the fundamental right of detainees to access healthcare, specifically, diagnosis, treatment, and the confidentiality of their medical data to prevent discrimination and stigmatization. All these aspects are part of the Nelson Mandela Rules (NMR), which are the updated version of the Minimum Standard Rules for the Treatment of Prisoners, approved by the United Nations in 1957. The NMR is globally used by monitoring and control mechanisms to assess the treatment of detainees by correctional systems in different countries. The Greek correctional code explicitly ensures detainees'' unhindered access to "prevention, diagnosis, and treatment of any illness," with a separate reference to HIV/infectious diseases and the need for interventions by Civil Society Organizations (CSOs).
The research conclusions clarified that, despite the provision of Primary Healthcare in detention facilities, instances arise where the lack of medical staff complicates healthcare delivery. Additionally, the conditions of detention and overcrowding burden the health of detainees. As closed structures, prisons enhance the likelihood of disease transmission due to shared needle use. Despite strict measures to eliminate intravenous drug use, the phenomenon has not been eradicated/restricted. The research also showed a significant level of insecurity regarding the confidentiality of medical history and personal data, while the establishment of the Forensic and Psychiatric Unit (PAUPEK), one of the program''s policy proposals, is considered a significant development for the universal, free, and unhindered access of detainees to public healthcare facilities.
As previously mentioned, the research results and the training conducted with 609 detainees and correctional staff highlighted the need for information about infectious diseases in prisons. This information was crucial for limiting/eliminating the marginalization and stigmatization of patients with viral hepatitis or HIV, as well as for protecting their medical and personal data. Furthermore, the project contributed to ensuring that detainees practically exercised their right to access healthcare through the issuance of the Temporary Health Identification Number for Detainees (PAUPEK). PAUPEK constituted one of the key pillars of the proposals outlined in the policy brief.