Prison Settings 

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 is 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 drug-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. Continued drug use frequently occurs in prison and this 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 policy makers on the HIV/AIDS situation in prisons. The strategy must address legal issues such as the development of alternative 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 at-risk, including mentally ill, juveniles, women, foreigners and inmates belonging to ethnic and other minorities.

The overall objective here is that every prisoner has access to essential HIV/AIDS prevention, treatment and care. The goal here is, therefore, to develop evidence-informed national strategies on HIV/ AIDS prevention, treatment, care and support in prison settings, and to establish national HIV/AIDS prevention and care programmes, which reach all prisoners and are linked with the services to the community.

UNODC's role includes helping countries ensure that health care and HIV/AIDS prevention and care for prisoners are safe and equivalent to that available in the general community. The Office assists countries to provide HIV/AIDS information and education to prisoners, wardens and other staff in prison settings, and also encourages countries to provide confidential and voluntary counselling and testing, psychosocial support, providing the means to prevent HIV, and the access to ARV treatment.

UNODC advocates that general prison conditions be scrutinized, both internally and externally, and that prisons should be secure, safe and orderly in order to reduce violence and the spread of HIV. The Office recommends classifying and separating juveniles from adult prisoners and for prisons to provide maternity wards for female prisoners. Meaningful rehabilitation activities should be put in place, including pre-release reintegration programmes. Prison staff should be trained on management of HIV/AIDS 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 countries to actively involve civil society organizations in prisons and for after-care services and to offer drug dependence treatment as an alternative to prison.