Prison as places for public health interventions
Each year about 110.000 people get imprisoned for the first time in Germany. There is a high turnover rate: citizens arrive and depart on a daily basis. Among those incarcerated are highly vulnerable people who use drugs (PWUD) due to prohibitive drug laws.
Each year about 110.000 people get imprisoned for the first time in Germany. There is a high turnover rate: citizens arrive and depart on a daily basis. Among those incarcerated are highly vulnerable people who use drugs (PWUD) due to prohibitive drug laws. The so-called DRUCK study from the Robert Koch Institute carried out between 2011-2015 demonstrates: that HCV and HIV prevalence among PWUD is way above average (HCV: 37-73%, HIV: 0-9%); that testing rates for PWUD are high, but newly discovered infections indicate that tests are less frequent and more could be done to offer tests for PWUD, in particular in prisons. The prevalence of HBV vaccination among PWUD was low (15-52%).
Data from 2010 indicates that chronic HCV in prison is 32-fold and HIV 24-fold higher compared to the general population. Given the fact that there are prison-related risks to acquiring blood-borne diseases (the DRUCK study found out that 40% of study participants reported drug consumption by injection in prison and that 3 % claimed that they had started consuming drugs by injection in prison). It makes sense to offer HIV/HCV counselling and testing services for prisoners and HAV/HBV-vaccination. However, due to suboptimal testing standards in prison, NGOs in Germany have been reluctant so far to offer counselling and testing services in prison. The risks for prisoners were perceived as too high with the result that community-led testing campaigns carried out countrywide for vulnerable populations, such as for gay men and PWUD, have not been available for incarcerated populations so far.
The rate of HIV late presenters (those with CD4 counts of less than 500) in Germany (approximately 30-50%), is still too high. More efforts are needed to detect undiagnosed PLHIV including in prison. Prison health must be perceived as part of public health. Supporting health in prison will contribute to ‘leave no one behind’ and achieving the 90-90-90 goals, that are identified as necessary to achieve the end of AIDS by 2030, an important element of the Sustainable Development Goals (SDG) that countries of the world have agreed upon.