According to the Joint United Nations Program on HIV/AIDS (UNAIDS), about 140,000 new HIV infections were registered in the Eastern Europe and Central Asia (EECA) region in 2021, an increase of 48% compared to 2010. These statistics underscore the need for effective prevention and treatment programs, especially in prisons, where the incidence of HIV, tuberculosis, and hepatitis is significantly higher than in the general population. In this context, increasing attention is being paid to the involvement of prisoners themselves in the provision of social and health services within prisons. This approach not only promotes access to health care but also engages people in jail in the service delivery system. One of the most successful formats is emerging as peer educator programs, in which specially trained prisoners support others in prison by sharing their personal experiences and knowledge, helping to reduce risk, prevent disease, and strengthen treatment adherence.
In 2023, syringe exchange points began operating for the first time in two correctional colonies in Ukraine. Prisoners who use drugs were able to obtain clean syringes and keep them with them without obstacles. The first such initiative was implemented in Odessa penal colony #14 with the direct participation of inmates trained as social workers by the FREE ZONE organization. They became peer counselors and started providing harm reduction services in prisons. During 2023, 13 outreach workers provided more than 10,000 services in prisons, including syringe exchange, counseling on safe drug use, overdose prevention, and participation in substitution maintenance therapy. More than 500 inmates who inject drugs received these services.
However, this is not the only successful example in the region. In Moldova, a pilot program for training peer counselors among prisoners was launched. After a careful selection process, six counselors from different penitentiary institutions were chosen. They received comprehensive training on topics such as counseling basics, risk behaviors, HIV, tuberculosis, hepatitis, drug use, and general health issues. As a result, two qualified counselors started providing counseling services inside prisons, and supervision and mentoring sessions were organized to support them.
“Peer-to-peer programs like this have some significant benefits,” says Anna Koshikova, Executive Director of the Eurasian Movement for the Right to Health in Prisons. “Prisoner counselors are constantly inside the system and can assist at any time. Prisoners are more likely to trust people with similar experiences, which increases the effectiveness of counseling. Participation in such programs helps counselors develop skills useful upon release, facilitating their social adjustment. And discussion of sensitive topics, such as HIV or substance use, becomes less stigmatized when it takes place between equals.”
The experience of Moldova and Ukraine demonstrates that such initiatives are effective in increasing prisoners’ access to health care. Involving prisoners in the provision of social and health services within prisons in the Eastern Europe and Central Asia region offers new opportunities to improve prisoners’ health, reduce the spread of infectious diseases, and facilitate their successful further social reintegration.