25 August 2016
The challenges of providing health services are greatly complicated by the intersecting vulnerabilities of prisoners, who have overlapping health and social needs.
“The [infection] prevalence [in prisons] is so high that this is an excellent venue for diagnosis, treatment and linkage to care. But it's not as simple as that because this population is impacted, not only by HIV, viral hepatitis and tuberculosis but also poverty, addiction, mental illness and the list goes on and on. These are disadvantaged populations,” said Professor Josiah Rich of Brown University who has a long history of working to improve health services in prison systems.
“In my own state of Rhode Island, we’ve identified that a third of the burden of HIV in the entire state is in the department of corrections.”
Prisoners not only have a high prevalence of blood-borne viruses and TB, said Prof. Adeeba Kamarulzaman of the University of Malaya in Kuala Lumpur, Malaysia, but are also at higher risk of acquiring these infections while imprisoned.
Her study found that basic prevention interventions were lacking in most countries:
- Condoms are only provided in 45 countries.
- Needle-syringe programmes, which have classically been deemed as very controversial – even though the evidence shows they are effective – are only present within the prisons of eight countries.
- Very few countries offer OST. In the few Central Asian and other countries where it is offered, it is usually on a ‘pilot’ basis, reaching less than 1% of the people who need it.
- Antiretroviral therapy for treatment and prevention is currently only available to prisoners in 43 countries.
One major issue is that health systems in prisons are separate and independent from their respective national health systems.
“Those two [systems] often don’t talk to each other and therefore not only do prisoners lack these prevention programmes that are so badly needed but often even basic primary care is not available in many prisons,” said Prof. Kamarulzaman.
This article was originally featured on NAM Aidsmap: http://www.aidsmap.com/Neglect-of-infectious-diseases-in-prisons-highli…