Strengthening Reproductive Health Services for Women in Prison in Irkutsk – Russia
This project was implemented by AIHA from February 2007 to September 2008 and focused on enhancing the quality of reproductive health services for women in prisons in Irkutsk Oblast.
The three main objectives of the project were to:
- Improve the knowledge of inmates on reproductive health and enhance their awareness about their reproductive health rights;
- Improve the quality of reproductive health services provided to inmates; and
- Improve the transition from the penitentiary system to the civil system with appropriate access for diagnostics and treatment for recently released inmates in the process of transition.
The project activities took place in the colonies of Bozoi, 120 kilometers from Irkutsk. Two women’s colonies (Nos. 11 and 40) and a settlement for men and women (No. 44) are located in Borzoi. There are more than 2,000 women who reside in both colonies. The reproductive health project was implemented in close collaboration with the Irkutsk branch of the Russian Red Cross, who received a subgrant from AIHA. Due to administrative difficulties and delays in awarding a subgrant to the Russian entity, regular visits to the colony and the actual work started in August 2007.
In March 2007, a baseline survey assessment was conducted to gauge the knowledge of the inmates and a follow-up assessment was conducted in February 2008. Despite the transience of the prison population, the surveys indicated that knowledge improved among the respondents.
The following training activities were conducted for the healthcare and correctional workers from the Medical Unit at the Irkutsk Department of Corrections and for employees from both colonies at Bozoi:
November 12-13, 2007 — A training of trainers was held for the chiefs of teams of inmates and NGO representatives who work with the peer educators among inmates (a total of 16 participants). The faculty
consisted of one US nurse, two trainers from the Red Cross, and the Chief Psychologist of the Irkutsk Oblast Department of Corrections. At this event, a manual was introduced for peer educators. The participants had a chance to practice presentation skills and working with the audience.
November 14-15, 2007 — A burnout prevention training was held for 13 participants (nine medical workers, the deputy chief on human resource issues for an alliance of three colonies, the chief of educational work with inmates at colony No. 11, and two trainers from the Red Cross). Three faculty members conducted the training: a US nurse, the chief psychologist of the Irkutsk Oblast department of corrections, and a psychologist from the Irkutsk training center. At the end of the training, participants made the following comments: “Now I know how to behave in certain situations.” “I’d like there to be a similar training for our administration.” “My question was answered with a practical exercise, and this was wonderful.”
April 2008 — Two educational workshops were conducted for the medical and non-medical workers of the colony.
April 16-19, 2008 — Two US trainers from the Albany Medical Center (a physician and a nurse), together with the trainers from the International Federation of the Red Cross, the Irkutsk branch of the Red Cross, and the Department of Corrections of Belarus, conducted a training for eight physicians and nurses from the Bozoi colonies as well as the detention center in Irkutsk. The workshop covered such topics as sexually transmitted infections (STIs), HIV treatment and prevention, stigma, and psychosocial issues. According to Dr. Inna
Barkhatova, a feldsher-obstetrician and the Chief of the Health Station at colony No. 40, “It was the first time that we were told about medications in a simple and understandable language. Before that, the AIDS Center provided some training but there were a lot of things we didn’t understand. Now that we are working with this we can see how the medications work and what kinds of side effects there can be.”
April 18-20, 2008 — The same instructors conducted a TOT course on HIV, STIs, contraception, stigma and discrimination, behavior change, reproductive rights of inmates, strategies of adult teaching and peer education techniques for 22 non-medical personnel and NGO representatives working in Bozoi and one employee from a settlement for youth in Taishet, 680 kilometers from Irkutsk.
Despite the short duration of the project, it had a positive impact on the vulnerable population of the region.
The local authorities are committed to finding ways to support the project in the future. As Andrei Lemeshevsky, Chief Medical Officer for the Irkutsk Oblast Department of Corrections, stated: “After the
project ends, we probably will not start anything new, but will support what we already have and try to involve NGOs in this work. We would very much want the project to continue, but that’s the problem with all projects. The system doesn’t change, the inmates come and go, and it’s a continuous process. The most important thing is that the inmates themselves are interested in the classes. Before the project started, this would not have been possible.”
