HIV In Prisons Research Articles

Imprisonment for South Ethiopian people living with HIV presents a double health burden: lived experiences of prisoners.

Optimal adherence is crucial for ensuring both therapeutic and preventative benefits of antiretroviral therapy (ART). Sub-optimal adherence is common in prisoners and little information is available about its predisposing circumstances in resource-limited settings. We explored lived experiences of inmates living with HIV (ILWH) and experiential accounts of service providers in South Ethiopia to identify barriers to and facilitators of HIV care use in the prison context. We conducted qualitative in-depth interviewing with eleven ILWH and eleven service providers. Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging concepts. We employed a descriptive phenomenological approach to abstract meaning attributed to the prisoners' lived experiences in relation to HIV care use and service providers' experiential account regarding care provision as presented to our consciousness. Several concepts emerged as barriers to HIV care use amongst ILWH in South Ethiopia including: limited access to standard care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, and food supply insufficiency. In addition to a unique opportunity offered by an imprisonment for some ILWH to refrain from health damaging behaviours, the presence of social support in the prison system facilitated care use. This study identified important structural and social contexts that can both hinder and enhance HIV care use amongst ILWH in South Ethiopia. Given the disproportionate burden of HIV in prisoners and the potential of transmission to others during and after incarceration, development of contextually-responsive strategies is required to address the barriers and to also strengthen the enablers.

An epidemic behind the bars: AIDS in American prisons

Recommendation:By analyzing current research, the article provides useful strategies to prevent, detect, and treat HIV infection among the incarcerated population in the United States, emphasizing the critical need for interventions to mitigate the impact of the HIV epidemic among prisoners.Objective:The aim of this text is to present the challenges associated with the spread of the virus in the population incarcerated in correctional facilities and to emphasize the difficulties that the prison system faces in this context.Materials and Methods: Review of available literature using PubMed and Google Scholar platforms. Results and Conclusions: The article presents complex relationships between HIV infection and the prison system, emphasizing specific challenges and risk factors for infection. The history and evolution of the virus, its impact on the lives and health of prisoners, and issues related to treatment within the prison environment are discussed. The epidemiology of HIV in prisons is analyzed, pointing out positive trends, but further action is necessary. Ongoing intervention, improvement of access to healthcare, and collaboration are essential to effectively manage the issue of HIV infection among incarcerated individuals.Implications: The article implies that effective management of the HIV problem in the prison system requires a comprehensive approach, encompassing preventive strategies, equal access to healthcare, integration of care before and after release, elimination of racial and social disparities, as well as interinstitutional cooperation.

Koping Positif Warga Binaan Pemasyarakatan dalam Menghadapi Stigma dan Diskriminasi

Introduction: Stigma and discrimination are more common among women and affect the development of coping skills for women with HIV. Research related to coping strategies for prisoners with HIV in prisons is still very limited. This study aimed to identify the positive coping methods used and the reasons for using these coping strategies in dealing with stigma and discrimination against female inmates with HIV.Methods: This research method is a qualitative descriptive phenomenological design. The population of this study was female inmates living with HIV with a total of eight participants. Sampling was done by purposive sampling technique. Data was collected through in-depth interviews and analyzed using the Colaizzi technique.Results: The results of the study found two themes: (1) don't care and stay away from people who cause stigma to avoid problems; (2) attract sympathy and be honest with others to lighten the burden on the mind.Conclusion: Indifference certainly does not always have positive but also negative implications such as the emergence of disputes or divisions and individualism among prisoners. Meanwhile, active coping such as telling the truth can improve prisoners' physical and psychological well-being. The development of intervention programs such as narrative enhancement and cognitive therapy (NECT), family therapy, spiritual emotional freedom technique (SELF), and HIV peer support groups in prisons to develop active coping for female inmates with HIV in facing internal and public stigma is urgently needed. Keywords: Coping, Correctional Setting, Discrimination Stigma, HIV.

