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Abstract

This research intends to reveal the collective perception of those who are deprived of their freedom in regards to the preventive measures and the attention of HIV. It also aims at understanding their own knowledge about the health protection rights they are entitled to as well as the instruments and instances for the protection of their fundamental rights.

By means of a qualitative investigation conducted in Ocaña Prison 1, in Toledo, Spain, through in-depth interviews, this study intends to approach the target population and their perceptions on the mentioned topics in order to establish a later contrast with the opinions of both the prison officers and the representatives of non-governmental organizations (NGOs) who deal with the HIV and drug comsuption issues in the Spanish prisons.

The freedom-deprived do not know their rights nor the instances to enforce them. However, they have learned enough about HIV because the NGOs have provided such information. The work of the prison officials is reduced to the treatment of the social aspect of HIV and drug comsumption problems. As a matter of fact, excessive medication such as the distribution of methadone and the supply of syringes to avoid their exchange have been applied, but these Public Health measures have been also highly questioned by the prisoners and the prison officers themselves due to the lack of efficient control to ensure the proper functioning of the programs.

The NGOs have become the answer to the new and complex social demands of those who are deprived of freedom suffering from HIV in Spain.

1.- Introduction

The Spanish penitentiary system is undergoing an important transformation process. Old prisons have been closed and modern, sophisticated penitentiary institutions have been inaugurated. New and controversial measures for the treatment of the drug problem have been introduced such as the use of methadone (The Omsbudsman 1998: 101-103) and the problem of syringe exchange is now dealt with in the Bilbao prison with the objective of reproducing this preventive effort in other prisons in the short term. (Ministry of the Interior 1997:21-22).

In spite of the efforts made by the General Board of Penitentiary Institutions in the enforcement of drug addiction and tuberculosis programs (Ministry of the Interior 1997: 1-2; Assistant General Board of Penitentiary Health 1996: 1-6; Ruiz Navarro and Bolea Laguarta 1995: 61-62) among others, the answers provided to face the HIV problem still seem inadequate. The AIDS situation in prison forces us to reflect upon the respect of fundamental rights, for both the freedom-deprived population portion that does not carry the virus, and for those who do. In several ocassions, based on the reports of UNAIDS, there is a lack of economic resources to provide enough, adequate health services to these institutions, which may affect the HIV prevention programs. (The United Nations AIDS Program 1996).

Several published studies have arrived to the conclusion that there is a devaluation of the fundamental rights of the freedom-deprived in Spain (The Omsbudsman: 1997: 103-112; Rivera 1997 a:373-398; Rivera 1997 b:85-88; Bergali 1992: 7-20).

In addition, the Omsbudsman has verified various different types of violations against the fundamental rights of the freedom-deprived, many of which have to do with the overall health conditions of the inmates. During the period of 1988 and 1996, the Omsbudsman has verified the serious subhuman conditions in the prisons and characterizes the situation as "the main problem of the Spanish penitentiary system." In addition, this report makes reference to hygiene problems, the discrimination against women regarding their fundamental rights, such as health, work, education, and information in prison, problems in the attention of health due to the deplorable conditions of the equipment and furniture in the dependencies, as well as the lack of adequate attention of mental health problems of the freedom-deprived.

The drug consumption problem inside the prisons still exists being this the reason why the Omsbudsman insists on improving the access to rehabilitation treatments.

Based on information provided by the Ombudsman, the number of immates that has initiated methadone treatment has steadily increased. As a matter of fact, the isolating condition of the immates classified with first penitentiary degree ( those who are secluded individually because they are considered highly dangerous, among other things,) results in a lack of specialized attention in order to prevent hostility which may in turn affect their physical and emotional health. (The Ombudsman,1998: 104-105).

Many people who are imprisoned in Spain not only consume drugs, but they frequently find the way to continue doing it there. (The Ombudsman, 1998: 102). In regards to the HIV/AIDS issue in prison, the Ombudsman congratulates the significant efforts being done by the Penitentiary Administration during 1997 in their attempt to spread the new combined drug therapies to treat a greater number of immates suffering from HIV/AIDS.

