Mass incarceration of drug users has driven up global epidemics of HIV, tuberculosis and hepatitis, a new study claims.
Up to 90 per cent of people who inject drugs will be jailed at some point in their lives.
It means prisons act as incubators of diseases contracted from needles.
With an estimated 30 million people passing in and out of prisons every year, convicts are key to controlling HIV and tuberculosis epidemics worldwide, warn experts in a major six-part series published in The Lancet.
The study being presented at the International AIDS Conference in Durban, South Africa, this week urges nations to introduce reduction and treatment strategies for addicts in the penal system.
Favoring imprisonment over rehabilitation is a recipe for disaster, the authors warn.
With an estimated 30 million people passing in and out of prisons every year, convicts are key to controlling HIV and tuberculosis epidemics worldwide, warn experts in a major six-part series published this week
‘The high level of mobility between prison and the community means that the health of prisoners should be a major public-health concern,’ says lead author Professor Chris Beyrer, president of the International AIDS Society.
‘Screening and treatment for infectious diseases are rarely made available to inmates, and only around 10 per cent of people who use drugs worldwide are being reached by treatment programs.
‘The most effective way of controlling infection in prisoners and the wider community is to reduce mass imprisonment of injecting drug users.’
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Professor Beyrer, a professor at John Hopkins Bloomberg School of Public Health in Baltimore, found lowering the number of prisoners who inject drug by 25 per cent could cut new HIV infections by 15 per cent in just five years.
Coupling that with more opioid agonist therapy (OAT) and antiretroviral therapy (ART) could prevent more than a quarter (28 per cent) of new HIV cases in five years, he says.
New research completed for the study showed HIV infections are three times higher among American prisoners than in the civilian population – 1.3 per cent as opposed to 0.3 per cent.
In western Europe, levels of HIV infection are 20 times higher among prisoners than in the civilian population – 4.2 per cent vs 0.2 per cent.
This figure is growing as the number of female prisoners grows, the study found.
Professor Beyrer, president of the International AIDS Society, found lowering the number of prisoners who inject drug by 25 per cent could cut new HIV (pictured) infections by 15 per cent in just five years
DAILY HIV PREVENTION DRUGS ‘CUT NEW CASES BY 33% IN 10 YEARS’
A daily pill to prevent HIV infection could reduce new cases among men who have sex with men by a third in the next 10 years, experts said today.
A new modelling study has shown the great potential to curb the disease in the US.
But, this expected and significant drop in HIV incidence, will however, depend on doctors prescribing the drugs according to federal guidelines.
And furthermore, it will require patients to use the medication as directed.
The pre-exposure prophylaxis (PrEP) drug, Truvada, was approved by the US Food and Drug Administration for daily use to prevent HIV in 2012.
An increasing body of scientific work has shown PrEP is highly effective, reducing the risk of getting HIV from sex by more than 90 per cent when it is used consistently.
In 2014, the Centers for Disease Control and Prevention (CDC) issued guidelines for PrEP’s use in clinical practice.
Hepatitis C is also prevalent in jails.
One in six inmates in parts of the US and Europe carry the virus.
And across the world, tuberculosis is higher in prisons than among the civilian population.
In Brazil, the level of TB infections in prisons is 40 times higher than in the general population.
Consequently, up to half of all new HIV infections over next 15 years in eastern Europe are expected to stem from inmates who inject drugs.
Prisons will also fuel tuberculosis diagnoses, driving them up by six per cent, according to new estimates calculated for the study.
‘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,’ says Professor Beyrer.
‘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.’
He adds: ‘Reforming laws and policies that criminalize drug use and sexual behaviors will be crucial to reducing prison populations that put large numbers at risk of potentially life-threatening infections, and which can be more effectively prevented and treated in community settings.
‘Non-violent drug-offenders, especially women, should be offered treatment as an alternative.’
The study concedes that many countries make it compulsory for prisons to offer treatment.
However, such programs are severely underfunded in all countries, both high- and low-income.
Furthermore, prison health services and national public health programs rarely work together.
Only eight countries in the world – Moldova, Armenia, Kyrgyzstan, Germany, Luxembourg, Portugal, Spain, and Switzerland – provide all six interventions recommended to combat infectious diseases in prisons
The authors reviewed six of the fifteen key interventions for the prevention and treatment of infectious diseases in prisons recommended by WHO/UNOCD: information (education, communication), counselling and testing, sterile needle exchange, OAT, condom provision, and ART.
Yet, globally, only eight countries (Moldova, Armenia, Kyrgyzstan, Germany, Luxembourg, Portugal, Spain, and Switzerland) provide all six interventions.
In 2014, only 43 countries offered OAT in at least one prison and less than one per cent of prisoners worldwide who need it actually receive this treatment.
In western Europe, only a third (10 of 29) of surveyed countries reported hepatitis C screening programs for prisoners.
And in 2012, ART was available to prisoners in just 43 countries worldwide.