It is difficult to get clean injecting or tattooing equipment in prisons, and having a needle is often a punishable offence. So, people share equipment to take drugs or tattoo other prisoners, which is one of the primary causes of HIV in prisons.
HIV and prisoners
- Prisoners are 7.2 times more likely to have HIV than other people.
- Around 4% of all prisoners have HIV.
- It is estimated that 11 million people are in prison on any given day.
Prisons, and other closed settings like detention centres, have high numbers of people with HIV.
For people with HIV who go to prison, interruption in care when being admitted, transferred and finally released means their HIV is poorly managed.
Sharing needles for drug use, the unavailability of condoms and limited ability to test for HIV all contribute to the spread of it in prisons.
Why are prisoners at higher risk of HIV?
Sharing needles for drug use or tattooing
Risky sexual activity, sexual violence and rape
Sex is often forbidden in prisons, but it does happen. The prevalence of sexual activity and sexual violence in prisons is largely unknown and thought to be significantly under reported due to denial, fear of stigma and homophobia, and the criminalisation of same sex conduct.
The unavailability of condoms
Condoms are often not available to prisoners, or only available by appointment, which limits prisoners’ willingness to get them. This means sexual activity in prisons is often unprotected which risks HIV and other sexually transmitted infections (STIs).
Low HIV testing rates
Without regular testing to find out their status, prisoners may get HIV and unknowingly pass it on to others, contributing to the spread of HIV in prisons.
Lack of antiretroviral treatment
For prisoners with HIV, adherence to antiretroviral treatment is often difficult. Prisoners are sometimes denied it, or their treatment is interrupted when they enter, move or leave prison.
Untreated sexually transmitted infections
STIs are common in prison, yet screening and treatment is lacking. Having an untreated STI can increase the risk of getting and transmitting HIV.
How can HIV services meet the needs of prisoners?
Uphold their rights
People in prisons, including those with HIV, have the right to health, to not experience violence, to be treated fairly, and to have their privacy respected. Run training programmes for prison staff so that they are educated on these rights.
Meet prisoners’ needs at all stages of incarceration
This includes before, during and after being in prison. Make sure that any HIV services provided in prisons are available to prisoners at all stages of incarceration.
Make condoms and lubricants available
This includes ensuring there are enough available for all prisoners, and without an appointment needed to access them.
Provide PrEP and PEP
Provide prisoners with the opportunity to take PrEP before possible exposure to HIV or PEP after exposure to HIV.
Provide harm reduction services
With a large proportion of prisoners incarcerated for drug-related crimes, and high amounts of drug use in prison, it is important to provide harm reduction services such as needle and syringe programmes and opioid agonist therapy.
Make HIV testing available
Offer regular HIV testing services so that prisoners know their HIV status.
Make antiretroviral treatment available
Prisoners with HIV must be given their antiretroviral treatment without interruption and have access to viral load or CD4 count testing like anyone else with HIV.
Make STI testing and treatment available
Ensure people in prison can access STI testing and treatment. Untreated STIs not only damage people’s health, they can help HIV to spread.
What systemic changes could reduce the risk of HIV for prisoners?
Make HIV services mandatory in prisons
Targeted HIV prevention programmes can reduce HIV transmission. Existing efforts need to be scaled-up, particularly comprehensive HIV prevention and treatment programmes, to provide prisoners with HIV with the services they need.
Remove laws that criminalise groups at risk of HIV
Some countries have laws that criminalise same sex sexual activity, sex work, gender identity, sexual orientation and HIV transmission. These should be removed so that these groups of people at higher risk of HIV are supported to reduce their HIV risk, rather than punished and incarcerated.
Reduce the number of people sent to prison for treatable substance use disorders
Mass incarceration for substance use leads to unnecessary sentencing instead of treatment. Providing treatment instead would reduce HIV transmission and improve lives.
Close compulsory treatment, rehabilitation and detention centres
Some countries send people who use drugs to centres to detox. These centres breach human rights laws and prevent people from accessing the HIV services they need. Treatment for people who use drugs should be provided in the community, not in compulsory centres.