Koping Positif Warga Binaan Pemasyarakatan dalam Menghadapi Stigma dan Diskriminasi

Introduction: Stigma and discrimination are more common among women and affect the development of coping skills for women with HIV. Research related to coping strategies for prisoners with HIV in prisons is still very limited. This study aimed to identify the positive coping methods used and the reasons for using these coping strategies in dealing with stigma and discrimination against female inmates with HIV.Methods: This research method is a qualitative descriptive phenomenological design. The population of this study was female inmates living with HIV with a total of eight participants. Sampling was done by purposive sampling technique. Data was collected through in-depth interviews and analyzed using the Colaizzi technique.Results: The results of the study found two themes: (1) don't care and stay away from people who cause stigma to avoid problems; (2) attract sympathy and be honest with others to lighten the burden on the mind.Conclusion: Indifference certainly does not always have positive but also negative implications such as the emergence of disputes or divisions and individualism among prisoners. Meanwhile, active coping such as telling the truth can improve prisoners' physical and psychological well-being. The development of intervention programs such as narrative enhancement and cognitive therapy (NECT), family therapy, spiritual emotional freedom technique (SELF), and HIV peer support groups in prisons to develop active coping for female inmates with HIV in facing internal and public stigma is urgently needed. Keywords: Coping, Correctional Setting, Discrimination Stigma, HIV.

Prevalence and Risk Factors of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Infections among Prisoners Admitted to DMCH

Background: There are approximately 66 thousand prisoners remained in 68 prisons in Bangladesh. (source: Kara Adhidoptar, Bangladesh). So these number of prisoners suffers from different diseases. Prisoners are associates with various high risk of infectious diseases, as a result of the possibility of transmission of infections in prisons surroundings. A high prevalence of blood borne hepatitis viruses and HIV carried out in correctional facilities around the world by investigations have shown. There are limited data on medical disorders among prison inmates in Bangladesh. The study was aimed at confirming prevalence of HIV, hepatitis B and hepatitis C as well to assess knowledge and attitudes related to HIV, HBV and HCV infections among prisoners admitted to DMCH who referred to medicine department and/ or attended out-patient department in DMCH. Objective: To determine the prevalence and risk factors of HIV, HBV and HCV infection among prisoners referred to tertiary care hospital. Methods: This cross sectional study was done with a total number of 100 inmates over a period of one year. Prisoners, imprisonment for more than six months and who gave consent voluntarily were included in the study. After taking consent from the patient’s/guardians history was taken and physical examination was done. Sample was selected from the population by purposive sampling technique. Data were analysis was done using SPSS version 22.0. Result was expressed in tables and graphs. Results: The results showed a significantly higher seroprevalence of HBV (6%) and HCV (4%) though no prisoner was found to be HIV positive compared to the seroprevalence of these virus infections reported in the general Bangladeshi population (5.8% for HBV and 0.3% for HCV). Exposure of risk factors estimated H/O foreign travels 12%, IV drug abuse 14%, extramarital sexual exposure 16%, sharing of needle 10%, H/O blood transfusion 08%, family H/O diseases 05%, immunization of hepatitis B only 8% and homo sexuality 0%. Risk factors for HBV infection was estimated-family h/o disease 20%, IV drug abuse 7.10%, sharing of needles & syringes 10%, sexual exposue12.50%, blood transfusion 12.50%. Risk factors for HCV infection was estimated -IV drug abuse 7.10%, sexual exposue6.25%, sharing of needles & syringes 20%. Risk factors for HIV infection 0% for all risk factors as no one was HIV infected. Among the IDUs 14% was HBV positive and 30% was HCV positive. Conclusion: The results indicate higher prevalence of HBV and HCV infections among prisoners which has proven that HBV and HCV are the emerging public health problem in a developing country like Bangladesh. Various risk factors contribute to raise prevalence of hepatitis B, hepatitis C and HIV in prisoners. So avoidance from these risk factors is essential to prevent transmission of infection in prison. So health education and dissemination of message about the moods of transmission of these diseases is very important in prison.

