HIV has emerged as one of the most pressing health and development challenges since its first reported cases in 1981. Unfortunately, prisons have become hotbeds for HIV transmission, posing significant risks to incarcerated individuals and society.
The challenges in prison settings
Prisons present a unique set of challenges to the spread of HIV. Overcrowding, inadequate resources, limited healthcare access, violence, and drug use are prevalent issues. Shockingly, the estimated number of people in prisons skyrocketed by 24% in 2021, reaching a staggering 10.8 million individuals globally. These circumstances place an immense burden on already strained prison systems and increase the prevalence of HIV within confined environments.
The statistics speak volumes: incarcerated individuals are 7.2 times more likely to live with HIV compared to the general population. Since 2017, HIV prevalence among prisoners has surged by 13%, reaching 4.3% in 2021. Although data on HIV prevalence in UK prisons is difficult to assess, available figures suggest a range of 0.1% to 4.5%.
The use and injection of drugs are prevalent among prisoners, with some countries reporting that up to 50% of incarcerated individuals engage in the practice. This restricted setting increases risks associated with drug use and injection, worsening HIV and hepatitis C transmission. Access to harm reduction services such as condoms, clean needles, syringes, and comprehensive drug treatment programmes is also limited, contributing to the worrying rates of infection.
The risks of HIV transmission
The transmission risks within prisons are something of a sobering story. Sharing needles for drug use or makeshift tattooing is disturbingly common, with prisoners often resorting to makeshift needles crafted from ball-point pens. When the risks of sharing needles and poor instruction in sexual health practices are combined, the issue becomes even more severe. Apart from HIV, incarcerated individuals face increased vulnerability to other infections, including hepatitis B, hepatitis C, STDs, and gonorrhoea (which makes individuals more susceptible to HIV transmission). It is already estimated that one in four prisoners may have hepatitis C.
Sexual abuse within prisons is also a dark reality, driven by the presence of individuals with violent criminal backgrounds and mental instability. This perpetuates the cycle of HIV transmission, with the absence of proper lubrication increasing the risks. What we cannot ignore is that sexual activity, whilst prohibited in prisons, is very much commonplace. However, due to fear of stigma, homophobia, and the criminalisation of same-sex conduct in many countries, this often remains taboo and is rarely addressed.
Looking beyond the prison walls
The impact of HIV within prison walls extends beyond the confines of correctional facilities. Effectively combatting HIV in prisons is not only crucial for the well-being of incarcerated individuals but also key to preventing HIV transmission in society. With the estimated number of infected individuals in prisons rising by 24% in 2021, remaining idle is already proving that the numbers will continue to rise if the situation is ignored.
Several countries and organisations have made significant strides in addressing HIV in prisons, offering hope and inspiration for effective solutions. Moldova has committed substantial resources to its prison systems. All 17 prisons in Moldova now provide comprehensive harm reduction services, including methadone therapy, access to psychiatrists, treatment programs, needle and syringe exchange, and HIV prevention, testing, treatment, and care. This approach places the incarcerated at the forefront, treating them as equals and prioritising their health through a solid public health framework rooted in human rights rather than bias and stigma.
France and Norway have also displayed leadership in addressing HIV in prisons. France's decision to transfer prison health to the Ministry of Health in 1994 has led to positive outcomes. Each prison in France is now twinned with a public hospital, and condoms are readily available in medical units. Open discussions on the importance of clean needles and syringes have also been encouraged. These successes demonstrate the need for a human-centred strategy that prioritises inmates' health and encourages collaboration between prison officials and healthcare practitioners.
Another innovative, yet controversial, approach to reducing HIV transmission is the provision of bleach in controlled settings to sterilise needles and syringes used for drug injection. While this method has been adopted by several prisons in Europe, Australia, Africa, and Central America, it remains controversial due to the potential misuse of bleach by prisoners.
There is also the obvious, yet frequently overlooked, technique of making it easier for convicts to obtain condoms and lubricant. By making condoms and lubricants readily available through dispensing machines, prison officials can do their part to promote safer sexual practices and respect prisoners' sexual preferences while maintaining privacy.
A human rights-based approach
Collaboration among governments, correctional authorities, and communities is critical to combatting HIV in prisons across the globe.
Efforts made by countries like Moldova, France, and Norway showcase the potential for progress when there is a commitment to prioritising the health and well-being of incarcerated individuals. However, global efforts need to be intensified to ensure that all prisons have access to essential services and embrace evidence-based approaches to HIV prevention, testing, treatment, and care.