Vanessa Towell, Program Manager, ASHM National Policy & Education Division
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Good prisoner health is good public health
Professor Kate Dolan from the National Drug and Alcohol Research Centre, UNSW, presented data from their global systematic review of the HIV situation in prisons, which looked at imprisonment rates, HIV prevalence, HIV incidence, AIDS-related mortality, and services provided in prison, in the time period under observation from 2008 to 2013.
The review identified that 30 million individuals enter and leave prison per year, leading to the conclusion that good prisoner health is good public health, as any diseases contracted in prison, or made worse by poor conditions in custodial settings, returns to the community.
Drug dependence is a key factor in imprisonment in Australia, with 84% of people who inject drugs in Australia re-incarcerated within two years of release and the mean number of prison sentences sitting at 5. Whilst HIV prevalence is very low amongst Australian prisoners, transmission remains a risk and the prevalence of hepatitis B and hepatitis C has remained high.
Dr Fabienne Hariga, from the United Nations Office on Drugs and Crime then outlined a comprehensive package of 15 interventions for HIV prevention, treatment, and care in prisons, in particular looking at the introduction of needle and syringe program (NSP) into prisons, which she stated should be the number one priority.
Dr Hariga outlined evidence from the evidence for action technical paper entitled Interventions to Address HIV in prisons: Needle and syringe programmes and decontamination strategies, which spoke to the feasibility and effectiveness of NSP in prison settings.
However, Dr Hariga conceded that current coverage of NSP in prisons is very low and many programs have not been sustainable to due strict controls implemented and a lack of confidentiality and anonymity, resulting in low uptake of the program by prisoners.
She concluded that a mixed model incorporating peer-based distribution, dispensing machines, and a health service, seems the best measure as part of a comprehensive package of interventions.