HIV testing inside Brazilian female prisons: results of a national survey

ABSTRACT This study aimed to identify the prevalence of women in prisons who have already had an HIV test inside prison and the factors associated with this test. A cross-sectional study was carried out with 1327 women in 15 prisons in 9 states in Brazil. Almost 60% (95% CI: 57.8–63.7) of women have already been tested for HIV in prison. The factors associated with this HIV test were age ≥41 years (OR = 1.9; 95% CI = 1.2–2.9), highest level of education (OR = 1.9; 95% CI = 1.3–2.8), having been arrested 3 or more times (OR = 1.9; 95% CI = 1.3–2.8), having received information about HIV/STI in the lifetime (OR = 1.4; 95% CI = 1.1–1.9) and perceived themselves to be at no risk for HIV infection (OR = 1.7; 95% CI = 1.2–2.5), black or mixed race (OR = 0.7; 95% CI = 0.5–0.9) and having a male sexual partner (OR = 0.6; 95% CI = 0.5–0.9). The routine HIV testing in prisons needs to be expanded to promote HIV prevention for a population with limited access to these services outside of prison.

Sexually transmitted infections in the penitentiary system (analysis of scientific publications and own data)

Objective — assessing the current prevalence of sexually transmitted infections (STIs) and HIV in prisons in the context of a holistic consideration of the problem, and taking into account our own pilot studies on the prevalence of herpes simplex virus infection type 1 (HSV-1) and disorders of the psycho-emotional state of patients.
 Materials and methods. The search was carried out in accordance with the recommendations of PRISMA 2009, 2020 (The Preferred Reporting Items for Systematic reviews and Meta-Analyses). The data of own research of 33 convicted men and 29 women are also presented.
 Results and discussion. Among 33 convicted men, IgM HSV-1 markers were diagnosed in 6.7 % cases, and among 29 women — in 4.9 % cases, IgG HSV-1 markers — in 92.8 % and 96.9 % cases, respectively. In the process of assessing the psycho-emotional state of patients with HSV-1 markers, the average scores on the scale of anxiety and depression (HADS) ranged from 7.6 to 8.9 points, which directly correlated with the duration of the disease, the number of exacerbations and rash in the labial, genital and perianal areas (61.9—71.4 %).Despite the difficult material, logistical and sanitary conditions in penitentiaries, they may be more favorable to the vast majority of convicts than the way of life they lived in freedom, given the fact that vulnerable groups often do not have adequate access to health care services. For most of them, imprisonment is an opportunity to get the treatment, preventive measures and basic health information they need.
 Conclusions. The significant prevalence of STIs/HIV in the penitentiary institutions of the world has been confirmed. Among convicts in Ukraine, serological markers of HSV-1 are quite common.

Determinants of coinfection tuberculosis and HIV in prisons in Brazil.

Prisons context has the potential for the spread of infectious diseases, like HIV and tuberculosis, which prevalence is higher in the people deprived of liberty compared to the general population. to analyze which are the determinants of coinfection tuberculosis and HIV in prisons. Case-control study conducted in the state of São Paulo, Brazil. New cases of tuberculosis in the population deprived of liberty in the period between 2015 and 2017 were considered. Data were obtained through the notification and monitoring system for tuberculosis cases in the state of São Paulo and included sociodemographic and clinical variables and diagnosis and treatment information. The data were analyzed through frequency distribution and bivariate analysis, testing the association of the dependent variable (tuberculosis/HIV coinfection vs. tuberculosis/HIV non-coinfection) with independent variables (sociodemographic, clinical and diagnostics variables) by calculating the odds ratio and p-value. Among the determinants of tuberculosis/HIV coinfection in prisons, we identified: age between 26-35, 36-55 and 56-84 years, notification in hospitals, negative sputum smear microscopy and culture, X-ray suggestive of another pathology, extrapulmonary and mixed clinical form, and alcoholism. A high percentage of death was also identified among coinfected people. identifying the determinants of the tuberculosis/HIV coinfected individual can assist in the development and implementation of guidelines aimed at controlling both infections in the prison environment.

