AIDS Treatment Hard to Get Behind Bars

Itar-TassAleksanyan speaking with his father, Georgy, in a Moscow court in 2006.
Facing embezzlement and tax evasion charges, former Yukos executive Vasily Aleksanyan claims that he was deliberately denied medical treatment for AIDS while in detention as punishment for not testifying against his bosses, Mikhail Khodorkovsky and Platon Lebedev.

But with few doctors, poor patient education and bureaucratic barriers in securing medical release, getting proper treatment is difficult for HIV/AIDS patients incarcerated in Russia, even if they're not tied up in a politically charged case, experts say.

There are around 42,000 HIV/AIDS patients who are inmates in Russian prisons and jails, Alexander Kononets, head of the Federal Prison Service's health department, told the Public Chamber late last year. Since 2004, the number of patients has grown by 10,000, according to agency statistics.

Experts say that while treatment of these patients and prisoners with other disease has improved somewhat in recent years, there is still a long way to go.

In the Leningrad region, for example, only around 100 HIV/AIDS patients out of 3,500 receive the treatment they require, said Tatyana Bakulina, head of IMENA, a St. Petersburg-based nongovernmental organization that runs support programs for HIV-positive inmates.

"Sometimes a prisoner will come down with a severe fever for three days and nobody will examine him or give him any medicine," she said. "If he is in pain, there are no painkillers available."

The situation for HIV patients is exacerbated by the fact that they often develop concomitant diseases such as tuberculosis and Hepatitis C, Bakulina said.

Suspects are screened for HIV upon placement in a detention facility and are often screened again when they are moved to a prison, Federal Prison Service spokesman Valery Zaitsev said. For most HIV-positive inmates, these screenings are the first time they are diagnosed with the virus, Zaitsev said.

Zaitsev defended the treatment HIV/AIDS patients receive while incarcerated.

"They receive antiretroviral drugs and other appropriate treatment," he said.

But even where treatment is available, additional efforts are desperately needed to help them to undergo it, said Yelena Panasenko, coordinator of support groups for prisoners with HIV/AIDS in the Saratov region.

Because of liver and stomach problems, it is exceedingly difficult for most of the patients to endure the treatment, and without being educated properly on the treatment process, they are prone to giving it up, Panasenko said.

"Prison doctors can offer treatment, but they will not persuade each inmate to undergo it," Panasenko said. Only a few NGOs are working to support antiretroviral therapy programs for patients behind bars, she said.

Written consent is required from each HIV/AIDS patient in order to be treated while in confinement.

Vadim Pokrovsky, head of the Federal AIDS Center, conceded that there are numerous difficulties in treating prisoners but said the situation was improving.

"The situation with medical treatment for them was pretty poor last year, but it is already getting better," Pokrovsky said.

Previously medicine for incarcerated HIV/AIDS patients was distributed by regional governments, though inmates are under federal jurisdiction, Pokrovsky said. Now they receive the medicine under a federal program, he said.

The difficulties released prisoners face reintegrating into society also complicates treatment, experts say. According to prison service statistics, around 230,000 convicts are released each year -- 90 percent of whom suffer from various diseases, Kononets, the prison health official, told the Public Chamber in October.

In addition to the 42,000 HIV/AIDS patients, there are 43,000 tuberculosis patients incarcerated, Kononets said.

There is little hope that those infected with HIV will seek out AIDS centers for treatment upon release, said Bakulina, the St. Petersburg activist.

"Most of them do not know what they will eat and where they will sleep after leaving the prison," Bakulina said. "Health cannot be a priority for these people in such a situation."

The Supreme Court on Tuesday rejected a request by Aleksanyan, the jailed former Yukos executive, to be released from detention so he could be treated for AIDS.

Under Russian law, a person diagnosed with serious health problems should not be kept in pre-trial detention.

But court rulings in favor of release are very difficult for incarcerated patients to obtain if no one is pressing on his behalf, Bakulina said.

"I know one mother who did her best to have her very ill son released from prison, but it took her too long, and the 18-year-old boy died of AIDS just one week after he was placed in a special hospital," she said.

Prosecutors claim that Aleksanyan refused treatment while in jail, though his lawyer, Yelena Lvova, says he gave written consent for therapy in July. Aleksanyan never received any treatment and has not had a medical examination since Dec. 30, Lvova claims.

Aleksanyan, 36, was diagnosed with HIV a few months after his detention in April 2006 and "could die any day," another one of his lawyers, Drew Holiner, said in a telephone interview from London, Bloomberg reported Wednesday.