In nearly all countries, HIV prevalence in prison is higher than in the community. Effective policies to prevent HIV inside prisons and other correctional institutions are often hampered by the denial of the problem as well as the denial of the existence of the factors that contribute to the spread of HIV: overcrowding, unsafe sexual activities and injecting drug use, violence, gangs, lack of protection for the youngest, female and weakest inmates, corruption and poor prison health services. These factors all create an environment that increases the vulnerability of prisoners to HIV infection and other diseases such as tuberculosis, hepatitis and other sexually transmitted infections.
There is a high turnover among prisoners. At any given time, there are more than 10 million people imprisoned worldwide. Taking into account the high numbers of both new and released prisoners, there are more than 30 million prisoners worldwide every year. In some countries, about three quarters of people in prison settings have alcohol or other substance-related problems, and more than one third may be dependent on drugs. Around one third will have been put in jail for drug-related offences. Often, drug use continues in prison, a pattern that is usually associated with a high risk of HIV transmission.
To address the situation, a comprehensive strategy must be developed. An essential first step in developing such a strategy is to create awareness among policymakers about the HIV/AIDS situation in prisons. The strategy must address legal issues such as the development of alternatives to imprisonment and the equivalence of health care; structural issues such as overcrowding and corruption; raise awareness among prison staff; and provide prisoners with information, means of prevention, counselling and drug dependence treatment (including opioid substitution treatment) and rehabilitation opportunities.
Special attention should be given to the needs of inmates especially those at risk of infection, including the mentally ill, juveniles, women, foreigners and those belonging to ethnic and other minorities.
The overall objective is to ensure that every prisoner has access to essential HIV/AIDS prevention, treatment and care services. In order to do so, it is important to develop national strategies on HIV/ AIDS prevention, treatment, care and support in prison settings that are based on evidence, and to establish national HIV/AIDS prevention and care programmes that reach all prisoners and are linked with the services available to the wider community.
The work of UNODC includes helping States ensure that the kind of health care and HIV/AIDS prevention and care services available to prisoners are equivalent to those available in the general population. UNODC assists Member States in providing HIV/AIDS information and education to prisoners, wardens and other staff in prison settings, and encourages States to provide confidential and voluntary counselling and testing, psychosocial support, providing the means to prevent HIV, and access to antiretroviral treatment.
General conditions in prisons should be scrutinized, both inside and outside, and prisons should be secure, safe and orderly in order to reduce violence and the spread of HIV. Meaningful rehabilitation activities should be put in place, including pre-release reintegration programmes. Prison staff should be trained on how to deal with HIV/AIDS cases in prisons and on the needs of HIV-infected prisoners. Antiretroviral therapy and improved hygiene, sanitation and diets for HIV-infected prisoners should be provided.
UNODC encourages States to actively involve civil society organizations in prisons and in the provision of aftercare services, and to offer drug dependence treatment as an alternative to imprisonmen