The Lancet Special Theme Issue: HIV, Viral Hepatitis, and TB among Prisoners

The Lancet Special Theme Issue:  HIV, Viral Hepatitis, and TB among Prisoners

Lancet July 2016 issue has been dedicated to prisoner health, with more information online available from the Lancet website.  It is a sincere hope that this issue and discussions raised at this conference will influence the care of prisoners around the globe.

In this sessions the lead authors presented: a global review of the burden of HIV, viral hepatitis and TB among prisoners; clinical care among incarcerated women and men; best practice for prevention in prisons and jail; human rights and right to health access; and two region-specific presentations- on prisoners in Eastern Europe and Central Asia and Sub Saharan Africa.  Kate Dolan from UNSW presented on the Global epidemiology of HIV, HCV and TB in prisoners.

Annually 30 million people are passing through some form of detention.  These people are at high risk of acquiring and transmitting infections due to risk that are in play before and after incarceration.

Developed nations are not leading by example with US having the highest incarceration rates in the world, with blacks over represented  in the prisons.   Only eight countries have needle and syringe exchange programmes in prison.  The focus of incarceration should be rehabilitation. 

There is a moral and legal imperative to provide appropriate care to prisoners.  Only by including them and other marginalised populations in the global HIV/AIDS response, will the fast-tract to accelerate the fight against HIV and to end the AIDS epidemic by 20130 become a reality.

Recommendations:

•  Reduce incarceration for key populations, especially people who inject drugs
• Introduce and scale-up HIV prevention with Opioid Agonist Therapy, Needle Syringe programmes and Anti Retroviral therapy, including effective transitional programs post-release
• Improve testing and treatment strategies (continuum of care) for HIV, HCV and TB.
• Eliminate the gap between prison and community treatment and prevention services, including structural impediments for service delivery and continuity.
• Integrate services given the high rate of medical and psychiatric co-morbidity.

The Standard Minimum Rules for the Treatment of Prisoners were first adopted in 1957, and in 2015 were revised and adopted as the Nelson Mandela Rules with eight substantive areas revised. By the UN General Assembly in December 2015.   

UN Standards on Treatments of Prisoners -- Mandela Rules (2015)

·         Prisoners must be managed in a manner to respect and protect the human rights and dignity of prisoners. 

·         Prison should be viewed as a place for preparation for reintegration of prisoners and society - minimise differences with outside world. 

Adequate space, food, sanitation.

No discrimination.

Health care to meet prisoner's needs throughout detention and linkage to public health.

Monitoring and accountability.

“It is said that no one truly knows a nation until one has been inside it jails.  A nation should not be judged by how it treats it highest citizens, but its lowest ones.”…………Nelson Mandela