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1 GROUP BILL No. 189/X establishes the implementation of a pilot project AIMED at combating and prevention of infectious diseases in PRISON explanatory memorandum to Portugal, one of the countries with the lowest crime rates in the European Union, beats all records in incarceration. The overcrowding of prisons, the Portuguese determines the inhumane conditions in which the detainees in prisons, an issue addressed by a study from the Office of Justice, released in 2003, and a large number of proposals to change a situation with very troubling contours. One of the major problems identified here is that of infectious diseases: year after year, the data available on the prevalence of infectious diseases in Portuguese prisons has prompted us to the alarming situation in prison. This report tells us that the public health indicators in prisons are alarming in our country: 30.6% of inmates have hepatitis, 8.5% is HIV-positive, 2.1% have AIDS. Portugal is the European Union country with the highest percentage of people with AIDS in prisons. These data are reinforced by the results of a study by Anália Torres and Maria do Carmo Gomes me 2002. Being certain that the investigation was based on auto-preenchidos, the surveys collected data lead the authors to admit that maybe 2 «the situation is even more troubling than that was clearly taken by inmates ' (Torres and Garcia, Drugs and prisons in Portugal, 2002:55). We are therefore faced with a situation of extreme gravity in Portuguese prisons. The consistency of these values with the estimated evolution by previous studies, can only lead to the conclusion that the strategies until here tried are not producing any results. On the contrary. There seems to be a continued increase of the prevalence of infectious diseases in prisons. There is, therefore, to move forward urgently with new responses that can reverse this situation. It should be pointed out that it's not just these studies that call attention to the issue, starting even generating a broad consensus in Portuguese society about the need to change the operation of the public health services in prisons, as the show statements of then Deputy PSD Jorge Nuno Sá, in parliamentary debate of 24 January 2003 : "What about the reality in our prisons and what happens? We're going to continue to ignore the situation? It takes, is essential, even, to join synergies and burocratizem and not complicate the possible solutions! ", idea shared by Mr Vitalino Canas of PS, who defended in a debate held on 28 February the same year, the enlargement of the needle-exchange program to prisons, stressing that this media is included in the national plan for combating drugs and drug addiction. The transmission of infectious diseases appears strongly related to two types of practices: sex "unsafe", and drug use by injection due to the sharing of syringes/needles. The response of the health services in prison should therefore work on these two aspects – information and provision of means to provide security in sexual contact, and programs for prevention and risk reduction measures and damages on drug use.
I – prevention of transmission of infectious diseases: protected sexual relations the study of towers and Gomes also indicates that the regular use of condoms is reduced in prison: about half of the inmates don't protect systematically the risks of sexual transmission, and if we present the numbers previously pointed to the prevalence of infectious diseases in prison population This is one of the most worrying aspects and that requires immediate response. 3 there are two types of questions. On the one hand, it is essential to bet on greater disclosure of information in prison of the risks involved in the practice of unprotected sex. On the other hand, it is necessary to place at the disposal of prisoners – so easy, practical and that doesn't involve constraints or invasion of privacy – means of protection. The Ombudsman's report of April 1999 warned already for the deficiencies found in several prisons in the regular availability of condoms, that made it a dead letter the provisions of circular No. 9/DSS/97. The failure in the implementation of measures as simple, but as fundamental, as the distribution of condoms in prisons, alerts us to the need to create mechanisms for regular monitoring, so that the distribution rule of two condoms for every inmate, each week, be fulfilled without exception. Finally, the health situation in prisons and persistence over time of risk behaviour, implies a change in the role of the GPSD, which should intervene more directly, and take responsibility for production of publicity materials of safe practices, and, in conjunction with Ministry of health, promoting a medical and nursing care to do also the pedagogy of primary prevention and health education in prison. These measures, provided for in the law 170/99 of 18 September, should be expanded and extended to become effective.