Lastly, the Ombudsman of the people of Andalusia has conducted a study on this topic and come to consider prisons as social, institutional resources in Spain since they shelter HIV/AIDS patients offering them health treatment and paliative care even within the limitations of a penitentiary center. (The Ombudsman of the People of Andalusia,1997: 94)

There are many problems related to HIV/AIDS and Spanish prisons: drug addiction, severely ill immates who are granted an early release sometimes due to their terminal condition, lack of a family or a home to go to, the economic burden upon the government to maintain medicine supply programs and hospital costs, the work overload for hospital and prison staff and the lack of psychological support and counseling in penitentiary services.

In Spain, the highest portion (32,7%) of the HIV possitive victims are within the group range of 30 to 34 years of age. (HIV/AIDS Prevention Program in Penitentiary Institutions 1998: 10)

In 1996, with a repetitive tendency a year later, parental drug use is mainly represented by the HIV possitive cases declared in prison, assuming that a 90,3% of all these cases were diagnosed in 1997.

Based on the medical treatment prevalence polls carried out by the General Board of Penitentiary Institutions in Spain, by July 1^st, 1997, the number of immates taking antiretrovirals was of 2.062 people. This supposes a 5,7 % from the total population entered, being this percentage somehow higher to that of January 1997 (4, 9 %). Nevertheless, there is still a 9, 2 % receiving monotherapy. (HIV/AIDS Prevention Program in Penitentiary Institutions 1998: 14).

2.- Objectives

With all this, it is important to provide an answer to the question: In what ways are attention to HIV and preventive measures exerting influence in the protection of the immates’ rights? It becomes specially necessary to know their perception of such rights with particular attention to the supply of methadone and the syringe exchange program to prevent HIV. To know the role of the organizations providing support to the immates is also intended as an objective as well as to determine what needs are still unfulfilled because of the lack of attention by the penitentiary system. Last, it remains as an objective to establish how much the immates themselves know about their rights and their perception of the instances to institutionally enforce the protection of such rights.

The main purpose of this research is to reveal and analyze the immates’ perception on the actions of the Spanish government, through the General Administrative Board of Penitentiary Institutions in its attention of the HIV/AIDS social problem existing in the prisons of Spain.

The proposed specific objectives are the following:

a.- To know the claims, needs, and disapproval from both healthy immates and from the freedom-deprived who suffer the HIV/AIDS problem.

b.- To know the perception that the freedom-deprived have about the preventive measures and the attention of HIV/AIDS in prison as well as how much their fundamental rights are respected.

c.- To establish the scope and limitations of the actions carried out by the NGOs’ (non governmental organizations) in providing attention to the requirements, needs, and problems of the freedom-deprived whether they are healthy or suffer from HIV/AIDS.

d.- To determine the scope and limitations of the Administrative Board of Penitentiary Institutions in the attention of HIV/AIDS as a social issue.

3.- Methodology and materials

This qualitative research was carried out in the Ocaña Prison 1, located in Toledo, Spain. A total of 19 interviews were done to both healthy and HIV/AIDS affected immates. The interviews were semistructured; that is to say, open interviews based on a script, in conformity with the rules of informed consent. In addition, a group of immates was contacted when they were going to health services of the Proyecto Hombre in Madrid. Under similar rules and conditions, the same type of interview was made to six penitentiary officials and one representative per each of the following extrapenitentiary organization: FASE (Anti-AIDS Foundation of Spain), Man Proyect and a volunteer group providing spiritual support in Ocaña Prison 1.

Finally, a new meeting was held in the seclusion area with thirteen immates in order to return the results of the interviews and to accordingly verify ttheir validity.

Throughout the study, the freedom-deprived and other people who were interviewed are identified with codes making reference to their immate number, their age and their time left to remain imprisoned either by years or months. As to the prison officers and other organization representatives who were interviewed, their code makes reference to the interview number, their occupation, and their sex.

