Much higher rates of HIV infection in prisoners

HIV/AIDS is a serious problem for prison populations across Europe and central Asia.  A number of countries in eastern Europe have incarceration rates that are among the highest in the world (for example, in the Russian Federation the incarceration rate in 2003 was 611 people per 100 000 population, second only to rates in the United States of America). Typical rates in western European countries are 50-100 people per 100 000.

In most European and central Asian countries, rates of HIV infection are many times higher in prisoners than in the population at large. Studies in European countries have found great variations in rates of HIV infection among prisoners. Rates are generally higher in eastern Europe, for example: Estonia (12% in 2002), the Russian Federation (4% in 2002) and Ukraine (7% in 2000). High rates in prisoners have been reported in some western European countries, such as Portugal (11% in 2000), in contrast to other western European countries (such as England), where successful prevention interventions were targeted at injecting drug users (IDU) early in the epidemic. Nevertheless, HIV prevalence rates among prisoners in western Europe are typically less than 1%.

Major HIV outbreaks occurred among prisoners in Glenochill, Scotland in 1993 and in the Alytus prison in Lithuania in 2002.

Exceptionally high-risk environments

Prisons are extremely high-risk environments for HIV because of overcrowding, poor nutrition, limited access to health care, continued drug use and unsafe injecting practices, unprotected sex and tattooing. Many incarcerated people come from marginalized populations – such as IDU - already at elevated risk of HIV. In most cases, high rates of HIV infection in prisons are linked to the sharing of injecting equipment and to unprotected sexual encounters. Syringe-sharing rates (typically over 70%) are invariably higher in prisons than outside them.

This situation is exacerbated by high rates of tuberculosis (often multidrug-resistant), sexually transmitted infections and hepatitis B and C. In 2002 tuberculosis rates in Russian prisons were over 2000 cases per 100 000 (close to 10% of those incarcerated), syphilis rates over 1200 per 100 000, and hepatitis C rates 26.5 per 100 000.

Few HIV preventive measures taken

Exceptionally, some pilot HIV prevention (harm reduction) programmes have been introduced in prisons in eastern Europe. In most countries in eastern Europe and central Asia, few adequate HIV preventive measures have been introduced in prisons, although they have been shown to be effective elsewhere, mainly in western European countries.

Successful HIV preventive measures in prisons include:¹: HIV/AIDS education and information; provision of bleach and clean needles and syringes; and access to drug treatment (including opioid substitution treatment) and provision of condoms. Denying access to such measures for people in prison places them at increased risk of HIV infection, and places prisoners living with HIV/AIDS at increased risk of health decline, co-infection with tuberculosis and hepatitis, and of death.

The failure to implement comprehensive programmes known to reduce the risk of HIV transmission in prisons and to promote the health of prisoners living with HIV/AIDS is often related to lack of political will, concerns about security, mistaken assumptions that such programmes will encourage injecting drug use and sexual risk behaviour, and a lack of resources and technology to meet the overwhelming need. This public health crisis requires urgent attention and action.

Governments' obligation to prevent the spread of HIV/AIDS in prisons

Under national and international law, governments have a moral and ethical obligation to prevent the spread of HIV/AIDS in prisons, and to provide proper and compassionate care, treatment and support for those infected. What needs to be done is clear. Policies and programmes that effectively reduce the spread of HIV in prisons and provide care, treatment and support for prisoners living with HIV/AIDS already exist in several countries and should be replicated elsewhere.  People in prison have the same right to health as people outside, and the lives and health of people in prison are connected to those outside in many ways. Protecting prisoners will also protect prison staff and broader communities.

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