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
- It is estimated that 12 million people are in prison on any given day.
- Prisoners are 5 times more likely to have HIV than other people.
- Although only 7% of prisoners are women, HIV prevalence among women in prison is 4% compared to 3% in men.
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 often poorly managed.
Sharing needles for drug use, the unavailability of condoms and limited ability to test for HIV all contribute to the transmission of HIV in prisons.
Why are prisoners at higher risk of HIV?
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.
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).
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.
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.
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?
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.
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.
This includes ensuring there are enough available for all prisoners, and without an appointment needed to access them.
Provide prisoners with the opportunity to take PrEP before possible exposure to HIV or PEP after exposure to HIV.
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.
Offer regular HIV testing services so that prisoners know their HIV status.
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.
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?
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.
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.
Mass incarceration for substance use leads to unnecessary sentencing instead of treatment. Providing treatment instead would reduce HIV transmission and improve lives.
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.