4.- Results

a.- General profile of the immates

"I was mostly embarqued in boats." (8-38-12)

Geographical origin

Nine of the interviewees are originally from Madrid, six belong to the cities of Andalusia, such as Granada, Málaga, and Seville. Others are originally from South America and Morocco.

Affective relationships

In most cases, these immates have their families, parents and siblings, who are used to come to visit them and provide emotional and economic support to them. Many of them are married and have children.

Most of the interviewees had a skill or occupation before they became immates. In many cases, selling drugs was an activity that they shared.  

Delinquency record

This study mostly deals with recurrent immates since some of them have reentered prison for the fourth or seventh time under new criminal charges. Others who have just become immates for the first time, have to be freedom-deprived doing a thirty-year prison sentence.

General health situation

Regarding HIV infection, six immates were infected with the virus. On the contrary, they claim to suffer from health problems related to their drug consumption, mainly due to hepatic deficiencies and tuberculosis. Others complain of vision or hearing problems, but in most of the cases, including the immates infected with the HIV, they claim to have suffered from emotional problems leading them to consume tranquilizers, anxiety inhibitors, and antidepressants.

Drug consumption, smoking heroine is what mostly characterizes this group of interviewed immates.

b.- Information about the immates’ rights upon entering, during their time in prison, and their perception of the institutional instances to protect their rights

"I’d like if many people were really interested in helping the community of immates. There’s a lot of ignorance out there in the patio, there’s a lot of misinformation in the patio, we are defenseless out there, there’s no culture out there; mostly because we have buried ourselves. Here you have to learn to trust noone, and partly because there are no means to it [...]" (6-30-6)

Entering prison

With the purpose of knowing the ways through which the immates have obtained information about their rights and how they can institutionally enforce them, with the support of organizations procurring the respect of fundamental rights, an attempt was made to know the experience of entering prison. In other words, we went through that first contact with the penitentiary institution and also analyzed the different services available to the immates.

In most of the cases, entering prison posed a traumatic situation that was hardly recalled by some simply because of two reasons, the need to know the time elapsed since then, and second, because in most of the cases, the immate enters the penitentiary system under the effects of drugs.

It is important to mention that no immate, except for a couple of them, had appropriate information about the functioning of the prison. On the contrary, during the first hours and the following days, the immate becomes a major information source and provider to the professionals and officers in prison as they go through the institutionalizing process.

The immate as a subject entitled to rights

The immate is not considered a person who deserves to have rights. It is common to listen to expressions such as these: "Here, human rights are mentioned with capital letters, but are not put into practice [...], you have a right to express with freedom, but we were deprived of this right when we were sentenced," (6-30-6), "I actually have no right to anything because I am mostly illiterate " (8-38-12); "regarding rights, here we have no rights, we have benefits," (9-42-8); "to know about it, yes, but what they put into practice is totally different," (15-36-1); or " I didn’t even know what was or was not my right." (18-24-6). However, another group of immates mentioned having a limited number of rights such as having a vis à vis, medical attention, study and work: " My rights, very little, not a lot about them, the right to two "vis à vis" per month, the right to communicate with my friends and family, too, to have a normal meal." " (7-44-7m).

In conclusion, the freedom-deprived do not know their fundamental rights.

Instances for the protection of fundamental rights in Spain

The freedom-deprived question the effectiveness of the instances for the protection of human rights and they greatly distrust the system. They perceive themselves as incapable of making claims given the lack of credibility that society has shown to them. In addition, they believe the system is corrupt, being this the reason why many who act wrongfully against their rights have immunity.

The immates demosnstrate having a great lack of knowledge about the Ombudsman. Many immates do not have the slightest idea of such figure, what it is, its function and scope. Others barely know the role and function of the prison judge and those who do, believe it just as an instance that grants benefits related to freedom.

c.- Perception and practice of preventive measures and the attention of HIV/AIDS in prison

To know the information and the perception of the immates about HIV/AIDS prevention related topics and given the close relation between drugs and infection with the virus, the interviews were centered on three main topics: the HIV/AIDS prevention information received in prison by the immate, the practice of HIV/AIDS preventive measures, and finally the immates’ perception about the supply of methadone and a possible program to prevent syringe exchange in prisons.