90-90-90 for everyone?: Access to HIV care and treatment for people with HIV who experience imprisonment in Ontario, Canada

ABSTRACT We examined HIV care and treatment in prison and after release for people with HIV in Ontario, Canada, and compared HIV care and treatment with the general population. We used administrative data to identify people with HIV released from provincial prison in 2010 and in the general population. We calculated the proportion of people with HIV who accessed HIV care in prison. We compared HIV care use between people with HIV on prison release and in the general population. We estimated the proportion of people with HIV on antiretroviral therapy in prison as the ratio of the average numbers of people prescribed antiretroviral therapy in prison in 2009/2010 and people with HIV in prison in January 2010. We compared the proportion of people with HIV on public drug benefits that filled an antiretroviral therapy prescription within 6 months for people postrelease and in the general population. Of 344 people with HIV on prison admission, 34.0% received HIV care in prison. Over 1 year, 63.6% of 330 people with HIV on prison release and 67.7% of 15,819 people with HIV in the general population accessed HIV care (p = 0.118), and 43.3% of people with HIV on prison release and 55.2% of people with HIV in the general population had 2 or more HIV care visits (p < 0.001). In prison, 52.4% of people with HIV (39.5/75.4) were on antiretroviral therapy. Of those accessing drug benefits, 60.1% of 226 people with HIV on prison release and 79.6% of 7458 people with HIV in the general population claimed an antiretroviral therapy prescription within 6 months (p < 0.001). Access to HIV care and treatment were suboptimal in prison, and sustained HIV care and treatment were worse for people post-release compared to the general population. Interventions are needed to support HIV care for this population.

Tales from behind the Wall: ACT UP/Philadelphia and HIV in Prisons

Tales from behind the Wall: ACT UP/Philadelphia and HIV in Prisons

Изучение экзистенциальных ценностей ВИЧ-инфицированных осужденных к лишению свободы

According to statistics from the Federal Penal Service of Russia annually 80–85% of convicts arriving at institutions of the penal system have chronic diseases. The number of people infected with HIV in prisons and colonies is growing every year. Correctional and educational work with this category of convicts has its own characteristics and requires the adoption of additional organizational and other measures to overcome their personal deformations, the formation of law-abiding behavior and social adaptation in terms of imprisonment. At the same time special attention is paid to existential values in connection with the loss by many convicts the meaning of life, the prospects of release from places of detention. Within the framework of the existential approach the correctional process appears as a flexible, variable system, where the actual differentiation of upbringing influences takes place. Also the content of the correctional process is purposefully shaped and enriched with moral values, meanings, traditions for the purpose of personal self-realization and self-esteem, helps the convicted person to understand the semantic sphere of his behavior and actions, to cope with negative emotional states, to develop a meaningful reference point. In order to study the existential sphere of HIV-infected convicts a study was conducted on the basis of the PKU SIZO-10 of the Federal Penal Service of Russia in the Moscow region, in which 30 HIV-infected men aged from 20 to 45 took part. A specially developed technique and questionnaire “Events of my life” of G.S. Nikiforova was offered for convicted. As a result of this study data were obtained indicating that the general condition of convicts with HIV infection and the social environment in which it is located have a significant impact on the presence and awareness of the meaning of life. These convicts do not see positive prospects in the future. The values associated with communicating with loved ones, family, understanding and compassion for them in the current situation come for them to the fore. Convicts with HIV infection are characterized by a low level of general meaningfulness of the future life and the past, which is expressed in the absence of goals and temporal perspectives, dissatisfaction with self-realization, a low level of selfcontrol and controllability. The article makes a number of recommendations for penal psychologists to work with this category of persons. Further individual in-depth analysis of the data obtained may become a promising study on the relationship of HIV-infected convicts to their own lives.

RELATIONS OF IMPROVEMENT OF DRUG USERS AND THE AVAILABILITY OF MEDICAL PERSONS WITH HIV / AIDS IN Correctional Institutions

The change of health paradigm on the world causing policy’s transformation and public concern regarding enhancement on Indonesian health rate rating. Medical problem happens in every line of social life, especially at Correctional Institutions and Correctional Detention Center as the place for criminals. Narcotics as one of the biggest problems in Correctional Sub-organizations are still one of the biggest contributors on overcrowded prison situations. This research intends to describe correlation between drug users and prisoners with HIV in prison. Methods being used are statistic correlative with qualitative approach which data obtained from Correctional Database System. Those data are narcotics users and prisoners with HIV in Correctional Suborganizations at 33 Ministry of Law and Human Rights Region Office. It can be concluded that the correlation between two variables is moderate relation.

