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Our Route
The Centro Poiesis has been founded by Gruppo
Exodus in 1993 with the intention to dedicate a particular attention
to the question of therapies and treatments for HIV and AIDS, giving
an extra attention to unconventional therapies, an area in which
research, information and verification, are rare, often approximate
and unable to give precise answers to persons with HIV or AIDS
(PcHa).
But the attention of Gruppo Exodus for prison and inmates is
certainly antecedent to this date, and dates back to 1983 when the
Gruppo was founded. Indeed Gruppo Exodus is a net of Therapeutical
Communities for Addiction problems, and misurated itself with
detention of drug consummers that, in Italy, represent the 30% (n1)
of inmate population. The Gruppo has been concerned with all the HIV
problems as in our country prevalence and incidence (65%) (n2) of
infections mainly reward addicted persons. So HIV positivity and
detention are expereience that regarded and regard a lot of persons
living in our structures and some operators.
Gruppo Exodus during these years organizzed different kind of
intervention inside and outside prison about seropositivity, among
these we remind the contribution to Progetto Ekotonos (n3) inside the
Casa Circondariale di San Vittore (Prison in Milan); the organization
with other associations of “Seminario di Studio “Carcere e
HIV” (n4) Torre Pelice 7-8May 1994; the organization with other
associations of the meeting “HIV/AIDS: therapeutical
opportunities and freedom of choice, 30 November 1994; the
organization of the workgroup “Freedom of therapeutical choice
and detention” inside the seminar “ Per una dottrina della
sicurezza ragionevole: ipotesi di lavoro per l’uso e la
sperimentazione delle terapie complementari per Hiv e aids”,
Bocca di Magra, 12-14 May 1995; the partecipation to the workgroup
“ Propositiv: propositiv coordination on overcrowding in
prisons” (n5) and definition of commun propositions;
contribution to the definition of projects voluntary service and
institution (n6).
Contributions for a reflection about some aspects of italian situation
Confidentiality
According to a study of Divisione
Amministrativa Penitenziaria (n7) in almost all italian prisons the
risult of HIV-test is comunicated to directors, in the half of
prisons is comunicated to maresciallo and educator, in 40%
psychologist and psychiatry are informed, in 30% social assistents;
from our experience, in addition, comes up that all the personal that
help doctors ( agents of prison police), in a way or another, come to
know the conditions of inmates. Furthermore in some Institute the
rooms where HIV-text are realized bring outside the door the the
indication “HIV-TEXT”, obtaining a double result: the risk,
for who makes the text, to be put at index, and the disincentivation
of the possibility to make the text for the scare of being identified
at the moment of execution of the text itself.
It is a heavy lack for the citizen inmate that can create, and
creates situations of discomfort and, sometimes, of
discrimination.
In Italy there is a law that safeguards the anonymousness of text, so
the problem isn’t to speed up new and sharper measures. It is a
situation due to cultural prejudices and false psycological
certainty: the precarious availability of means and the particular
situations of intervention put the health operators in the condition
of thinking that “the more they know the best they’ll
do”.
It is necessary a work of sensibilizzation about inmate’s human
rights and a sharper action, from prison administration, to protect
inmate’s right of text-confidentiality.
Text obligatoriness
At the moment, in Italy, the text is
no-obligatory for every citizen, inmate or not, and this represents a
high moment of juridical civilization. Even the World Health
Organization has underlined that text-obligatoriness is against moral
and unesefull (n8).
A recent sentence of Constitutional Court (n9) has introduced the
principle of text obligatoriness for some classes of workers, but, at
this moment, the Minister of Health has not identified the categury
yet, so in Italy the text is completely voluntary.
A small number of prison operators and lawmakers would like to
introduce text-obligatoriness in jails (n10).
It is necessary to mantain the present situation promoting a
sensibilizzation work on this point (n11). The “window
period” and the necessity to found the citizen-institution ratio
on a level of partecipation and faith, must bring us to substain the
absolut voluntariness of HIV-text.
Freedom of therapeutical choice
Freedom of therapeutical choice is, today, a
question felt by association of fight aginst AIDS in Italy (n12) and
by a lot of inmates (n13).
