Prison health is public health
Virtually all people in prison will return to their communities, many within a few months to a year. Health in prisons and other closed settings is thus closely connected to the health of the wider society, especially as it relates to communicable diseases.
People in prison have multiple vulnerabilities to HIV, tuberculosis, hepatitis and other infections
Globally, prisons are characterized by relatively high prevalence of HIV, hepatitis B and C virus and tuberculosis, as well as elevated risks of contracting such diseases and diminished access to health services.In some settings, the HIV burden among people living in prisons may be up to 50 times higher than in the general population. HIV transmission in prison often occurs through the multi-use of equipment among people who inject drugs; consensual or coerced unsafe sexual practices; unsafe skin piercing and tattooing practices; multi-use of shaving razors, blood brotherhood rituals and the improper sterilization or reuse of medical or dental instruments. HIV in prison may also be transmitted from mothers living with HIV to their infants during pregnancy or delivery.
Almost 11 million people are held in prisons and other closed settings at any given time
4.8% are living with HIV
15.1% are living with hepatitis C
4.8% have chronic hepatitis B
2.8% have active tuberculosis
The UNODC/ILO/UNDP/WHO/UNAIDS policy brief HIV prevention, treatment and care in prisons and other closed settings: a comprehensive package of interventions recommends 15 key interventions that are essential for effective HIV prevention, testing, treatment and care in prisons and other closed settings. While each of these interventions alone is useful in addressing HIV, together they form a package and have the greatest impact when delivered as a whole.
Isolated from public health services including national HIV and TB programmes, prisons and other closed settings are seriously neglected in country responses to address HIV and TB prevention, treatment and care.
Of 189 countries assessed:
Only 57 countries provide condoms for people in prison
Only 56 countries provide opioid substitution therapy for people who use drugs in prison
Only 11 countries have needle and syringe programmes in prison settings
Only 79 countries perform HIV testing for people in prison
Only 88 countries provide antiretroviral therapy for people in prison