Infectious diseases in prisons and their prevention

Lifetime prevalence of injecting drug use among prisoners is generally reported to be between 15 % and 50 %; however, some studies have reported values as low as 1 % or as high as 69 %.

Where comparable data are available, they show that young offenders are less likely to inject than adults and that among the prison population women are more likely to inject than men (109). Based on several studies in the EU, Bird and Rotily (2002) have shown that around one-third of adult male prisoners are drug injectors. According to available data provided by the Reitox focal points, between 0.2 % and 34 % of inmates (110) have injected drugs while in prison. This raises issues of access to sterile injection equipment and hygienic sharing practices among the prison population and the potential spread of infectious diseases if these matters are not addressed.

Prisons are a high-risk setting for the spread of such diseases. Among the practices that have proven to be able to reduce infectious diseases are the treatment of sexually transmitted diseases and the provision of condoms, substitution treatment, vaccination programmes and needle and syringe exchange programmes.

Substitution treatment is increasingly provided in prisons. In Belgium, Denmark, Spain, Austria and Slovenia substitution treatment is available in all prisons. Belgium, Denmark, Luxembourg and Norway allow prisoners to start substitution treatment while incarcerated. In Italy initiation of substitution treatment usually targets remand prisoners. Prescriptions for progressively reducing substitution treatment until abstinence is achieved are available in most German Länder, the Netherlands, Slovenia and in prisons serving larger cities in Italy. In the United Kingdom maintenance programmes are considered appropriate mainly for prisoners on remand or serving short sentences.

A specific scheme for hepatitis B vaccination, adapted for prisoners, was recommended in 2002 by the National Immunisation Committee of Ireland. It comprises three consecutive weekly injections with a booster after 12 months and results in 99 % protection at 13 months (Zuckerman, 2003).

A review of 14 international studies examining the effectiveness of needle and syringe exchange programmes in prison settings concluded that such programmes are feasible and result in a reduction in both high-risk behaviours and transmission of blood-borne viruses without any negative consequences such as accidental needlestick injuries or deliberate use of needles as a weapon against prison staff or other inmates (Dolan et al., 2003). During 2002, needle and syringe exchange programmes were implemented in 27 penitentiary centres in Spain and 12 970 syringes were distributed with no incidents reported.

However, in Spain an increasing number of prisons are providing facilities for needle and syringe exchange, such programmes have been discontinued in the German Länder of Hamburg and Lower Saxony (Stöver and Nelles, 2003). Although there is still a needle and syringe exchange programme in one women’s prison in Germany (Berlin). In Josefstadt prison, Vienna, a pilot project is in preparation, and in Luxembourg it is intended to provide injection equipment for drug addicts in prisons under the healthcare programme (Table 11 OL).

Table 11 OL: Socio-health services targeting drug users in EU prisons in 2002

(109) See Prison_Tbl 2 in the 2004 Statistical bulletin.

(110) See Prison_Tbl 4 in the 2004 Statistical bulletin.