In particular it is important that the possibility for persons with
HIV/AIDS to make informed choice (n14) is warranted. Informed choice
means: availability of good data-banks, adeqate information, but,
above all, of an authoritative net of alternative medicin’s
practicioners, of an unprejudiced research that studies
unconventional therapies area (omeopathy, fitotherapy, trditional
chinese medicine etc.) and a project for the sperimentation of
economic support of these therapies.
For what concerns detenction in Italy (n15) the prisoner can be
visited from his family doctor and assume the latter’s
prescriptions. This is not always the case because of the ignorance
versus non-traditional therapies.
Moreover, the PcHA partecipating to experimental trials have to give
up once they are arrested because the external medical staff does not
want to take care of them anymore.
Still, people taking medicines that haven’t been registered yet
in our country (e.g. Ritonavir, Indinavir, Squinavir, 3TC, etc...)
can hardly keep on doing it.
As already mentioned (n16) it is instead important to treat equally
people on detention and people who are not. In particular, giving
them the chance to keep on attending trials started when not on
detention and giving them the chance to take any kind of medicine
(traditional and not) once they are prescibed by a doctor.
It is important that the prisoner has the same opportunity of being
cured that the citizen has.
Prevenction
Inside italian jails prevenction undergoes to
the same coditionings you can find outside them.
The sensibility of jail administration and of some institute
directions has permitted the realization of important projects as the
Ekotonos one inside the jail of San Vittore, Milan. Since 1992 inside
this jail you can attend classes on “Health information”
and “Self-aid groups”. These are only exceptions due to the
massive presence of volunteers in the big cities (Milan, Taurin,
Rome).
We should finally obtain a bigger to the realization of longlasting
as classes on health education, self-aid groups and cultural
project.
Inmates women and HIV
Seropositiv inmate woman is a particular
reality (n17).Lots of inmates women comes from rape experiencies,
lots have to take care of their sons and from recent interviews comes
that inmates women are more often left behind from thir partners than
the contrary. Besides, they have to do with an institution (Jail)
thought and realized from and for males. For these and other reasons
it is important to pay a particular attention to projects involving
women HIV positive and AIDS affected (DcHA) (n18)
Citizen born in other countries
At this point our country must do a lot not
only about the situation of the foreign prisoner but also for the
situation of the foreign free. Actually the foreign who is not in
order with the residence permit can not have a health protection in
our country. Except for some infectious disease, the pregnancy and
the first-aid. While we think that health is a primary right and it
doesn’t have to be in function of the juridical position of the
person. In Italy we suppose that some hundreds thousands people are
not in order with the residence permit; we talk about thousands
people that are not protected on the healty side. This mean to damage
the dignity and the rights of the peolple and put the whole community
under epidemic danger because the lack of epidemiological
surveillance precludes the first-aid of public hygiene.
We considere important that European Community base its intervention
with a spirit inspirred to the principals of solidarity, reception
and guarantee of sanitary rights.
The question where the gap is strong is on opportunities to
resettling and to contacts with the outside (n19) (argument that can
be done for all stranger citizens, seropositives and not ), and on
reception in a structure outside the jail, considered that this
persons are lacking in familiar net that could receive them.
In this sense it is important to study projects for sustaining the
voluntary services to realize forms of receptions outside prisons for
these prisoners (n20). Its important, furthermore, to introduce in
European legislation some precise rules that guarantee the rights for
terminally ills to live outside the jail.
Extradition
We have news about italian persons with
HIV/AIDS living in prison of other countries of European Community
that find difficulties to come back to Italy to serve a prison
sentence, being able to be near to family and friends.
We dont know exactly the differents laws about this and even dont
know how real is this problem.
However we consider important to make easier the possibility to be
detentioned in ones own country, by making automatic the
exradiction
Overcrowding
In Italy there are 50000 prisoners in prisons
that could give hospitality only to the half. This fact creates a
situation of unlivablity (n21). Even Italian Parlament has underlined
how this situation cant be stood on a sanitary level (n22). For
persons with HIV and AIDS is a situation that damages them,
considered that precarious situation provoke a psychological
depression influencing immunitary sistem.