II – prevention of transmission of infectious diseases: risk prevention and harm reduction in drug injectors
Much of the prison population was detained for acts directly or indirectly related to drugs. In 2002, drug trafficking and crimes aimed at reaching ways to consume drugs are the grounds of detention of about 73% of the prison population (Torres and Garcia, op. cit., 2002:78). Thus, drugs and prison detention in Portuguese society a strong association, which makes drug-trafficking and consumption-a central element of everyday life of the prison experience. The situation is worrying because the continued prevalence of drug injection in prison is around 30%. In this segment, 4 risk practices remain: about 35% declares not always use new needles, and about a quarter of inmates admit to sharing syringes in prison. If we consider that more than 90% of those who declared themselves HIV positive took drug consuming, the relationship between HIV and drug use is worryingly strong. Here's the cycle that is necessary to break. Levels of prevalence of infectious diseases and injecting drug use in prison require to create multi-faceted risk reduction strategies. It is not acceptable that a prison sentence can often be equivalent to a death sentence for the inmates. In this sense, it is necessary to adopt a diverse set of measures. Essentially, all they want to, on the one hand, to limit the possibilities of transmission of infectious diseases, and, on the other hand, facilitate access and contact consumer prison population of drug injection with the prison health care system and improve health levels and possibly forward for treatment. Firstly, as already mentioned, it is considered that the primary prevention policies laid down by 170 degree/99 of 18 September should be widely enforced and applied in all prison establishments, for despistagens frequent exams, access to information or the distribution of condoms to be a reality. Secondly, there is an urgent need to implement a system of needle exchange in prisons. The argument of the security issues that involved such a program can't resist a careful analysis. As the Ombudsman in 1999, the issue of security ' should not be (...) fully weighted solution inhibitor (...). The figures for drug addiction in prisons are worrisome. The numbers, for your time, concerning the evolution of infectious diseases in prison medium, are alarming. These numbers associated with the first will necessarily be the subject of a profound reflection '. In Spain, for example, a needle-exchange program has been in operation for several years – according to the EMCDDA Report/2005, only in 2003 have been distributed syringes 2060-without put any security problem. On the contrary, the adoption of various measures of risk reduction and the provision of treatment allowed the substitution treatment covering 18% of the prison population, about 82% of drug users arrested. It should be recalled that the legislative amendment made in the neighboring country was only 5 approved after the completion of a pilot project and the positive evaluation of its results. While in Portugal everything remains the same, the new legal framework of the Spanish State had a result: Portugal traded with the unenviable position of country with the worst indicators of HIV in prisons. It is then time to adopt similar procedures in our country, and carry out awareness and training of workers in the prison system. On the other hand, the situation of detention cannot deny the most fundamental rights of ' citizens ' equality in access to health care, no matter what your economic situation and wherever they live, as indicates the health framework law, which establishes the need to implement special measures for higher risk groups '. Accordingly, imprisonment should not deny the inmate the opportunity to Exchange syringes, like any other citizen. This needle-exchange program, must join the creation of assisted injection rooms, where prisoners can make consumption in conditions of hygiene and safety, under anonymity and accompanied by qualified technicians. The delivery of the syringe at the entrance of the enclosure, and the mandatory refund your ex will limit the risk of aggression, and, at the same time, lock the transmission through needle sharing as well, should be implemented in prisons a needle-exchange program, associated with a pilot project aimed at the creation and evaluation of the operation of a set of assisted injection rooms in different establishments. In this sense, and under the regimental standards in force, the parliamentary group of the left bloc proposes: article 1 (subject matter) this law establishes the operating framework of a pilot project to reduce risks to public health in prisons. 6 article 2 (Scope) the pilot project to reduce risks to public health in prisons provides for the creation of assisted injection and needle exchange in a selected set of prisons.
Article 3 (pilot project) 1-the pilot project to reduce risks to public health in prisons will be applied in four prisons, located in different districts, determine by Ordinance of the Ministry of Justice. 2-in the choice of prison establishments referred to in the preceding paragraph priority will be given to establishments with higher incidence of infectious diseases and drug addicts. 3-all assisted injection rooms created under the pilot project have appropriate medical assistance, under a protocol to be concluded between the ministries of health and justice.
Article 4 (creation of assisted injection rooms) 1-injection rooms are considered assisted facilities where drug consumption is taken intravenously, with receiving system of the syringe compartment against your ex return in conditions of health and hygiene control. 2-the creation of assisted injection rooms in prisons covered by the pilot project for reducing risks to public health is determined by the Ministry of Justice and the application of this decision is the competence of the Ministry of health, safeguarding the necessary security measures.
7 article 5 (conditions for the use of assisted injection rooms) 1 – Are prohibited any commercial acts within the assisted injection rooms. 2-All the necessary materials to consumption, with the exception of narcotic substance, are provided to user under proper conditions of hygiene and, after consumption, staying in power of the room. 3-non-compliance with the safety standards of the room by the wearer makes it access again to this facility.
Article 6 (supervision of assisted injection rooms) 1-the supervision and monitoring of staff and of the operation of assisted injection rooms are the responsibility of the Ministry of health. 2-the infrastructure dedicated to the operation of injection rooms assisted should also serve to provide information to drug users by facilitating the voluntary referral to treatment systems.
Article 7 (needle exchange) 1-the Ministry of Justice coordinates the program of needle exchange in prisons, through protocols with the Ministry of health. 2-the exchange of syringes is free, made in anonymous form and under conditions that ensure risk reduction among drug addict.
Article 8 (support) 1 – all prison establishments covered by the pilot project for reducing risks to public health have a support Office, supervised and accompanied by technicians from the Ministry of health, which will coordinate the 8 needle exchange program and free distribution of condoms, ensuring respect for the anonymity of users.
Article. 9th (coordination and evaluation of the pilot project) 1 — the pilot project is elaborated and implemented jointly by the ministries of health and Justice. 2 — the evaluation of the pilot project is held two years after your home, through report that is submitted to Parliament. 3-the Committee of the Assembly of the Republic for the health sector will accompany this process and make recommendations to the guardianship.
Article 10 (Regulation) the present law shall be regulated by the Government within a maximum of 120 days.
Article 11 (entry into force) this Act shall enter into force on the day following the approval of the State budget of the following year.
Palácio de s. Bento, 20 December 2005. Members of the left-wing Block
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