Prison Population Research Articles

Self-administered sexual health testing in an open prison setting: a pilot health impact assessment and social return on investment analysis.

The sexual health of the male prison population is often among the poorest in a country. This paper aims to identify the wider health impacts and social value of a sexual health self-sampling programme offered to male prisoners in an open prison setting in Wales. This study applied a unique pilot approach of using Health Impact Assessment and Social Return on Investment Frameworks in tandem. Key stakeholder groups affected by the intervention were identified, and engaged with through workshops, interviews and questionnaires to identify and quantify the health impacts and wider outcomes. Outcomes were then valued using proxy financial values to present the overall estimated social value of the self-sampling service. Based on a small sample, results indicate that for every £1 spent on the self-sampling service in the prison, a potential value of £4.14 was created. This resulted in a ratio of £4.14:£1. Approximately one-third of the value created (£1,517.95) was categorised as monetarily returnable, whereas the remaining value (£3,260.40) was purely illustrative social value, for example improved mental well-being. This unique pilot study demonstrates the health impacts and wider social value of providing a self-sampling sexual health service to prisoners within an open prison setting. By innovatively testing the feasibility of using a Health Impact Assessment process alongside Social Return on Investment analyses, this paper has outlined how the frameworks can be used in synergy to illustrate not just direct return on investment but also the social value of providing such a service.

Disparity and Fragmentation of Formal and Non-Formal Education in Men's Prisons in the Metropolitan Region, Chile

Objective: The goal of this study is to map the education provided in contexts of confinements in the Metropolitan Region of Chile. This article focuses on the manners in which formal and non-formal education is developed in male penitentiaries, those with the largest prison population. Theoretical Framework: The concepts of legal prison and real prison, as well as theories on the purposes of prison education, serve as a basis for the study, giving rise to various ways of implementing education. Method: The methodology is qualitative and the sample includes the total of the prisons in the Metropolitan Region. The sequential design includes a survey in prisons, semi-structured interviews and discussion groups from 68 institutions that provide education in prisons. Results and Discussion: A great disparity and fragmentation of formal and non-formal education in prisons, lack of articulation, low coverage and solitary work are revealed. No planning of the offer or the interests of those deprived of liberty was found. The real prison does not materialize the current public policies in terms of education, maintaining practices from the 19th century. Implications of the research: The results demonstrate the need to articulate public policies in an inter-ministerial plan that incorporates qualitative dimensions, beyond the fulfillment of goals and decisions of each prison. Originality/Value: This research is relevant because there are few studies of the actual functioning of formal and non-formal education in prisons.

INCIDÊNCIA DE SÍFILIS NA POPULAÇÃO CARCERÁRIA MASCULINA ENTRE OS ANOS DE 2000 À 2024: UM ESTUDO DE REVISÃO INTEGRATIVA DA LITERATURA

This study analyzed the incidence of syphilis among the male prison population in Brazil from 2000 to 2024. It emphasizes that syphilis, caused by Treponema pallidum, is a Sexually Transmitted Infection (STI) with high prevalence in this vulnerable group, primarily due to poor hygiene conditions and limited access to healthcare services. An integrative literature review was conducted, including eight articles that met the inclusion criteria of studies published between 2000 and 2024 specifically addressing syphilis in the male prison population. Articles focusing on other STIs without direct relevance and studies with inadequate methodologies were excluded. The search was performed in the databases PubMed, BVS, MedLine, and Scielo, using descriptors such as “syphilis,” “prison population,” and “Sexually Transmitted Infections (STIs).” The findings indicate a high incidence of syphilis, exacerbated by risk practices such as unprotected sex and the sharing of syringes, along with the absence of adequate health policies. The study highlights the urgent need for effective interventions, including systematic screening and health education, to control the spread of the disease and improve the quality of life for inmates. These measures are essential not only for the health of prisoners but also for preventing the transmission of syphilis to the broader population.

English

Introduction: Addressing the health problems of prison inmates is a major challenge for public administrations, which are responsible for guaranteeing the necessary services to deal with them. It is therefore essential to know which are the chronic pathologies that affect them most frequently, what impact they have on the oral cavity and what type of treatments are required. The aim of this study is to shed further light on these questions. Material and method: Articles in PubMed on chronic and oral pathologies and treatment needs were reviewed. Results: The most prevalent chronic pathologies are heart disease, chronic respiratory disease, diabetes and cancer. Anxiety and depression are also highly prevalent among the prison population, along with the consumption of tobacco, alcohol and drugs of abuse. They are responsible for the appearance of caries and periodontal diseases, the treatment of which should be carried out in the prison environment. Conclusions: The level of dental care among the prison population is very low. Therefore, it is necessary to implement preventive and therapeutic measures among inmates to improve their oral health and, consequently, their general health.