It is certainly an interior problem of our country that we hope could
find a solution with new government. It would be important that
European Comunity found a way to prevent in a better way the
elementar rights of inmates in Italy even for the problem of
overcrowding in prison.
Incompatibility between detention and AIDS
In Italy the law 222-93 (n23) established
incompatibilty between prison and AIDS, that is to say the right to
be released from prison for who have a diagnosis of AIDS or a serious
immunodeficiency with a CD4 count less to 100mm³.
When CD4 were between 100 and 200 mm³ the release from prison
was discretionary, it depended on the personal decision of the public
prosecutor about the single case.
However a recent conviction of the Constitutional Court (n24) had
quashed the automatisms of the 222-93 law, introducing the discretion
of the public prosecutor in the whole cases, even in presence of a
diagnosis of AIDS. We think the principle of incompatibility among
detention, AIDS and serious immunodeficiency (n25) has to be kept as
most of the associations of volunteers and of the welfare workwers
had several times emphasized. Nowadays in our country we just
can’t leave this conviction out of consideration when we plan
the future. That’s why we agree with the lawer of Associazione
Solidarietà AIDS of Milan (n26 - n27) who made
the suggestion that all prisoners with AIDS should be released from
prison and that only the ones who commit heavy crimes against persons
sholud be put under house arrest. This way human rights and welfare
state could be satisfied as the recent Constituzional Court‘s
convictions demand.
Health and punishment’s culture
The injured party has got the whole rights to
ask the guilty to be punished for his behavior.It is a natural a
human reaction but it can make much thinking. It happens too often
that the legal experts are the only defenders of civil rights instead
of the public opinion, injured and scared of the crimes and of their
spreading. In all european countries we have to promote serious
reflections upon the sense of punishment and upon the re-education of
the guilty. In particular we must promote a great cultural campaign
upon the hospitalization out of prison of seriously ill
prisoners.Just promoting this culture we could propose laws hoping
that they will be applied. It could not be necessary and we’d
risk the opposite effect. Therefore we have to develop a project
involving anybody out of jail without own resources.
Final considerations
The main interveening field is the cultural one
followed by juridical one. Only by means of this double action it
would be possible to reach our aims. We all think that only together
we can contribute to this process of meeting and reflection.
Resource
[1] De Martino D. L’Aids in
carcere. in Il libro italiano dell’AIDS. McGraw-Hill, p. 105
[2] Notiziario dell’istituto Superiore di Sanità.
Aprile 1996, Vol. 9, N. 4 (Suppl.1)
[3] Vedi Progetto Ekotonos, 1^ e 2^ valutazione. Atti
convegno Milano 28-29 ottobre 1994 ( chiedere a Centro Poiesis del
Gruppo Exodus, V.le Marotta 18/20 Milano. tel 0039-2-2150428/2140344
fax 0039-2-26412801, e-mail poiesis@galactica.it) Per Ekotonos vedi
anche http://www.sociol.unimi.it/cayenna/ekotonos/ekotonos.html
[4] Atti del Seminario. Reperibili c/o Centro documentazione
“carcere e salute” USSL Torino 1 Via Bertola 53 Torino Tel.
0039-11-5754510
[5] Raccolta proposte orientate a favorire la soluzione del
problema sovraffollamento nelle carceri” a cura del
coordinamento PROPOSITIVO, ottobre 1994.
[6] Problematiche giudiziarie e sociali per persone con
hiv/aids. Quaderno di documentazione. ottobre 1995. centro Operativo
Aids Comune di Milano- Progetto Città Sane.
[7] CFR nota n.1 p.107
[8] Organizzazione Mondiale della Sanità. Direttive
dell’OMS sull’infezione da HIV e AIDS nei carceri. Ginevra
1993. Sezione B, punto 10
[9] Corte Costituzionale Sentenza n. 218. Anno 1994
[10] Ceraudo F. Il problema dell’aids nelle carceri
italiane. Medicina Penitenziaria. N. 23 Luglio-Dicembre 1994 anno
XII, pp.1618
[11] Agnoletto Vittorio “Aids Tossicodipendenza e
carcere”. Atti convegno Ekotonos 28-29 ottobre 1994 Milano
Italy.
