UNODC is the custodian of the United Nations Standard Minimum Rules for the Treatment of Prisoners and assists countries in implementing international standards and United Nations resolutions that demand that all inmates have the right to receive health care, including HIV prevention and care, without discrimination and equivalent to those available in the community. Prison settings include, in addition to regular prisons, police lock-ups, pre-trial detention centres and closed institutions for juveniles in conflict with the law.
Worldwide, the levels of HIV infection among prison populations tend to be much higher than in the population outside prisons. Even in many countries where HIV prevalence in the community as a whole is low, it is a serious health threat for prison populations, and presents significant challenges for prison and public health authorities and national governments. This situation is often accompanied and exacerbated by high rates of other infectious diseases such as hepatitis and tuberculosis. The generally accepted principle that prisons and prisoners remain part of the broader community means that the health threat of HIV within prisons, and the health threat outside of prisons, are inextricably linked and therefore demand coordinated action.
In addition to drug use and unsafe sexual practices, factors such as prison overcrowding, inadequate nutritional provisions, poor health services, unsafe tattooing and blood rituals, violence, corruption and poor prison management, make prisons a high-risk environment for transmission of HIV, tuberculosis and other communicable diseases. The lack of knowledge and education amongst prisoners about the risks of contracting and transmitting HIV, along with the absence of protective measures and proper health services, increases their risks of infection. Within this environment the risks for staff and in turn, their families, also increases. Worldwide there is a very high turnover in the prison population (almost 30 million annually) as most prisoners are incarcerated for short period of time. Upon release, most return to the community where they engage in pre-existing sexual behaviour of multiple concurrent partners and injecting drug use.
Although there is generally accepted recognition that prisons present a high-risk environment for the transmission of HIV there remains serious gaps in most countries' response and attitude to it. Available information on the prevalence of HIV and the extent of high-risk behaviours and practices such as IDU and unprotected sex in prison settings is vague, drawn from statistically non-representative samples from a limited number of countries. The lack of information is in part due to government's sensitivities to the collection and subsequent release of data necessary to mount, monitor and evaluate an effective response to the epidemic. As a result and for the most part, strategies to address HIV in prisons are isolated and not well situated within national HIV action plans and strategies.
While prison authorities have a central role in implementing effective measures and strategies to address HIV/AIDS, this task is not solely the responsibility of prison systems. The development and implementation of prison-based HIV/AIDS prevention, treatment and care requires input, support and ownership at all levels; namely at the policy level, prison management level and at service provider level. It also requires collaboration and full participation of all stakeholders, such as health, law enforcement and criminal justice sectors, as well as non-governmental organizations and people living with or affected by HIV.