Imprisonment link to HIV spread

Angus Morgan

15 July, 2016

Reducing imprisonment rates among people who inject drugs will be crucial to preventing the wider spread of HIV, viral hepatitis and tuberculosis over the next 15 years.

That’s a key finding of a Burnet-supported study, Global burden of HIV, viral hepatitis and tuberculosis among prisoners and detainees, published in The Lancet to coincide with the 21st International AIDS Conference (AIDS 2016), in Durban.

“The prison environment presents both a challenge and an opportunity,” co-author, Professor Margaret Hellard, Head of Burnet’s Centre for Population Health, said.

“We know that the prevalence of blood-borne viruses – HIV, hepatitis C (HCV), hepatitis B (HBV), as well as tuberculosis is higher in the prison setting than in the general community.

“Invariably this is related to people coming from very vulnerable backgrounds, including an over-representation in many places of people who inject drugs, so it’s not surprising.

“What is surprising though is that we don’t use the incarceration of prisoners as an opportunity to improve their health care.

“Providing HIV and hepatitis C treatment in prisons and ensuring more prisoners are vaccinated are simple things we could do.”

Lead author Professor Kate Dolan of the National Drug and Alcohol Research Centre in NSW said the public health risk is not isolated to prisoners themselves, but includes the broader communities in which they circulate.

“Prisons can act as an incubator of HIV and hepatitis and with the high level of mobility of prisoners – an estimated 100,000 people in Australia go through prison each year – so infection transmission in prison is a major public health concern,” Professor Dolan said.

“Our work shows that high rates of imprisonment come at an enormous social and human cost when there is little evidence that imprisonment of injecting drug users has either a deterrent effect or assists with rehabilitation."

Of the estimated 10.2 million people incarcerated worldwide on any given day, the research estimated that 3.8 percent have HIV (389,000 living with HIV), 15.1 percent have HCV (1,546,500), 4.8 percent have chronic HBV (491,500) and 2.8 percent have active TB (286,000).

While it’s likely there is some transmission of blood borne viruses and TB within prisons, the evidence doesn’t suggest huge outbreaks.

“It’s more about opportunities because most prisoners are part of the general community who will spend time in the prison environment, then come back out again,” Professor Hellard said.

“So anything where we’re not trying to provide sensible support and health care, where we’re thinking that they’re locked away, out of sight, out of mind, is actually not helping the individual or the community in response to these infections.

“The key issue is that we are incarcerating many people who are already infected or vulnerable to these diseases, and if we are going to do that we need to set up systems to provide quality care, quality harm reduction to reduce the disease, to reduce the transmission.

“The prison environment in many places throughout the world is not well suited, not set up to do that, but there are opportunities to improve people’s health.”

Professor Dolan will present the study at an AIDS 2016 session on the results of a special theme issue of The Lancet on HIV, HCV and TB among prisoners and detainees.

Contact Details

For more information in relation to this news article, please contact:

Professor Margaret Hellard AM

Deputy Director (Programs); Adjunct Professor, Monash University, DEPM.




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