The penitentiary institution does not seem to function as an effective source of information. It has been mentioned that neither the doctor, the nurse, nor the teacher provide this type of information. Nevertheless, all immates claim to know about the AIDS preventive measures established in a seclusion center: using condoms, not sharing syringes or personal use objects are mentioned as the most common measures. On the contrary, non govenrmental organizations have become the providers of this information.

Programs of intervention with drug addicts and HIV/AIDS prevention

There are several programs of intervention with those who are addicted to drugs in penitentiary institutions coordinated by the Assistant General Board of Penitentiary Health of the Ministry of the Interior. Their goal is to prevent and reduce the damages and risks associated with drug consumption. In this study, the immates’ perceptions of the methadone supply program and the prevention of syringe exchange are analyzed due to their implications in the Public Health of prisons.  

Methadone supply program

The immates perceive taking methadone as a damaging measure for those who use it. They agree that methadone creates an addiction; thus, it adds to the problem of drug addiction in prison.

The problem is not the consumption of methadone itself, but its simultaneous combination with other drugs and medicines hindering the effectiveness of the program and acting directly against the health of the immate.

The only possitive aspect of methadone mentioned by the immates is that whoever takes it does not need to steal or commit another crime to get the drug because the estate has simply solved the question by supplying it to them.

Syringe exchange

"I know from what I have read and the information, but here, there is really not such thing as syringe exchange, I have not had, maybe a couple of times, heroine shots, it is always smoked, maybe twice on the street, but never here." (1-32-5)

The program to prevent syringe exchange turned out to be unknown by five immates, a very necessary type of intervention in prison for other eight immates, and for six of them, something totally unnecessary given the drug consumption pattern change in the Spanish prisons, from heroine shots to heroine smoking.

The freedom-deprived clearly understand that the sharing of syringes without sterilization by two or more people poses the risk of being infected with HIV/AIDS. In most cases, they have witnessed some sort of syringe exchange among immates and others even admit to have exchanged syringes with other people. "I have seen real atrocities in the streets and here in prison, I mean, people make syringes with ballpoint pens." Another immate similarly said: "Well, here inside prison, it would be fine to exchange an old syringe for a new one because there would be less AIDS, you know, some people come from the street without AIDS and they have gotten it here." (10-24-2). Lastly, it was added: "Here, the service should be, I believe, to supply syringes to those who use drugs, mostly to those who get the shots."

The immates’ perceptions towards the syringe exchange program seem to vary among the interviewees. It is significant to mention that despite the fact that the consumption pattern has changed, there are still some who take drug shots.  

d.- Claims, needs and disapproval of the freedom-deprived regarding their health services in prison

"Despite everything, medicine wise, there’s no problem." (19-44-15)

Health state of the immates

Regarding the health state of the immates, these results are similar to others obtained in Spain: "the first bit of information to recall is that only a 41% subjectively define their general health state as good or excellent. The remaining 60% of the interviewees claim to have an OK, poor, or very poor health. " (Ríos 1998: 167).

The freedom-deprived have been subdivided in groups according to the types of sicknesses that they have suffered during their time in prison.

The first group includes thirteen people and it corresponds to the freedom-deprived who have not yet suffered from serious health problems. This group has three people diagnosed as HIV possitive, but remain without showing symptoms. The second group, composed of four immates, has suffered hepatitis problems. The third group consists on two people who have been ill with tuberculosis.

Two immates, one with hepatitis and the other with tuberculosis, claim to have had problems because they were misdiagnosed or not treated timely.

The ones diagnosed as HIV possitive express that their diagnosis was given upon entering prison, except others whose diagnosis took place before the entry: "I was diagnosed with AIDS in prison XXX in the year 96" (11-26-5); "well, I was not informed I was an HIV carrier until I got here in prison. " (13-29-3).