Prevalence and associated risk factors of HIV in prisons in Balochistan, Pakistan: a cross-sectional study.

Background: The prevalence of HIV is 0.1% in Pakistan, with epidemicity in high-risk groups. The infection is on verge of transmission from key populations to the general population through people who inject drugs and sexual transmission. Prisoners are vulnerable to infectious diseases like HIV. This study was conducted in four prisons in Balochistan, Pakistan to determine the prevalence of HIV and associated risk factors. Methods: This cross sectional study was conducted from March to June 2018, in the prisons of Balochistan. WHO-approved rapid diagnostic kits were used for determining the prevalence of HIV and structured interviews were conducted for the assessment of risk factors. Results: Out of 2084 screened prisoners, 33 (1.6%) were found to be positive. A subset of 104 interviews was analyzed for risk factors of HIV. Among HIV-infected prisoners 68.8% (OR 4.48; 95% CI 1.41-14.2) had extramarital sex, 43.8% (OR 2.09 95% CI 0.69-6.28) had a homosexual experience, and 50% had a history of needle sharing (OR 43; 95% CI 7.77-237). About 94% (OR 16.42; 95% CI 2.09-129.81) of prisoners had a history of drug addiction of any type while 50% (OR 13; 95% CI 2.82-60.01) of HIV-infected had a history of using injectable drugs. Around 75% of HIV-infected prisoners had spent 1-5 years in prison, and 25% had spent more than 10 years. Conclusion: The high prevalence of HIV in prisons of Balochistan demands that preventive and treatment strategies should be designed and implemented carefully, allowing early diagnosis and treatment initiation to minimize the spread of infection among the prisons and ultimately their onward transmission into the community.

Prevalence of Tuberculosis in HIV-positive Prisoners: A Systematic Review and Meta-analysis.

The prevalence of TB among HIV-positive prisoners is high worldwide. Screening of TB in this population is essential for the treatment of both diseases. Syndemics of TB and HIV in prisoners during the past three decades have created an alarming situation across the world. Hence, coordinated policies are essential for the early identification and effective treatment of this vulnerable population.

Prevalence and associated risk factors of HIV in prisons in Balochistan, Pakistan: a cross-sectional study

Background: The prevalence of HIV is 0.1% in Pakistan, with epidemicity in high-risk groups. The infection is on verge of transmission from key populations to the general population through people who inject drugs and sexual transmission. Prisoners are vulnerable to infectious diseases like HIV. This study was conducted in four prisons in Balochistan, Pakistan to determine the prevalence of HIV and associated risk factors. Methods: This cross sectional study was conducted from March to June 2018, in the prisons of Balochistan. WHO-approved rapid diagnostic kits were used for determining the prevalence of HIV and structured interviews were conducted for the assessment of risk factors. Results: Out of 2084 screened prisoners, 33 (1.6%) were found to be positive. A subset of 104 interviews was analyzed for risk factors of HIV. Among HIV-infected prisoners 68.8% (OR 4.48; 95% CI 1.41-14.2) had extramarital sex, 43.8% (OR 2.09 95% CI 0.69-6.28) had a homosexual experience, and 50% had a history of needle sharing (OR 43; 95% CI 7.77-237). About 94% (OR 16.42; 95% CI 2.09-129.81) of prisoners had a history of drug addiction of any type while 50% (OR 13; 95% CI 2.82-60.01) of HIV-infected had a history of using injectable drugs. Around 75% of HIV-infected prisoners had spent 1-5 years in prison, and 25% had spent more than 10 years. Conclusion: The high prevalence of HIV in prisons of Balochistan demands that preventive and treatment strategies should be designed and implemented carefully, allowing early diagnosis and treatment initiation to minimize the spread of infection among the prisons and ultimately their onward transmission into the community.

