received did not satisfy the demand. Nevertheless there were enough basic medicines. The SPT recommends that the supply of medicines should be increased to meet prescription requirements. In the case of a shortage of medicines, doctors should establish an order of priority among patients. 176.The SPT found the pharmacy at Pedro Juan Caballero Regional Prison to be well stocked. During conversations with prison staff, it became clear that that was not the usual state of affairs and that the medicines had arrived three days before the SPT visit. 177.Staff at both prisons stated that access to a doctor was unlimited and free of charge. This was denied, however, in testimony received from prisoners. At Tacumbú National Prison, inmates talked of having to pay up to 5,000 guaraníes to attend the clinic. At Pedro Juan Caballero Regional Prison, some inmates said that they had been punished with beatings or solitary confinement simply for asking to see a doctor. This is a matter of grave concern to the SPT, considering the large number of inmates with manifest health problems, in particular weight loss, coughs and skin infections. The SPT underlines that the right of prisoners to see a doctor at any time free of charge must be respected, and recommends that steps be taken to give effect to that right. Prisoners should be able to seek professional medical assistance in confidence and without their requests being obstructed or filtered by guards or other inmates. 178.During conversations with the authorities and medical staff, the SPT established that there is no information on the number of HIV-positive prisoners in Paraguayan prisons or that the information available is clearly incorrect. At Tacumbú National Prison, HIV/AIDS and tuberculosis were diagnosed at the clinic and treatment is being administered in accordance with national guidelines and under the supervision of specialists. Of the nine people diagnosed as HIV-positive, five were receiving treatment. Tuberculosis is a serious problem in Tacumbú, where the incidence of the disease is considerably higher than among the Paraguayan population. Routine checks to detect tuberculosis are not carried out. At Pedro Juan Caballero Regional Prison, the authorities did not know whether there were any HIV-positive inmates among a population of almost 200. Two detainees have tuberculosis and are receiving treatment. According to the prison director, inmates suffering from tuberculosis are isolated for a period of two weeks after which they are returned to their wings. 179. The SPT recommends that all prisoners should have the opportunity to be X-rayed for tuberculosis using mobile Xray units and that treatment should commence for inmates who have tested positive. Prisoners sharing a cell with a person infected with tuberculosis should be allowed to undergo a second X-ray and the Mantoux test (for prisoners who have not been vaccinated) three months later. This procedure should be repeated periodically to prevent the outbreak of further cases. As regards HIV/AIDS, the SPT recommends that all prisoners should be provided with a free and voluntary HIV test. The tests should be confidential, be accompanied by advice and be administered only with the prisoners ’ informed consent. 180.The SPT has been informed of plans to establish a health promotion system at Tacumbú National Prison under the supervision of prisoners trained for that purpose. The SPT requests information on any progress made with the establishment of this system and in particular on the control of infectious diseases such as HIV/AIDS and tuberculosis. 181.The SPT visited the wing for mentally disabled inmates in Tacumbú National Prison, which was found to be acceptably clean. Nevertheless, it noticed that certain beds and the roof of the wing were in need of repair and that no activities whatsoever were organized for patients. In the course of discussions, the prison director referred to the problem posed by the lack of clear legal provisions regarding the treatment of mentally disabled persons in conflict with the law, which had on several occasions resulted in the transfer of inmates to the neuropsychiatric hospital and then back to Tacumbú. He also said that the facility did not have the skilled specialists and appropriate medication to care for inmates of this kind. 182. The SPT recommends that Paraguay should adopt legislation guaranteeing the rights of mentally disabled patients deprived of their liberty and/or under treatment against their will. The SPT further recommends that mentally disabled persons deprived of their liberty should be transferred as soon as possible to specialized institutions under medical management. The SPT also recommends that the furniture and roof of the wing for the mentally disabled in Tacumbú National Prison should be repaired and that programmes of activities should be organized for those patients who are able and willing to participate. 5.Material conditions 183.Accommodation, food and hygiene are factors which contribute to the dignity and well-being of persons deprived of their liberty and of prison staff. When substandard material conditions are combined with a high level of overcrowding, both have an adverse effect on living and working conditions in the prison, and give rise to tensions among inmates and between inmates and prison staff. The SPT visited the cells, dormitories, communal areas, kitchen and toilet facilities in the two prisons and found their general state to be deplorable in terms of maintenance and hygiene. Most of the wings did not have natural light or proper ventilation and were extremely overcrowded. The SPT has concluded that the material conditions of the prisons do not comply with national legislation (in particular, the Prisons Act (No. 210/1970)) and relevant international standards. 184.The solitary confinement cells at Tacumbú National Prison were in a particularly bad state. There were three cells that were approximately 2.5 m² by 2.5 m², one of which had up to five prisoners crammed into it. None of the bathrooms were working properly, and two of them leaked incessantly. The prisoners said that there were rats in them. The stench along with poor ventilation and the heat in the cells made it difficult to breathe. The SPT interviewed the 11 prisoners who were being held in the solitary confinement wing on various grounds, including clashes with other prisoners, disobeying the orders of prison staff, attempted escape and possession of knives or drugs. One of the prisoners had been in solitary confinement for almost three months, yet the prison regulations and the Prisons Act (No. 210/1970) establish the maximum period of solitary confinement as 30 days. All the prisoners interviewed confirmed that prison staff demanded payment of a large sum of money as a condition for leaving the solitary confinement wing. The medical officer should visit prisoners held in solitary confinement every day, on the understanding that such visits should be in the