English

Introduction: The prison population in Peru exceeds 90,000 individuals, many of whom face conditions that increase their vulnerability to human immunodeficiency virus (HIV), such as exposure to illicit substances, risky sexual behaviors, and discrimination. Materials and Methods: A secondary analysis was carried out, using data from the 2016 national prison population census to identify factors associated with HIV risk in the incarcerated population of Peru. A total of 75,613 male inmates from prisons across the country participated, answering a comprehensive questionnaire consisting of 405 items. Multivariable regression Poisson models were used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Our findings revealed significant associations between HIV risk and sexual orientation, with homosexual (aPR: 5.50; CI: 2.62-11.56) and bisexual (aPR: 4.92; 95% CI: 2.26-10.72) individuals being at higher risk. Additionally, a history of tuberculosis (aPR: 2.82; 95% CI: 1.75-4.56) and sexually transmitted diseases (aPR 48.14; 95% CI: 31.07-74.56) were strongly correlated with increased HIV risk. Marital status, specifically being widowed, divorced, separated, or single, also showed a statistically significant association with HIV infection in both raw and adjusted regression models. Discussion: Our study highlights important risk factors for HIV infection among the male prison population in Peru. The identified associations will inform the development of effective health policies aimed at identifying and addressing HIV transmission within the country’s prisons. Furthermore, our findings provide a basis for future research in similar settings with a comparable male prison population profile.

AUDIÊNCIA DE CUSTÓDIA E RISCOS À SEGURANÇA:ANÁLISE CRÍTICA DO DIREITO PUNITIVO

This article examines custody hearings from the perspective of the right to punish and public security challenges, highlighting their role in protecting detainees' fundamental rights and reducing unnecessary pretrial detention. The analysis reveals the complex relationship between punitive law and prison overcrowding, which undermines the effectiveness of the penal system and creates inhumane incarceration conditions. Additionally, resocialization is discussed as a core goal of the penal system, emphasizing that punishment should go beyond mere imprisonment to promote social reintegration. The study also explores how public perception and media influence trust in custody hearings, impacting public opinion and criminal policies. The conclusion advocates for reforms in punitive law to balance public security with respect for human rights, aiming for a more just and humane justice system.

Understanding and improving the quality of primary care for people in prison: a mixed-methods study.

People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities. To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved. A mixed-methods study with six interlinked work packages. Predominantly the North of England. Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups. Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment. Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ. Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change. This study is registered at researchregistry.com (Ref: 5098). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.

Advocating Grant of Parole to Undertrial Prisoners through Legal Reforms: Protecting Human Rights and Alleviating Prison Overcrowding

Under Trial Prisoners (UTPs), who account for approximately 75-80% of India's prison population, face prolonged periods of detention largely due to systemic delays within the judicial framework and stringent bail conditions. These individuals frequently encounter significant challenges in securing bail and parole resulting in dire living environments that exacerbate overcrowding, violate human rights, and undermine their mental and physical health. Despite the existence of legal instruments like the Bharatiya Nagarik Suraksha Sanhita, 2023, which offer some degree of protection, UTPs often find themselves ensnared in enduring cycles of incarceration. To effectively tackle these pressing issues, reforms in parole, bail, and expedited judicial processes are imperative. Notably, UTPs are not afforded regular parole opportunities, even though convicts benefit from such provisions. However, the adoption of technological advancements, such as electronic monitoring, offers promising alternatives for the safe temporary release of UTPs on parole. Establishing explicit guidelines regarding eligibility, conditions and effective supervision for the release of UTPs on remand could help protect human rights while ensuring public safety. This approach not only facilitates their reintegration into society but also alleviates the strain on India’s correctional facilities due to overcrowding.

Mental health and well-being in prisons and places of detention.

