From the other side of the fence. How civil society and patients see prison healthcare

— 115 — The spread of the human immunodeficiency virus (HIV) and AIDS in the mid-eighties was an organisational and operational challenge for the Spanish National Health System (SNS), particularly for prison healthcare. The problem reached its climax in 1994, when 763 cases of AIDS were declared and more than 400 inmates died from AIDS-related complications in prisons run by the Civil Service (AGE)1. This figure includes both inmates inside centres and those who died while on probation or on leave. Taking into consideration the size of the prison population at the time, these figures mean that one out of every 50 inmates developed AIDS, and that there was a prevalence of infection by HIV of 22%, or rather, almost one in four inmates. The impact of this new disease on prison healthcare is undeniable. Since then, a collaborative structure of interests has been built between prison health workers and non-governmental organisations (NGO) to respond to HIV and AIDS. Together, we have achieved great things; the implementation of opiate substitute and needle exchange programs in prisons are just two examples of our work. Another achievement is the exponential growth in the presence and provision of services by NGOs. We have more recent examples of successful collaborations between healthcare professionals and the associations movement organised around the issues of HIV and viral hepatitis. Such a collaboration has been essential in ensuring the dispensation of direct action antivirals against hepatitis C in all the prisons of the Valencia region. Associations, especially those operating in the field of healthcare, are the natural allies of prison health workers, because we share the same aim, which is none other than to enable inmates to receive medical care that is on a par with other citizens. Furthermore, civil society has more freedom in accessing healthcare administrations and the media. However, this collaboration is frequently limited to the volunteer work of one local clinic and an NGO that is informally coordinated to work on one common objective. One result of this spirit of collaboration is the assignment I have received from this magazine as chair of the State Coordinating Body of HIV and AIDS Associations (CESIDA) to write this editorial in which I shall set out to answer the following questions: What are the main problems of prison health today? How is it perceived by patients and entities in civil society? And how could it be improved? To prepare this article, I drew up a small questionnaire for entities of the CESIDA that implement programs in prisons, and held some interviews with inmates on day release or probation. I shall then show the results of this small piece of research that, despite lacking any pretensions of scientific rigour, has given me a broader perspective on these issues. One problem that bodies in the CESIDA most frequently comment on when answering the questionnaire is the lack of communication with medical staff, especially with the doctors. Although there are many differences between prisons, the interlocutor for entities is usually the Treatment Department. This situation improves in activities linked to mental health and those geared towards persons included in the Programs for interdisciplinary care of the mentally ill (PAIEM), where there is more communication with medical coordinators in work such as selecting participants in health mediation training and in identifying persons for the PAIEM. However, it is also quite common for this coordination to be established more often with social workers or psychologists and less frequently with clinical practitioners. We feel that there is a lot of room for improvement in this area, not just in the activities organised within the prisons themselves but also in the situation Editorial