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Romanian prisons fight spread of TB, HIV

Funding and democracy helped Romania improve conditions in prisons. But will the funding run out?

Prison guards walk the hallways of Jilava Prison in Jilava, Romania, in February 2010. Guards jockey for roles that put them into contact with tuberculosis-infected inmates in order to receive a 50 percent bump in pay. (Michael J. Jordan/GlobalPost)

JILAVA, Romania — Communist Romania was a vast den of spies and paranoia, with thousands locked up inside one of Eastern Europe’s cruelest prison systems. Twenty years later, prisoners land behind bars for different reasons, but they still have much to fear.

Prisons are widely considered a leading source of HIV and tuberculosis (TB) infection. And Romania, which already claims the highest TB rate in the 27-member European Union, now worries that heroin injection with tainted needles is spurring an HIV crisis. (Overcrowding and lack of hygiene are leading causes of TB in the slums of Mumbai, as well.)

But thanks to the work of Veronica Broasca and others, as the world marks Tuberculosis Day today, Romania’s prisons can be held up as a success story.

Broasca, an activist with the Romanian Association Against AIDS, heads up the group’s prisons program. She and her colleagues are allowed into Romania’s prisons to provide drug-addiction services, offering inmates a chance to come forward for either clean needles or methadone treatment. Before she leaves, Broasca also unloads a batch of condoms, lubricants and HIV literature in the prison’s visitation room.

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She credits prison officials for their progressive mindset, but said they’re also driven by fear of inmates’ ability to seek revenge through the courts. Recent lawsuits accuse prisons of denying them access to proper health care.

“Convicts know their rights,” said Broasca. Prison administrators “tell us they’ll be sued in one second if they don’t provide the treatment needed.”

This new respect for prisoner rights also reveals that in Romania two decades of post-communist democratization has grown roots. Romania’s campaign to join the EU obliged it to align its laws and values with club members. As further incentive, Europe dangled a carrot: cash to tackle problems such as the TB infection rate.

This adds up to a rare success: While the World Health Organization (WHO) last week lamented that Europe’s TB treatment has grown less effective, Romania has dramatically reduced its rate of incidence.

“They understood they had a problem, needed international help, and the funding was there,” said Giovanni Battista Migliori, the Italian director of the WHO Collaborative Center for TB and Lung Diseases, who has worked with Romania since 1995. “The condition was change, and they said ‘OK.’”

That change represents a remarkable about-face. Longtime Romanian dictator Nicolae Ceausescu zealously guarded state secrets from both his people and the outside world. TB was a third rail for Romanian medicine. Since it was seen as a poor man’s affliction, Ceausescu — obsessed with his regime’s image — refused to admit the problem even existed.

Mihai Apavaloaei recalls that during his medical training in the 1980s he was forbidden from writing a patient’s diagnosis as “tuberculosis.” Today, Apavaloaei speaks freely about his challenges as chief commissar of the Jilava prison hospital, Romania’s largest.