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HIV/AIDS

• Statistics shows that in most countries in Europe and central Asia, rates of HIV infection are much higher among prisoners than the outside population. Studies in European countries have found great variation in the rates of HIV infection among prisoners.
• Prisons are a breeding ground for HIV/AIDS and other infectious diseases, because of:
• • injection of drugs in the absence of sterile syringes;
  • sharing other injection equipment (water, spoons, etc.) and razors, toothbrushes: hepatitis C and B;
  • tattooing, piercing, scarification;
  • unprotected sexual relations: voluntary (circumstances), prostitution, rape;
  • accidental punctures with infected needles: searches in the cells;
  • limited access to health care;
  • safety of medical equipment (dental, medical, gynecological).
• By far most HIV/AIDS epidemics in developing or transitional countries, started among injecting drug users (IDU). Injecting drug use is responsible for around 10% of HIV/AIDS and hepatitis infections worldwide, and over 80% of HIV/AIDS and hepatitis infections in eastern Europe and central Asia.

Tuberculosis (TB)

• Since the early 1990s, TB outbreaks in prisons have been reported in many countries in eastern Europe, and TB strains transmitted in prisons are more likely to be drug-resistant or associated with HIV co-infection.
• Rates of multidrug-resistant (MDR) TB are higher among prisoners than people outside prison.
• Due to overcrowding and poor nutrition, tuberculosis rates in many prisons are 10–100 times higher than in the community outside prisons.

Drugs

• A high proportion of IDUs in prison share needles, with a high risk of transmitting HIV and other infectious diseases.
• Illicit drug use varies widely in the European Union: 22–86%. Regular drug use or dependence prior to imprisonment is reported by 8–73% of the inmates and lifetime injecting drug use by about 15–50%, although some studies have reported values as low as 1% or as high as 69%.
• Of the people imprisoned for drug-related crimes and not treated during their incarceration, 70–98% relapse within the year following release.
• As of March 2009, 77 countries worldwide have introduced needle and syringe exchange programmes (NSP) in community. Of these 77 countries, at least 10 have started needle and exchange programmes in prisons. At the moment, NSP have been introduced in over 60 prisons in Armenia, Germany, the Islamic republic of Iran, Kyrgyzstan, Luxembourg, Portugal, the Republic of Moldova, Romania, Spain and Switzerland.
• Substitution treatment reduces heroin use and is more effective in retaining drug users in treatment than detoxification on its own. Substitution treatment has many benefits, including stabilizing drug users, interrupting chaotic lifestyles and improving the levels of social functioning and employment.
• As of March 2009, 65 countries worldwide had opioid substitution therapy available in the community. Of these 65 countries, 37 also had this therapy available in prisons.

Mental health

• Of the 2 million prisoners in Europe, at least 400 000 suffer from a significant mental disorder, and more suffer from common mental health problems such as depression and anxiety.
• Overcrowding, bullying, marginalization, stigma and discrimination harm mental health.
• Evidence indicates that the most common form of mental health problem in prisons is personality disorder; a substantial part of the remaining prison population suffers from psychosis-related problems

Women’s health

• Although women constitute a very small proportion of the total prison population in Europe, 4–5% on average, the number of women in prison is increasing rapidly. There are about 100 000 women in prison in Europe on any given day. Most offences for which women are imprisoned are non-violent, property or drug related. Women who are sent to prison bring with them a complex set of problems, needs, anxieties, illnesses and distress. Prison worsens these problems, and increases the vulnerability of most of these women.
• Incarcerated women are far more likely to have had traumatic experiences in early childhood than incarcerated men, such as early sexual, mental and physical abuse. Half will also have experienced domestic violence.
• Many women in prison are mothers and usually the primary or sole carers for their children. Around 10 000 babies and children in Europe are estimated to be affected by their mother’s imprisonment. In most European countries, babies and young children can stay in prison with their mothers: 3 years is the most common age limit. Facilities vary widely between countries.
• At least 75% of women entering European prisons are estimated to have problems with drug and alcohol use. Further, women prisoners are more likely than male prisoners to inject drugs.  
• Mental illnesses are overrepresented among women prisoners; 80% of women in prison have an identifiable mental illness. Two thirds of women prisoners suffer from post-traumatic stress disorder. One in ten will have attempted suicide before being imprisoned. Women prisoners are more likely to harm themselves and commit suicide than male prisoners, while suicide is more common among men outside prison.
• The prevalence of HIV and other infectious diseases is often higher among women prisoners.
• Women prisoners have specific needs related to reproductive health issues such as menstruation, pregnancy and menopause. This includes access to regular showers and a greater need for adequate nutrition and personal care products.

Co-morbidity and mental health

• Co-morbidity (dual diagnosis) of conditions, such as personality disorder, alcoholism and drug dependence, is common in prisons. Co-morbidity patients are sensitive to depression and anxieties. A substantial number of them have a history of emotional, physical and sexual abuse.
• Overall the percentage of prisoners who suffer from a mental health problem and/or a drug dependence has been estimated to be 60–65%.
• The lifetime prevalence of psychiatric co-morbidity is 2–3 times higher in drug users in prison than the general population.

Young offenders

• Young offenders are likely to become adult offenders without early intervention and care. The diversion of young, vulnerable people is therefore particularly important and relevant, both morally and economically.
• Young people in prison are 18 times more likely to commit suicide than those in the community.
• Young people in prison have an even greater prevalence of poor mental health than adults, with 95% having at least one mental health problem and 80% having more than one.

Overcrowding

• In many countries the prison population has steadily increased over recent years, and the capacity of prison services has not kept pace. Overcrowding is an obvious cause or contributing factor to many of the health problems in prisons, most notably communicable diseases and mental health issues, including the use of psychoactive substances.
• While overcrowding is a health issue all over Europe, the situation is particularly serious in the countries of central and eastern Europe and central Asia, where overcrowding goes hand in hand with massive health problems. Imprisonment rates are considerably higher than in western European countries. While 50–99 persons per 100 000 people are imprisoned in most western European countries, the rates are 200–300 per 100 000 in many of the countries of central and eastern Europe and 300–500 in many of the newly independent states.