Prisoners are more likely to have used drugs compared with the general population, and are exposed to various sources of higher risk like injecting, tattooing, unsafe sex. Many prisoners have complex health and social needs and assessment and treatment of drug related problems is important in prison. This highlights the role of the prison setting, in particular as a critical location for addressing problems for high-risk drug users. Significant considerable health and social gains can be won if a good prison care and support is linked with ensured continuation of service delivery.
An example of this is the potential value that can be derived from scaling up the testing and treatment of infectious diseases among the prison population. In-prison screening and treatment of infectious diseases (like HIV, HBV, HCV, STD or TB) can give substantial benefits:
- When it continues treatment and care that is provided earlier before-incarceration
- When it prepares a continued treatment and care after-release
- When it uses the window of opportunity in prison time, to offer targeted health promotion and health care and initiate for instance screening and referral to specific follow-up like HCV treatment.
People in prison experience a higher burden of communicable diseases such as hepatitis B (HBV), hepatitis C (HCV) and HIV often linked to a history of injecting drug use. In addition, incarceration can result in a higher risk of transmission of communicable diseases, due to factors such as overcrowding, poor healthcare facilities and delayed diagnosis. In a joint report published in July 2018 the European Centre on Disease Control and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) outline evidence-based and effective measures to help prevent and control the transmission of blood-borne viruses in prison settings.
The EMCDDA report provides detailed recommendations on service provision, monitoring & surveillance, prevention, testing, access to treatmant/care, guidelines/programmes and protocols.
A joint EMCDDA/ECDC (2018) report makes a strong case for more active active case finding of infectious diseases llike BBVs, STIs and TB.
- Based on the available evidence on active case finding for HBV, HCV and HIV in prison settings, and considering the high prevalence of infection and the availability of effective prevention and control measures, it is advisable to offer testing for HBV, HCV and HIV to all people in prison. The available evidence suggests that provider-initiated strategies for viral hepatitis and HIV testing yield a higher uptake than client-initiated strategies.
- Available evidence suggests that provider-initiated strategies for STIs testing yield a higher uptake than client- initiated strategies.
- Based on available evidence on TB active case finding in prison settings, and taking into account the public health implications of TB transmission in closed settings, it is advisable to offer universal provider-initiated testing at prison intake.
Analysis of data on HIV and HCV prevalence among people who inject drugs from 17 European countries, covering 2006 to 2017, showed that the prevalence of HIV and HCV are significantly higher among individuals with a history of incarceration in most countries: 10 out of 17 countries in the case of HIV and 14 out of 17 in the case of HCV. (EMCDDA, European Drug Report 2018).
Infectious diseases testing (HIV, HBV, HCV and tuberculosis) is available in prisons in most countries, although this may be limited to testing on entry or of symptomatic individuals only.
Almost all countries report the provision of one or more of these treatment options. Most European countries have established interagency partnerships between prison health services and providers in the community, in order to facilitate delivery of health education and treatment interventions in prison and to ensure continuity of care upon prison entry and release. Preparation for prison release, including social reintegration, is carried out in all countries. Programmes to prevent the risk of drug overdose, which is particularly high among opioid injectors in the period after leaving prison, are reported in 5 countries and include training and information and the provision of naloxone upon prison release.