HIV in Prison: What Are the Risks and What Can Be Done?

Around the world, prisons are recognized as key sites for the transmission of blood-borne viruses (BBVs). Transmission risks are higher in prison for two important reasons. In most Western nations, many persons entering prison have a history of injecting drug use (IDU); therefore, they already experience higher rates of BBVs. In addition, the lack or short supply of prevention measures like condoms and clean needles, combined with extreme social conditions in prison, create more opportunities for BBV transmission.

In developed nations, HIV prevalence among prisoners ranges from 0.2 percent in Australia to greater than 10 percent in some European nations. Case reports indicate that HIV is spreading in prisons due to shared injection equipment and sexual activity. One study found that nearly half of prisoners who contracted HIV in prison reported male-to-male sex in prison, 18 percent reported injecting drugs in prison, and 15 percent reported both behaviors.

In Australia, a recent study in Victorian prisons found that prisoners with a history of IDU injected less frequently while in prison but were less likely to use a clean needle and more likely to share equipment than when they were not incarcerated. Prison sex is not always consensual; logic dictates that rape carries a greater risk of HIV transmission. Tattooing has also been reported as a risk factor for BBV transmission in prison. Assaults -- by prisoners as well as staff -- also take place in prison. While the risk of HIV transmission due to violence appears to be small relative to other transmission modes, two cases of hepatitis C infection possibly resulted from prison assaults in New South Wales.

If they are to successfully reduce the risk of BBV transmission, prison-based harm-reduction programs need the support of prisoners and prisoner support groups, prison staff and management, government departments that manage prisons, politicians, and the public, the authors wrote. "Not all prisoners support the provision of condoms in prison because of concerns about the risk of sexual assault, thus, it is important for interventions to be discussed with prisoner peers and prisoners prior to their introduction. Prison workers are often resistant to introducing condoms, needle and syringe programmes and tattooing programmes into prison, for reasons that include a lack of training, concern for personal safety, the illegal nature of some of the behaviours involved, and increasing work loads."

"The key stakeholders and the community need to be informed that the provision of condoms, needle and syringe programmes and tattooing in prison is good public health policy," the researchers concluded. "In Australia, the vast majority of prison inmates are incarcerated for only a few months before returning to the community -- thus they are, over the long term, more appropriately regarded as 'citizens' than 'prisoners.' Our public health policy must involve all sections of the community, including prison inmates, if we are to reduce transmission of HIV and other BBVs."

Back to other news for September 8, 2004