Prevalence and associated risk factors of HIV in prisons in Balochistan, Pakistan: a cross-sectional study

Background: The prevalence of HIV is 0.1% in Pakistan, with epidemicity in high-risk groups. The infection is on verge of transmission from key populations to the general population through people who inject drugs and sexual transmission. Prisoners are vulnerable to infectious diseases like HIV. This study was conducted in four prisons in Balochistan. Pakistan to determine the prevalence of HIV and associated risk factors. Methods: This cross sectional study was conducted from March to June 2018, in the prisons of Balochistan. WHO-approved rapid diagnostic kits were used for determining the prevalence of HIV and structured interviews were conducted for the assessment of risk factors. Results: Out of 2084 screened prisoners, 33 (1.6%) were found to be positive. A subset of 104 interviews were analysed for risk factors of HIV. Among HIV-infected prisoners 68.8% (OR 4.48; 95% CI 1.41-14.2) had extramarital sex, 43.8% (OR 2.09 95% CI 0.69-6.28) had homosexual experience, and 50% had history of needle sharing (OR 43; 95% CI 7.77-237). About 94% (OR 16.42; 95% CI 2.09-129.81) of prisoners had history of drug addiction of any type while 50% (OR 13; 95% CI 2.82-60.01) of those infected with HIV had a history of using injectable drugs. Around 75% of HIV-infected prisoners had spent 1-5 years in prison, and 25% had spent more than 10 years. Conclusion: The high prevalence of HIV in prisons of Balochistan demands that preventive and treatment strategies should be designed and implemented carefully, allowing early diagnosis and treatment initiation to minimize the spread of infection among the prisons and ultimately their onward transmission into the community.

Ethical and Social Issues in Health Research Involving Incarcerated People.

The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.

Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia.

The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

Enquête comportementale et sérologique sur le VIH/sida chez les détenus à Nouakchott (Mauritanie)

In Mauritania, epidemiological data estimate national HIV prevalence to less than 1%. Our study is the first joint survey on HIV/AIDS conducted among prisoners in Mauritania. It is a cross-sectional survey with anonymity and informed consent. The study covered a sample of 296 prisoners enrolled in a population of 706 prisoners held in Nouakchott. The sex ratio was 14.6. The refusal rate of blood sample was 4.7%. HIV prevalence in the sample was 3.9%. 53.37% of prisoners knew the concept of seropositivity but only 7.4% had a perfect knowledge of the ways of HIV transmission untainted by false beliefs. The results showed that 99% of prisoners knew that the condom is a means of protection against HIV infection, but they also showed many false beliefs about protection against HIV in the majority of prisoners. Indeed, 98.49% of respondents said they protected themselves by avoiding sex with strangers and 94.97% of them thought that sex with young girls or virgins are protection against HIV. Nearly one quarter of the prisoners did not have a good perception of risk of contracting HIV in prison although homosexual relations between prisoners have been reported. This study showed that prisoners in Mauritania are a vulnerable group to HIV because the prevalence of HIV in this group was higher than the national prevalence and this sub-population was unfamiliar with the disease and adopt risk behaviors.

People who inject drugs in prison: HIV prevalence, transmission and prevention

In 2011, over 10.1 million people were held in prisons around the world. HIV prevalence is elevated in prison and this is due to the over representation of people who inject drugs (PWID). Yet HIV prevention programs for PWID are scarce in the prison setting. With a high proportion of drug users and few prevention programs, HIV transmission occurs and sometimes at an alarming rate.This commentary focuses primarily on drug users in prison; their risk behaviours and levels of infection. It also comments on the transmission of HIV including outbreaks and the efforts to prevent transmission within the prison setting.The spread of HIV in prison has substantial public health implications as virtually all prisoners return to the community. HIV prevention and treatment strategies known to be effective in community settings, such as methadone maintenance treatment, needle and syringe programs, condoms and antiretroviral therapy should be provided to prisoners as a matter of urgency.