Health services in prison. Pharmacological treatment and emotional support services

In general, the freedom-deprived claim that their health services are adequate because they usually receive the correct attention, without any inconvenience or any objection by the health staff. It was even mentioned, in one case, that the health service was better than outside in the street.

The immates request pharmacological treatment to face depression and anxiety problems since they have the perception that the human resources in prison (the psychologist, the social worker, and the teacher) are not capable to help them solve their emotional problems.

HIV possitive patients agree that all health services are acceptable and that they have gotten support from the health staff in prison in terms of quitting drugs and developing tolerance to the antiretroviral treatment: "They tell you upon entering that if you are going to continue with the treatment, whatever it is that you are going to take, you have to set your mind to it, take it seriously because the change doesn’t happen overnight, it is going to take a lot of time. Depending on your use of the treatment, you can be either vaccinating the virus or fooling yourself." (4-29-4).

At last, in terms of the treatment provided by the prison staff, specially the health staff, all HIV possitive immates maintain they feel well, they do not feel rejected in any way, they feel they are treated in equal conditions as the rest of the healthy immates, they have never been discriminated against because of their seropossitive condition.

The greatest inconvenience that they have in order to be able to start or tolerate the antiretroviral treatment is directly related with drug consumption. That is, the main problem of an HIV possitive immate is his/her own consumption of drugs in prison. It is interesting that the immates are conscious about this limitation. "I have fallen back, I have been in jail many times and I have returned to drugs, so during the time I have consumed them, I had neither a doctor nor health attention." (19-44-15).

There only seem to be problems in relation to receiving attention by the specialists, the commuting of the immates to the hospitals, and the coordinating with other penitentiary institutions.  

e.- Scope and limitations in the actions of the Administrative Board of Penitentiary Institutions in the attention of HIV/AIDS as a social problem

The functionaries of the penitentiary institutions are faced with three important limitations: one referring to the penitentiary legal aspect, the second limitation responds to the work aspect making reference to the scarcity of human and material resources, and the third one concerns the type of population they deal with.

Limitations due to the legal aspects

The legal aspect limitations make allusion to the unreal possibility to be able to help the freedom-deprived by performing a series of interventions that do seem feasible outside a closed institution.

Limitations due to the lack of human and material resources

The limitations which refer to the lack of human and material resources hinder the possibility for the penitentiary functionaries to provide the immate with the human and material resources that may improve the quality of the service. Besides, there is not enough time to meet the demands of a population with these specific characteristics: "There should be another psychologist here." (21-PS-F); "To begin with, we have a limited staff" (24-JR-V).  

Limitations due to the type of population dealt with

A third group of limitations refers to the type of population these institutions deal with. In this sense, it is of outmost importance to mention the unstability of the immates in several activities such as work or study, mainly due to transfers to other prisons and specially because of drug consumption. This leads the immates to have serious behavioral problems which hinder the compliance with the stages required by the penitentiary treatment.

Consequences of the immate-prison employee relation

It is worth mentioning that as a consequence of these three types of limitations, there are other problems and complaints that arise between the immates and the prison staff. Such complaints result in a lack of trust from the immates towards the professional team. (Ríos 1998:51-52). For example, the psychologist in prison represents a penitentiary functionary who cannot therefore, be fully trusted by the immate even when attending appointments.

According to the penitentiary workers themselves, the HIV possitive immates do not trust them since they have not fully expressed everything that happens to them in regards to their HIV/AIDS needs and complaints.

Consequences in terms of HIV/AIDS prevention

The functionaries’ perception regarding the issue of HIV/AIDS prevention is that they lack the necessary time to fulfill such additional activities and therefore, it is mainly the doctors’ duty and responsability to deal with this issue. "I believe that the doctors in this prison are great professionals. Besides, I know that there are a lot of people outside who teach this type of courses." (22-MA-F); "HIV/AIDS prevention programs are usually dealt with by the medical team." (23-TS-F).

