THE PRACTICE OF imprisoning drug users is driving huge epidemics of infectious diseases such as HIV, according to major new international research.
Levels of HIV, tuberculosis, and hepatitis B and C infection among prisoners are far higher than in the general population, globally, the study finds.
The authors say the The War on Drugs – where governments treat drug use as an issue for law enforcement rather than public health - and mass incarceration mean jails are hothousing infectious diseases.
Around 30 million people pass through prisons every year, often passing on diseases caught while behind bars, due to a lack of adequate treatment in prisons.
Around 10.2 million people are imprisoned worldwide at any given time – nearly 2.2 million in the USA alone.
Eastern Europe
Moreover, up to half of all new HIV infections over the next 15 years in eastern Europe will stem from inmates who inject drugs, according to the study, presented at the International AIDS Conference in Durban, South Africa.
The study concluded that treatment like ‘opioid substitution therapy (OST), in prisons and after release, could prevent over a quarter of new HIV infections among injecting drug users’.
Incubator prisons
Professor Chris Beyrer, lead author of the study and president of the International AIDS Society, said:
“Prisons can act as incubators of tuberculosis, hepatitis C, and HIV and the high level of mobility between prison and the community means that the health of prisoners should be a major public-health concern.
“Yet, screening and treatment for infectious diseases are rarely made available to inmates, and only around 10% of people who use drugs worldwide are being reached by treatment programmes.
The most effective way of controlling infection in prisoners and the wider community is to reduce mass imprisonment of injecting drug users.
Worldwide, between 56% and 90% of people who inject drugs will be incarcerated at some point.
In parts of Europe, over a third of inmates inject drugs (38%), while in Australia it is more than half, or 55%.
This is in stark contrast with injecting drug use in the general population (0.3% in EU and 0.2% in Australia).
Eastern Europe
The series of studies show that the prevalence of infectious diseases has grown in keeping with growing numbers of injecting drug users in prison.
Levels of HIV infection are 20 times higher among prisoners in western Europe than the civilian population (4.2% vs 0.2%).
HIV rates are around three times higher among prisoners in eastern and southern Africa (15.6% vs 4.7%) and north America (1.3% vs. 0.3%).
While most prisoners are men, women and girls are the fastest growing imprisoned group worldwide.
In most regions of the world, levels of HIV infection are higher in female inmates than male prisoners including eastern Europe and central Asia (22% vs 8.5%).
High rates of hepatitis C are also seen among prisoners, with one in six inmates in parts of Europe and the USA carrying the hepatitis C virus.
Prevalence of active tuberculosis is higher in prisons than the general population in all settings.
Brazil
The prevalence was 40 times higher in one prison in Brazil than the general population.
Imprisonment could be responsible for three-quarters of new tuberculosis infections among people who inject drugs, and around 6% of all yearly tuberculosis infections.
High rates of injecting drug use in some settings, lack of access to condoms, unsanitary conditions, and gross overcrowding have made prisons and detention centers high risk environments for spread of these infections.
Almost half of countries in sub-Saharan Africa report that prisons are at 150% capacity or higher.
If a prisoner is locked up frequently and for longer periods, they are more likely to be infected with HIV and tuberculosis – and then export the problem to the world outside.
An estimated 30 million pass in and out of prison each year, meanwhile, bringing large numbers of undiagnosed and untreated prison infections to the community at large.
The research shows that countries can reduce and even reverse levels of infectious disease by scaling up opioid agonist therapy, antiretroviral therapy, hepatitis B vaccination, condom distribution, and sterile needle and syringe exchange.
Reducing mass incarceration of people who use drugs by a quarter could result in a 7–15% drop in new cases of HIV among injecting drug users in the wider community over five years.
European successes
Globally, only eight countries provide six key interventions recommended by the WHO for the prevention and treatment of infectious diseases in prisons – Portugal, Spain, Germany, Moldova, Armenia, Kyrgyzstan, Germany, Luxembourg, and Switzerland.
In western Europe, only a third (10 of 29) of surveyed countries reported hepatitis C screening programmes for prisoners; and in 2012, and antiretroviral therapy was available to prisoners in just 43 countries worldwide.
Iranian reduction
Yet in Iran, where more than 60% of prisoners are incarcerated for drug-related crimes, HIV prevalence among injecting drug users in prisons dropped from 18.2% in 2003 to 2.3% in 2007.
This was down to a combination of voluntary HIV testing, OST, condoms, and needle and syringe exchange programmes.
Professor Beyrer added:
“The response to the HIV, tuberculosis, and hepatitis epidemics in prisons has been slow and piecemeal, and the majority of governments continue to ignore the strategic importance of prison health care to public health.
“Most strategies for dealing with infectious diseases in prisons focus on a zero-tolerance approach to drug users.
“The fact that infection rates are still climbing confirms that this approach does not work.”
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