According to Marina Dudarchuk, a medical specialist at the Irkutsk Oblast Department of Corrections, “This was the first experience of this kind with the medical workers of GUFSIN. We had a food program for medical workers, but nothing that involved the inmates. The most important problem is that the colony is far from the city. In Bozoi, there is a shortage of employees and this project was a real help.”
Elena Ageeva, Chief Psychologist for the Irkutsk Oblast Department of Corrections, noted, “In a situation where we have to put in bunk beds to have sufficient sleeping space for the inmates, it was a great achievement to have the colony administration allocate a room for the inmates’ Resource Center.”
Improved Inmate Knowledge on Reproductive Health Issues
Bi-monthly two-day trainings were held for the inmates. A total of 572 participated in the educational trainings on reproductive health, which included lessons on male and female reproductive systems, contraception and STIs, and general information about STDs and HIV.
To assure project sustainability, 65 peer educators were prepared in both colonies. The Administration of the Department of Corrections recognized the peer-educators’ work and awarded them with certificates and letters of gratitude. Nineteen peer-educators provided the Red Cross (RRC) with reports on trainings they conducted. In total, there were 43 trainings held by peer educators and 320 inmates took part in them on a regular basis. Thus, 572 inmates were trained by RRC and 320 by peer educators. In total 892 inmates completed the training program.
Inmates and staff were provided with educational charts and posters, anatomical model of a pregnant uterus, and self-help books.
RRC trainers used a participatory approach in training activities and actively involved inmates in the development of the peer manual, which was highly appreciated by future peer-educators.
An educational film for inmates on communicable diseases that was developed at the Albany Medical Center was dubbed into Russian to be aired on the colonies’ TV channel and used in educational rooms.
Improved Quality of Reproductive Health Services Provided to Inmates
From August 2007- September 2008, there were 699 women consulted in total, among them, 146 women returned again for a second consultation. In total, 855 consultations were provided. There were 203 consultations with infectionists, 292 with venereologists, and 360 with ob/gyns.
Regular visits of medical specialists helped diagnose many women with various STIs, gynecological, and oncological diseases and some of them were provided with treatment. However, due to the insufficient funding available to the Medical Unit of the Department of Corrections, the distance from Irkutsk, and a set of limitations established by the Department of Corrections related to security for transferring inmates to medical facilities, a number of women with newly diagnosed, and sometimes life-threatening conditions, have not received any treatment.
Trainings were provided to the colony workers on: reproductive health for medical workers (April 16-19, 2007 – eight medical workers); reproductive health for non-medical workers (April 18-20, 2007 – 23 trained); training of trainers (November 12-13, 2007 – 18 trained); and burnout prevention (November 14-15, 2007 – 13 medical and administrative staff from the colony and the Red Cross trained);
A laptop and a printer were purchased for the Department of Corrections. One used laptop was donated for the educational activities with inmates.
During the program, 17 convicted women started taking ARVs, even though this treatment was recommended for 25 people, due to stigma and misperceptions about HAART, only 17 of them initiated the therapy. Prior to initiating the treatment, the peer counselor and
adherence specialists from the multidisciplinary team were invited to the colony to consult with the staff regarding HAART, the importance of adherence, and various psychological issues. The team conducted a group session on general information about HIV. As of the end of 2008, all the women who initiated treatment are continuing with their therapy.
Organizations that donated informational materials to the project include the International Federation of the Red Cross (IFRC), AFEW, John Snow International (JSI) and the Open Society Institute (OSI). Since September 2007, with the support of UNODC, AFEW has been implementing a project on “case management units” and ”social bureaus” in six regions of Russia, including Irkutsk Oblast. The local partner is the Irkutsk Red Cross, the AIDS Center, and a local NGO. This project is helping to sustain the resource centers in the two colonies established by AIHA. AIHA shared training materials developed through this project with UNODC and AFEW, agencies that
implement a long-term program for incarcerated people in 10 territories of the Russian Federation.
For a PDF Overview of the Strengthening Reproductive Health Services for Women in Prison in Irkutsk, Russia Project, please click here.