Romania’s prisons are slowly gaining ground on tuberculosis, but the prognosis on AIDS is less encouraging.
by Petru Zoltan and Michael J. Jordan
JILAVA, Romania | In 2007, Octavian Balescu was sentenced to seven years in jail for trying to sell less than half a gram of heroin.
He was thrown into Romania’s Jilava prison, just outside the capital, Bucharest. Jilava, once notorious for its inhumane treatment of prisoners, is where, in November 1940, Romania’s fascist leader Marshal Ion Antonescu and his Legionnaires executed 64 opponents. And it was where, during four decades of communism, the paranoid regime of Nicolae Ceausescu would send anyone it deemed a threat.
Today, Romanian prisoners are surely better off. With the country a new member of the EU, it has adopted Western-style prisoner rights, of which inmates are informed.
Still, prisoners have something to fear: Jilava could make them gravely ill, as it has done to Balescu. “My most basic right is to do my time without getting sick,” he said. But somewhere along the way, he contracted tuberculosis and landed in the Jilava prison hospital, the largest in the Romanian prison system.
His plight is hardly surprising in Romania, which has the highest TB rate among the 27 EU countries. Observers say the prison system is a primary source of infection, not only for the inmates, but for their visitors and their jailers as well.
There’s positive news, though. Romania’s TB rate is declining, and officials continue to reverse a Ceausescu policy built on lies. They are no longer denying the problem exists and are accepting Western assistance.
In fact, while the World Health Organization chastised Europe earlier this year for easing off the fight against TB, Romania dramatically cut the illness back to 118 cases per 100,000 people in 2008, according to the most recent figures, from a peak of 153 in 2002. Still, that’s almost twice the incidence of the disease in Lithuania and much higher than the 16.7 average for the European Union overall.
Romanian officials “understood they had a problem, needed international help, and the funding was there,” said epidemiologist Giovanni Battista Migliori, who began working with Bucharest in 1995 and today is chief of the WHO Collaborative Center for TB and Lung Diseases.
Nevertheless, the Romanian infection rate towers over those of its EU partners, while much of this poor country remains ignorant of TB’s spread. And despite the glimmer of progress, Romanian prisons face a new test: HIV infection. Activists and prison officials alike say that heroin injection with tainted needles may soon spawn an HIV/AIDS crisis in Bucharest and elsewhere around the country.
Yet another sign of the times, then, is that the Romanian Penitentiaries Administration (ANP) has opened its doors to prisoner-health advocates.
The Romanian Association Against AIDS and four other groups have formed the “Initiative 38” consortium, which so far has lectured to 10,000 prisoners about HIV transmission. It also drops off condoms, lubricants, and literature on HIV in prisoner-visitation rooms.
Meanwhile, the ANP, with backing from the UN Office on Drugs and Crime, offers drug-addicted prisoners either clean needles or methadone treatment.
Veronica Broasca, who heads the AIDS association’s prisons program, said newly empowered prisoners have already hit the prison system with a few lawsuits for subpar care. “If an inmate is denied adequate medical assistance, he can start legal proceedings against prison management for infringement of that right,” she said.
It’s a stunning turnabout from only two decades ago.
While maintaining an iron grip on society, Ceausescu was preoccupied with Romania’s image abroad. TB had long been viewed as a poor man’s disease, so Ceausescu ensured that it was struck from the national lexicon – even by those who knew better.
Mihai Apavaloaei, director of the Jilava prison hospital, recalls that while training to become a doctor during the 1980s, staffers were barred from diagnosing patients with tuberculosis. Even into the post-communist 1990s, the word remained taboo. This despite the crowding, poor ventilation, often late diagnoses, and limited access to specialized medical care that allowed TB to spread in the country’s prisons. That attitude only began to change around 2000, when Romania got serious about joining the EU.
Aligning laws and values with those in the EU also meant greater respect for human rights – including those of prisoners – and transparency about all that ailed Romanian society. Especially if Romania wanted access to Western aid.
“We realized that hiding the health issues within our prison system would be an impediment,” Apavaloaei said. “It was like a millstone, because we couldn’t develop or ask for funds if we didn’t declare the real situation we had in the prisons.”
With money from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the prison administration consolidated major medical treatment for its 45 prisons, which contain some 29,000 prisoners, into six prison hospitals specializing in TB, HIV, and hepatitis. Jilava is the largest.
These funds also helped build new isolation rooms, where inmates could be diagnosed and quarantined more quickly, and to expand nursing services. According to Apavaloaei, the system today counts some 400 TB-infected inmates, down from 800 in early 2003.