[12] Vedi “Mozione finale” Seminario di studio
“Per una dottrina della sicurezza ragionevole: ipotesi di lavoro
per l’uso e la sperimentazione delle terapie complementari per
hiv e aids”, Bocca di Magra 12-14 maggio 1995
[13] Balderi Maruska “Solo una dolce determinazione
(Intervento di apertura a nome dei detenuti e delle detenute progeto
Ekotonos”. in Atti convegno Progetto Ekotonos Milano 28-29
ottobre 1994
[14] Balderi Maruska. I miei diritti di persona
sieropositiva. Incontro nazionale HIV/AIDS: opportunità
terapeutica e libertà di scelta. 30 novembre 1994 Torino
Italia.
[15] Continuità terapeutica in “Problematiche
giudiziarie e sociali per persone con hiv/aids”. Quaderno di
documentazione. ottobre 1995. centro Operativo Aids Comune di Milano-
Progetto Città Sane.
[16] Durante Alesandra, “Carcere e libertà di
scelta terapeutica” in atti Seminario di Studio “Carcere e
hiv”. Torre Pellice 7-8 Maggio 1994
[17] Cecilia “Donne tra carcere e
sieropositività” in atti Seminario di Studio
“Carcere e hiv” Torre Pellice 7-8 Maggio 1994.
[18] Ambroset S. “Donne, carcere e hiv: note su alcuni
aspetti etico-giuridici” in atti Seminario di Studio
“Carcere e hiv”. Torre Pellice 7-8 Maggio 1994
[19] Ahmad Khatib “Extracomunitari è tempo di
svegliarsi” Magazine 2. Il giornale di San Vittore n.1 Maggio
1996
[20] Progetto Ekotonos. 2^ valutazione. Atti convegno
“Progetto Ekotonos” Milano 28-29 ottobre. p.33
[21] Rapport sur les conditions de detention et les mauvais
traitements en Italie. A cura di Association pour la Prevention de la
torture di Ginevra su comissione del “Comitè
européen pour la prevention de la torture et des peines ou
traitements inhumains ou degradant (CPT). Autunno 1995. p. 33
[22] Relazione della Commissione Sanità del Senato
approvata nella seduta del 12 gennaio 1994. Riportata in
“Proibito ammalarsi: prigioni o lazzareti in Narcomafie,
febbraio 1994. pp 5-7
[23] Decreto Legge 222 del 14 luglio 1993 “Disposizioni
urgenti relative al trattamento di persone affette da infezione da
HIV e di tossicodipendenti”. in Gazzetta Ufficiale 14 luglio
1993. Vedi anche Decreto interministeriale del 25 maggio 1993 in
Gazzetta Ufficiale 5 Giugno 1993 n. 130 “Definizione della
condizione di incompatibilità con lo stato di detenzione per
le persone con infezione da hiv”.
[24] Corte Costituzionale Sentenza n. 439 del 18 ottobre
1995, pubblicata sulla Gazzetta Ufficiale n. 44 del 25 ottobre 1995,
1^ serie speciale. Ed anche Corte Costituzionale Sentenza n. 438 del
18 ottobre 1995, pubblicata sulla Gazzetta Ufficiale n. 44 del 25
ottobre 1995, 1^ serie speciale
[25] Raccolta proposte orientate a favorire la soluzione del
problema sovraffollamento nelle carceri” a cura del
coordinamento PROPOSITIVO, Ottobre 1994 Milano. pp. 32
[26] Palumbo Gianfranco. Proposta in materia di detenzione
delle persone ammalate di aids. Relazione convegno “Il Vaso di
Pandora” 16-18 Maggio 1996 Roma Italia.
[27] Palumbo Gianfranco. Una possibile soluzione per il
problema dei malati di aids in carcere. in EssePiù anno VI
numero 3 1996. p. 15