The HCLU presents its study on risks related to blood borne and sexually transmitted infections and drug use in the Hungarian prison system, based on interviews with formerly incarcerated injecting drug users.
The study summarizes the findings of in depth interviews with 15 former inmate injecting drug users, conducted by the Drug Prevention Foundation in Budapest. The study is meant to be a reader, in which interviewees tell their stories from behind the prison walls in their own words.
In the research qualitative method was used; therefore it is not representative of the current situation in Hungarian prisons. It is the sum of the experiences had by a high-risk group during their incarceration. The findings in this study however show us a detailed insight on potential risky behaviors inside prisons, which allow adjusting and improving the methods to prevent and manage these risks accordingly.
You can read or download the study here.
We can sum up the findings in the following way.
1. There are psychoactive substances used in Hungarian prisons. The most common is the non-medical use of medications (mostly Rivotril). Inmates use large amounts of cigarettes and caffeine.
2. There is illicit drug use in Hungarian prisons; the most common substance is cannabis. Depending on the amount of contacts and money, all drugs can be acquired.
3. There is injecting drug use in Hungarian prisons. Although many of our interviewees injected inside, this event is rare according to our interviewees. They reported no sharing themselves, but reported seeing others who did share their equipment, which carries a high risk of infection.
4. According to our interviewees, there are other risks of blood born infections beyond injecting, which are:
• Tattooing – interviewees said it to be very common, with a high risk of infection
• Implants and piercings (penis balls, Vaseline under the skin) – interviewees said it to be common with high risk of infections.
• Fights – interviewees said it to be common.
• Sexual relationships – including rape. Interviewees said it to be rare. Some indicated that inmates use condoms, while other said they don‘t. The interviewees said that it was impossible to discern or even discuss the level of condom use in instances of rape.
5. Our interviewees said that the quality of the healthcare services provided varied between prisons. They often rated healthcare in prisons as very poor, especially in case of the Tököl Prison Hospital. More than one interviewee complained that they were not properly informed about what medication they were given, that staff may have not believed them when they said they were ill, that they got the same medications for different illnesses or that they did not get the proper medication.
6. According to the interviewees, they received no proper medical treatment for their withdrawal symptoms when they were admitted. Methadone treatment recommended by WHO and other UN bodies, was not available. There was and still is no methadone assisted detox or methadone substitution. One interviewee reported that she was refused methadone even though she was on methadone maintenance therapy before being in prison. We discovered only one NGO, a methadone ambulance, which kept providing methadone to its patient after the patient was imprisoned. The patient was taken out daily to get his medication at the center. The last participant interviewed in 2008 reported being offered Suboxone a few weeks before release, which indicates that the prisons had started experimenting with Suboxone.
7. Some of the interviewees were offered voluntary HCV and HIV screening, but others were not. There was one interviewee who received interferon treatments for his HCV status, while others did not. None of the interviewees received any counselling, briefing, or guidance regarding blood borne and/or sexually transmitted diseases, and some were given flyers or read posters in the prison.
8. HIV positive inmates are separated from other inmates at Tököl.
9. HCV positive inmates reported being segregated at intake and being subjected to unnecessary safety precautions. Later, their segregation ended.
10. The Hungarian prison system created “prevention units” for drug user inmates, where they get informational and help services in a more comfort environment than average inmates. The aim is a more successful reintegration of drug users.
11. The interviewees named several services that prepare them for their of release. They all found the services of psychologists, priests and NGOs useful.
12. Of the NGOs we could identify from 2007, only two were providing information about sexually transmitted and blood borne diseases, and only one organization had leaflets about AIDS.
13. According the interviewees, there is a need for more information on blood borne and sexually transmitted diseases
14. According to the former inmates interviewed, one of the biggest problems was boredom in prisons, hence more work opportunities and chances for activities would have reduce risks related to blood borne and sexually transmitted diseases.
In the original research plan we wanted to compare the experiences of former prisoners with current inmates, prison staff and Prison Administration staff, to get a more balanced insight. However, during the two-year period of our research we were not allowed to enter prisons, therefore this part of the research was not possible to implement. You can read about the problems of cooperating with the Prison Administration in detail in the study.
The study was made possible with the support of the European Commission, in the framework of the "CONNECTIONS – Integrated responses to drugs and infections across European criminal justice systems" project. The own contribution part of the research of the Drug Prevention Foundation was made possible by the support of the Hungarian MInistry of Social Affairs and Labour.
István Gábor Takács
4. January 2011.