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People who end up in jail often come from situations that leave them at greater risk of contracting HIV. When imprisoned, the dangers multiply as many face overcrowded cells and lack basic nutrition, health, hygiene, and the ability to protect themselves from infection. Young people in prison face particularly high prevalence of poor mental health.
“HIV incidence in prisons of Eastern Europe and Central Asia is 10 to 20 times – and in Russia 30 times – higher than in the general population of that country. Tuberculosis rates in many prisons are 10 to 100 times higher than in the communities outside the prisons. We want to deliver this message to the international donor institutions while some of them have decided to discontinue supporting HIV prevention programs in that region,” says Anke Van Dam, AIDS Foundation East-West’s executive director.
Without adequate care and treatment, disease spreads, drug resistance develops, and HIV transmission occurs to other prisoners, staff, visitors – and eventually the community to which most prisoners and their health problems return.
“Turning the tide against the global AIDS epidemic will not be successful without paying attention to what happens in prisons, including access to treatment, prevention and justice,” says Dr John P May, president of Health Through Walls, as its film on conditions in a Haiti prison demonstrates in lurid detail:
Prisoners around the world are disproportionately affected by HIV and their incarceration offers the opportunity to directly reach people most at risk to HIV with medical interventions, yet responses to improve the conditions in which prisoners live have so far been limited.
HIV prevention and care for prisoners
Most inmates come from poor communities or high risk environments. Often, they will have had little prior exposure to regular healthcare services. Correctional healthcare programs are uniquely positioned to screen and identify health conditions of which a prisoner might have been previously unaware. This creates an opportunity for someone to be made more aware about health and disease, meaning they might adopt lower risk behaviours, which in turn reduces the burden on public health.
World health experts recognize prisons as important points of intervention for the control, identification and treatment of HIV and infectious diseases. Prison-based health interventions are proven to be beneficial and effective, resulting in better health levels in prisons and the communities in which prisoners live post-release. Prison health professionals in most countries understand this potential but often lack the resources to implement and sustain effective disease risk reduction, techniques and strategies.
An interesting and innovative first step is addressing this issue is happening now at the 19th International AIDS Conference. The first ever Prisoners Networking Zone, the brainchild of AIDS Foundation East-West and Health Through Walls, is providing an open space for medical and non-medical professionals who work with prisoners to deliberate on challenges and opportunities in providing viable healthcare access, treatment and prevention, as well as justice and human rights, to prisoners.
The health of prisoners has consequence for everyone. HIV respects neither the borders of prison walls nor the borders of national shores. Adequate prisoner health not only controls HIV it also contributes to safe, secure, and humane institutions - part of establishing a global society of justice, prosperity, and peace.
Advocating for community response and resources to address the health issues of incarcerated persons ultimately benefits the health of us all.
Ishdeep Kohli is a member of the Key Correspondents team, a global network of community-based writers from around 50 countries across Asia, Africa, Latin America and the Caribbean supported by the International HIV/AIDS Alliance. A large number of KCs are people living with or affected by HIV. All are volunteers and include those working in advocacy, media, health and development. Follow the KC team on Twitter @thekcteam.