The specific issue of the benefits established by Art. 196 of the Penitentiary Code (that relate to being granted conditional release because of suffering a terminal disease) was not considered a claim by the seropossitive immates who were interviewed. This may be due to the fact that they do not quite suffer from AIDS yet, and it is just mentioned as a problem or at least a main concern.

f.- Scope and limitations of the actions carried out by extrapenitentiary organizations regarding the social problem of HIV/AIDS in prisons

"Problems, well, as hard as it may sound, one problem is the economic one. If things are not being made here is not because there is no need, but because the NGOs cannot afford them anymore. There are 45.000 prisoners in Spain and we can’t afford that." (25-AB-F)

With the purpose of knowing the work of extrapenitentiary organizations, the study focused on one organization devoted to the attention of the drug consumption problem, a second organization that concentrates on the AIDS problem, and a third instance, an organized religious group that seeks to fulfill several needs of the immates.

Two non governmental organizations and one organizational instance of the Catholic Church share a common interest in the issues of drugs, HIV/AIDS, and delinquency. They carry out certain common actions regarding these social problems, mainly dealing with prevention, information, education, training, rehabilitation, emotional support and counseling to the affected ones and their families. The freedom-deprived; therefore, have identified the NGOs as one more resource that they have mostly in terms of providing them with the information on HIV/AIDS prevention and the attention of the drug problem.

There is a overwhelmingly increasing demand of support services required by the freedom-deprived in Spain. Such needs are not being fulfilled by the penitentiary institutions resulting in the fact that the NGOs are doing the work that should correspond to the prisons as to carrying out actions for the prevention of AIDS and the gradual quitting of the habits of drug consumption. These NGOs admit that their main limitation is economic, so they have to turn to a lot of volunteering.

These institutions are not instances to make public claims regarding the penitentiary system and its function; in other words, they cannot assert claims in terms of the immates’ rights since it is not their main purpose.

5.- Discussion

To begin with this discussion, it is necessary to mention that the freedom-deprived and the penitentiary functionaries differ greatly in their perceptions and discourse regarding these issues. Traditionally, the freedom of speech has been limited to the freedom-deprived. Thus, approaching the knowledge and perceptions of the immates about such topics allows them to exert their freedom of speech and secures an opportunity to be heard. Julián Ríos takes that first step in Mil Voces Presas, with the similar intention of demonstrating that the freedom-deprived have the right to express opinions just as anybody else.

The penitentiary system has developed and carried out programs tending to solve the health problems of the immates, to offer paid work alternatives, education, rehabilitation treatments, gradual quitting of the drug habit, the possibility to develop certain artistic skills, to practice sports, to have visits from outside, to ocasionally be able to get out of prison under a determined trust code, to have proper dieting, and other rights that are contemplated in the current legislation. However, the main omission detected by this study lies in the exercise of the right to information. With the proper information, the immates can become aware of the existence of such conditions and enjoy them, but they do not perceive them as rights they are entitled to.

It must be clear that knowing the information about one’s rights is not like delivering a pamphlet or brochure upon entering prison. Information activities can be talks about human rights, specific rights or institutions, the use of information spreading mechanisms like fliers, posters, informative boards and other supporting materials as well as cultural and participative activities. There is a strict relation between information availability and health promotion.

The right to health is not only a primary right, it is a fundamental right recognized by the Political Constitution of Spain, Number 45, therefore, it is a right that does not prescribe with the loss of liberty presuposed by imprisonment.

The best information that the immates have in terms of HIV/AIDS prevention consists on access to three condoms for their personal use. There is an absence of an integral plan for the prevention of AIDS involving all the different professional groups who justified with time constraints, consider that this effort exclusively corresponds to the medical staff, procurring the objective through several health programs in prison. This situation, together with the serious drug consumption problem in prisons have degenerated the AIDS prevention programs into programs to avoid toxic trends in the immates.  