“Half of the TB-diagnosed inmates got the disease in the Romanian prison system, and the rest in private life,” said Apavaloaei, who has worked in prison hospitals for 15 years.
A disproportionate number of those infected in, as well as outside, Romania’s prisons are likely to be Roma. Some Romani communities have Romania’s highest rates of tuberculosis, hepatitis, and AIDS, and incarceration only increases their risk of infection.
Although physicians in Romania are barred from collecting ethnic data on their patients, a doctor in the TB ward at the Jilava prison hospital estimated that about half of her prisoner-patients are Roma. Nationwide, Roma may constitute about 10 percent of the population of 22 million.
Sufferers’ woes are often compounded by their status as outcasts.
“People in the countryside run away from the sick because they are ignorant about this disease,” said inmate Gheorghe Tanase, 57. “At first it bothered me, but then I got used to it.”
Tanase contracted TB in 2002. Five years later, he was jailed for stealing corn and wheat from a field. In prison, his illness has evolved into recurrent TB, which is tougher to fight.
While conditions in the Jilava hospital seem clean and modern, the detention facilities in Jilava are purportedly far harsher. Sergiu Stupu, president of the Jilava prison-guard union, said inmates contend with rats and contaminated tap water.
Even though the guards themselves face peril in such proximity to airborne TB, Stupu said many men desperate for extra pay will maneuver for the riskiest jobs – for the 50 percent bonus it includes.
“It’s a lottery of fate,” Stupu said. “They take a chance: Maybe I’ll get [TB], maybe I won’t. They think only the unlucky ones get it.”
Unlucky ones like Marius Stoian. He contracted TB three years after he started working as a guard at Jilava in 2002. Neither he nor his wife suspected.
“The day I started spitting blood, I went to the doctor and they said I had three holes in my lung,” Stoian said. “I’ll never forget that day. My first thought was my child, who was 13 years old at the time. If he was sick, too, he wouldn’t be able to go to school.”
After treatment, Stoian returned to work: no longer in the ward, he escorts inmates to court.
Asked about Stoian’s case, Apavaloaei would say only, “We can’t deny the fact there are cases of staff developing the disease.”
AIDS, PAST AND FUTURE
Romania’s first HIV/AIDS case was diagnosed in 1985. As with TB, Ceausescu denied the disease was a problem or that high-risk categories existed. The country got a wake-up call in the early 1990s, when Western health experts started to investigate a disproportionately high rate of incidence among children. They concluded that the misuse of blood products and non-sterile transfusions in hospitals and orphanages were fueling the disease’s rapid spread.
Apavaloaei said incompetence compounded the problem. “You could hardly get a correct diagnosis then. Some of those children have become delinquents and ended up in prisons.”
In 2007, four HIV-infected inmates died in Jilava prison, Apavaloaei said. Overall, the prison system today claims 52 HIV-infected inmates, although determining the real number is difficult, as a test can be administered only with an inmate’s permission, he said.
However, in yet another step toward candor and transparency, 20 years into the post-communist transition, Romanian authorities admit they can prevent neither unprotected sex nor drug use among inmates. In April, the Directorate for Organized Crime and Terrorism spotlighted the problem in a report on the sale and use of drugs in the country’s prisons.
Catalin Tone, director of the drug squad in the Bucharest police’s organized crime unit, said drugs are often hidden in food that inmates’ families bring into prisons. But the real culprit, she said, are organized crime groups that specialize in smuggling drugs into jails. “Once a woman came to visit a prisoner and she had hidden drugs in her vagina. Others hide the drugs inside their mouths,” she said.
Broasca, the activist, says that when drug users are supplied with disinfectants the risk of transmitting disease through shared needles goes down. Still, she worries if Romania will continue to fund anti-HIV prison projects. Now inside the wealthy EU club, Romania sees fewer opportunities for Western financial assistance. “The future of these projects is always called into question,” she said.
This at a time when she and Apavaloaei predict that rising heroin addiction will fuel HIV rates, both in society and in prison. Bucharest pharmacies, for example, employ their own anti-addict strategy: only three pharmacies in the city of 2 million sell syringes. But critics say that approach only encourages addicts to share dirty needles.
If the crisis hits, Apavaloaei said, his hospital will be ready “with rooms, beds, medical staff and treatment for the patients.”
Petru Zoltan is a journalist in Bucharest with the daily Jurnalul National. He was one of Freedom House Romania’s Young Journalists of the Year for 2009. Michael J. Jordan is a correspondent for the Christian Science Monitor in Bratislava. He blogs about Central and Eastern Europe at Jordan Ink. Photos by Michael J. Jordan.