The unintentional punishment: time in prison should not lead to infection with HIV or tuberculosis

Health experts in Europe agree on recommendations to reduce communicable diseases in prisons

Copenhagen and Madrid, 29 October 2009

At any given time, over two million people are imprisoned in penal institutions in Europe. Prisons are extremely high-risk environments for the transmission of infectious diseases because of a high number of risk factors, such as overcrowding, poor nutrition, limited access to health care, continued illicit drug use and unsafe injecting practices, unprotected sex and tattooing. If prisons are not to become a breeding ground for infectious diseases, health and medical care, and prevention and treatment must be an integral part of the penal system. Prison health policy should be integrated into national policy and prison health should be closely linked to the public health service. This applies to all health issues but is particularly important in the case of communicable diseases.

The unintentional punishment

A prison sentence is not always over on release from prison. Individuals who are healthy on entry have a high risk of leaving prison infected with HIV or tuberculosis (TB) or with an addiction to drugs. Added to the stigma of a prison sentence, this hampers their reintegration into society and makes a normal family and social life difficult. The post-release period is very important, as ex-prisoners are at greater risk of dying within the first weeks after release from prison, primarily as a result of an overdose of illicit drugs. An effective throughcare plan must be developed between prisons and public health systems.

“Rather than rehabilitating inmates, a prison sentence often makes matters worse,” says Dr Marc Danzon, WHO Regional Director for Europe. “It is unacceptable that we allow prisons to encourage unhealthy practices, meaning that people leave prison in poorer health than when they arrived. This lowers their chances of reintegrating into society and spreads infectious diseases beyond the prison walls. Work by countries to protect the health of prisoners helps not only individuals but the whole of society.”

The health of prisoners affects the rest of society

Overcrowding, the high turnover in the prison population and the intensive interaction between prison and society encourages the spread of communicable diseases. Neglecting the health of prisoners impacts on the wider public, putting them at risk of infection from diseases like TB and HIV.

The Madrid Recommendation

An international conference on prison health protection is taking place in Madrid from 29 to 31 October 2009. Health experts from over 50 countries have agreed on a set of recommendations to tackle the issue of communicable diseases in prisons. The aim of the Madrid Recommendation is to ensure that, rather than making matters worse, prisons are a setting where health and health behaviour are improved and the risk of reoffending is reduced. These cost-effective measures include:

  • treatment programmes for infectious diseases, including HIV/AIDS, hepatitis C and TB;
  • treatment programmes for drug users;
  • harm reduction measures;
  • guidelines on hygiene requirements;
  • guaranteed throughcare for prisoners on entry to and after release from prison, in close collaboration with stakeholders;
  • mental health support for prisoners suffering from communicable diseases; and
  • training for all prison staff in the prevention, treatment and control of communicable diseases.

For more information contact:

Technical information:

Dr Lars Moller
Regional Adviser a.i. Alcohol and Drugs,
Health in Prisons Project
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel.: +45 39 17 12 14
Fax: +45 39 17 18 18

Ms Brenda Van den Bergh
Technical Officer, Health in Prisons Project
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel.: +45 39 17 14 01
Fax: +45 39 17 18 18

Press information:

Ms Liuba Negru
Press and Media Relations Officer
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel.: +45 39 17 13 44
Fax: +45 39 17 18 80