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In Moldova, Prison-based Harm Reduction Programs Prevent HIV and Protect Human Rights

By The Global Fund

December 7^th, 2023

For nearly 30 years Ion Popescu was a heavy drug user, and the scars of his decades-long addiction remain very visible today.

After being hit by a train in Moscow while using drugs, Ion now walks with a limp and the help of a crutch. A deep scar runs along the right side of his face, a reminder of the surgery that removed parts of his jaw due to osteomyelitis, a bone infection common among people who inject drugs.

Today, Ion is bright and well-spoken with a sharp, sarcastic sense of humor. He hasn’t used drugs since attending a prison-based rehabilitation program that he completed four months ago.

“I didn’t want my children to be ashamed of their father anymore,” he says. “I lost everything, my family, the trust of my parents, my friends. Drugs kept bringing me to jail.”

Like in most countries, drug use in Moldova is illegal and Ion’s life has been shaped by the health and personal challenges of illicit drug use. Today, Ion is serving a three-year prison sentence in Penitentiary no. 4-Cricova in Moldova’s capital city, Chisinau.

The prison has around 680 male inmates serving up to 10-year sentences. The facility is semi-closed, meaning prisoners can move freely within most of the indoor and outdoor areas of the complex. Constructed in 1958, the penitentiary is a maze of dark concrete hallways and is under constant surveillance by armed guards and secured by meters-high fencing, barbed wire and heavy metal doors.

In Moldova, Prison-based Harm Reduction Programs Prevent HIV and Protect Human Rights

This is Ion’s third time in prison. He previously served eight- and seven-year sentences. Now 43, Ion says this is the best he’s felt since he was 13 years old.

“I feel that I am living, I have emotions, I have thoughts and plans,” he says.

This time, the prison sentence feels different for Ion. Not only is he off drugs, but he’s also a volunteer playing a vital role in preventing the spread of HIV and other diseases within the prison.

Selected by the penitentiary medical team to participate in the prison’s harm reduction programs, Ion and two other inmates are trained and equipped with tools to prevent others from contracting HIV and hepatitis.

Next to the bed where Ion sleeps is a large drawer full of medical supplies – clean syringes, disinfectants, gloves and medical creams that he distributes to fellow inmates. He gives them information on how they can use drugs as safely as possible, and when they return a used syringe, Ion disposes it safely and provides a clean one. He has been trained in responding to an overdose before medical staff arrive on scene.

Ion Popescu pictured at Penitentiary no. 4-Cricova in Chisinau, Moldova.

Ion is also a trusted confidant, someone who other men, often living through a very difficult time in their lives, can turn to for support. He can personally relate to the stigma, discrimination and shame they often feel. He says multiple men approach him every day for help.

“I feel now that people know that if they come to me, I will do what I can to help them,” he says.

Despite Moldova being one of the poorest places in Europe, this small land-locked country is a global leader in effective prison-based harm reduction programs, which have proved incredibly successful at preventing the spread of HIV.

Globally, people in prison are around 7 times more likely to be living with HIV than other adults. According to UNAIDS, HIV prevalence has been on the rise among people in prisons since 2017.

Moldova initiated its prison-based harm reduction programs back in 2000 and today, with the support of Global Fund investments, they have rolled out these programs in every penitentiary across the country.

The programs include daily opioid substitution therapy, psychiatric care as well as a network of 36 peer volunteers like Ion who facilitate clean needle exchanges and provide other support.

Dr. Irina Barbiros is the head of the medical team at the Moldovan National Penitentiary Department. She oversees all prison-based medical services in the country, including the harm reduction programs.

She explains that prior to prison-based clean needle exchanges, HIV spread throughout the institutions. In 1999 for example, 35 people contracted HIV in a single penitentiary of 800 people.

Dr. Irina Barbiros, Head of the Medical Team at the Moldovan National Penitentiary Department.

Today, prisoners are offered HIV tests every six months, and over the last five years there has only been one case of HIV transmission among Moldova’s entire prison population of approximately 6,000 people.

Dr. Barbiros says addiction is a disease that needs to be treated rather than penalized, and that the harm reduction programs have been vital in protecting both prisoners and staff.

“Even in the highest security penitentiary, there are methods to get drugs in, and inmates will find dangerous ways to use them,” she says. “We don’t have an increase in the number of drug users since 1999, but we do have a marked reduction in cases of HIV and hepatitis. A decrease in these diseases benefits everyone.”

In addition to the needle exchange program, every day at 10 a.m. approximately 40 men, one at a time, enter a small office in the penitentiary’s medical unit.

Two nurses dispense either methadone or buprenorphine – both opioid replacement therapies – which help treat addiction while reducing the risk of HIV and hepatitis transmission and overdoses.

A psychiatrist visits the medical unit for consultations every Monday, Wednesday and Friday. And people in the prison who are living with HIV have access to daily antiretroviral therapy.

Dr. Ruslan Tica manages the harm reduction program in Penitentiary no. 4-Cricova. On average he has consultations with 40 to 50 men every day. He says that his job is very demanding, but also fulfilling.

“Indeed, these people have made mistakes, but they deserve a second chance and at least they deserve to maintain their health,” he says.

Ion is looking forward to his second chance. He says that when he leaves prison he wants to try scuba diving, but most importantly, he wants to see his sons.

“We have an obligation to help others, and let people know that they can choose life. I choose life, and I hope I can get my family back,” he says.

Since 2006, the Global Fund has invested approximately US$165 million to support Moldova’s efforts to fight HIV and TB and protect the rights of people most affected by the two diseases, including people in prison.

Footnotes

Written by Melanie Sharpe. Photos by Ioana Moldovan (VII Photo). With many thanks to the Medical Department of the Moldova National Prison Administration.

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FootNotes

Written by Melanie Sharpe. Photos by Ioana Moldovan (VII Photo). With many thanks to the Medical Department of the Moldova National Prison Administration.

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In Moldova, Prison-based Harm Reduction Programs Prevent HIV and Protect Human Rights

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