According to some Spanish authors, far from helping to decrease the number of drug addicts in gradual quitting programs, the implementation of methadone treatments has increased the number of patients. "Likewise, there are numerous cases when the interviewees talk about having seen people die because of a methadone overdose." (Ríos 1998: 91).

The program to prevent syringe exchange is a controversial issue in Spain. However, the Spanish legislation has recognized it as a right of the freedom-deprived and on the basis of the principle of juridical equality, it is not possible to exclude the drug addicts from such preventive programs that are available in prisons: "On the light of the exposed laws, we must include the right of every individual who is not in seclusion to be protected from infection as part of their right to health protection, adopted in the form of preventive measures by the official authorities, just as important as the right to receive the social benefits in case of becoming ill, secluded individuals are entitled to have the same right. " (Local Hearing of Navarra, October 14^th, 1996)

Therefore, health services deal with the attention of the immediate needs of the immates, they coordinate the services of the specialist to the appointed hospitals, but the resources are not enough to provide the immate with an interdisciplinary, integral solution. The supply of methadone proves to be a poor solution.

Extrapenitentiary resources have represented the answer to cover the pending tasks. It is observed that this kind of resources greatly cooperate with prisons, but they are not instances that may generate criticism to the penitentiary system. Each time more organizations and programs are taking part as NGOs inside the prison scenario. Just to mention some, the antiretroviral treatment in HIV/AIDS patients, and in terms of drug addiction, the use of methadone and naltrexone.

Given the great number of HIV possitive persons who are in conditions of seclusion in the Spanish prisons, together with the existence of HIV/AIDS as a chronic disease, it seems reasonable to reflect upon the possibilities of the Spanish penitentiary system to be able to meet more new demands of resources and services in cooperation with the extrapenitentiary organizations.  

Finally, this study has arrived to the following conclusions:

a.- The immates do not know their fundamental rights and this lack of knowledge is basically due to the insufficient amount of information received both upon entering prison and during their permanence there, and because of the noticeable communication gap between the immates and the rather limited penitentiary staff that is mostly busy carrying out burocratic tasks on the detriment of providing a more individualized treatment.

b.- The freedom-deprived does not know the competence and powers of the figure of the Ombudsman as a Spanish institution in charged of procuring their fundamental rights.

c.- The immates complain about problems to have more and better information about HIV/AIDS preventive measures, which are qualified as not being enough in some cases and nonexistent in others. In this respect, the immates end up getting information about these measures because of the real imminence of HIV/AIDS infection and the fear of becoming ill.

d.- Health promotion and education regarding HIV/AIDS prevention are not interdisciplinary nor have they been structured as such. Their objective has been reduced to pharmacological treatment, mostly through the supply of antiretrovirals, methadone, and other medicines to help in the care of pathologies associated with drug consumption and emotional unstability of the immates.

e.- Health services satisfy the minimum needs of the immates since everything in medical attention services from the diagnosis to the care of the different pathologies is covered by the doctors. However, problems arise in relation to the attention of the specialialists, the commuting of the immates to the hospitals, and the coordination with other prisons to receive medical attention.

f.- The issue of methadone deserves further and careful study by the penitentiary authorities. This program must go beyond the mere role of methadone supplier, contemplate the idea of supporting the doctors’ team with more medical staff and including more social workers, psychologists, and experts in the area. The extrapenitentiary resources should also be considered.

g.- The syringe exchange prevention program seems to be necessary in prisons. It would allow the right of secluded people to prevent AIDS just as it is the right of non secluded people.

h.- From a wholistic point of view, enjoying the right to health seems not to be enough in prisons given that it means more than being provided with medical attention. As human resources are not enough, the offered service is imcomplete. The external resources seem to be the answer to many of the unresolved problems in penitentiary institutions.
The NGOs have become important protagonists in the satisfaction of the immates’ right to health. Similarly, these extrapenitentiary support groups seem to suffer a common problem with the prisons: the lack of sufficient economic resources.

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