This study aims to address the critical mental health challenges faced by individuals in prisons and places of detention. By introducing and validating a novel conceptual framework that integrates social determinants of health with the stress process model, this study aims to provide actionable insights for improving mental health care in correctional settings. The research seeks to inform policymakers, prison administrators and mental health professionals about effective interventions and systemic reforms that can reduce recidivism, enhance rehabilitation and promote a more humane and just criminal justice system. This study uses a multi-method research design integrating a systematic literature review, qualitative interviews, multi-criteria evaluation (MCE) and a small-scale empirical study within a correctional facility. The systematic review follows PRISMA guidelines, analysing peer-reviewed articles, government reports and policy documents. Semi-structured interviews with 25 mental health professionals provide practical insights, whereas the MCE assesses intervention effectiveness based on expert consensus. The empirical study involves baseline assessments, intervention implementation and follow-up evaluations using validated tools, providing robust data to validate the proposed conceptual framework that integrates social determinants of health with the stress process model. This study finds that mental health disorders are significantly more prevalent in prison populations than in the general population, with interventions like cognitive behavioural therapy (CBT), peer support programs and trauma-informed care showing considerable effectiveness in reducing symptoms. Emerging technologies such as AI and telemedicine present promising avenues for enhancing care but require careful ethical consideration. The research also highlights the critical role of social determinants and the importance of systemic reforms, such as reducing solitary confinement and integrating prison health care with broader public health systems, in improving inmate mental health and reducing recidivism. This study's quasi-experimental design, while robust, may limit the generalizability of the findings to other correctional settings because of specific facility characteristics. Additionally, the sample size for qualitative interviews, although diverse, could have been larger to provide more nuanced insights, particularly for underrepresented groups. This study highlights the need for more longitudinal research to assess the long-term effects of interventions and the scalability of approaches across different cultural and legal contexts. Future studies should address these limitations by using more diverse sampling, larger sample sizes and extended follow-up periods. This study provides actionable insights for policymakers and prison administrators, emphasizing the need to integrate evidence-based mental health interventions, such as CBT and trauma-informed care, into prison reform strategies. It highlights the importance of training correctional staff in mental health first aid and the potential of emerging technologies like AI and telemedicine to enhance care delivery in resource-limited settings. Implementing these recommendations could significantly improve inmate mental health outcomes, reduce recidivism rates and promote a more humane and effective correctional system, with broader benefits for public health and social equity. Improving mental health care in prisons has significant social implications, particularly in promoting social justice and reducing inequalities. Effective mental health interventions can help break the cycle of incarceration and recidivism, particularly in marginalized communities disproportionately affected by the criminal justice system. By addressing the mental health needs of incarcerated individuals, society can foster safer communities, reduce crime rates and alleviate the economic burden on the criminal justice and health-care systems. Furthermore, enhancing mental health care in prisons reflects a commitment to human dignity, fairness and the rehabilitation of offenders, contributing to a more just and compassionate society. This study introduces a novel conceptual framework that integrates social determinants of health with the stress process model, specifically tailored for correctional facilities. It provides original empirical data from a real-world prison setting, offering new insights into the effectiveness of mental health interventions, such as CBT and trauma-informed care. The study's value lies in its comprehensive approach, combining quantitative and qualitative methods, and its focus on underrepresented populations in correctional settings. By addressing significant gaps in the literature, this research offers practical recommendations for policymakers and practitioners, contributing to improved mental health outcomes and reduced recidivism.

EDUCATION OF YOUNG PEOPLE AND ADULTS AS A VARIABLE FOR REDUCING CRIME RATES IN BRAZIL

This study aims to investigate whether there is a relationship between education and the reduction of crime rates in Brazil. The research problem is, therefore, to verify whether Youth and Adult Education has the potential to influence crime rates in Brazil. As a hypothesis, it is suggested that youth and adult education has the potential to influence crime rates in Brazil for at least two reasons: i) for a logical reason, the time in which the student is in class is not available for criminal activities; ii) education allows for better placement in the job market, changing the opportunities and costs of involvement in criminal activities. To confirm or refute the hypothesis, it was necessary to understand the historical construction of youth and adult education in Brazil, identify the profile of the prison population and verify how education has the potential to influence crime rates. At the end of the research, the hypothesis was confirmed.

Barriers to and Facilitators of Opioid Substitution Therapy in Penal Institutions: A Qualitative Study from Baden-Wuerttemberg, Germany

BACKGROUND: Opioid use is prevalent throughout prison populations worldwide. To date, opioid substitution treatment (OST) is considered as one of the most effective treatments for reducing drug-related harm associated with opioid dependence. Yet, large gaps prevail in the access and availability of OST in detention facilities in Germany. We investigated the views and attitudes of health professionals working in prisons in the federal state of Baden-Wuerttemberg towards OST and identified barriers and facilitators to the implementation of prison-based OST.METHODS: We conducted semi-structured expert interviews with nine physicians and one psychologist working in prisons in Baden-Wuerttemberg. The data was analyzed in MAXQDA using a qualitative content analysis approach. RESULTS: A majority of study participants (90%) held positive attitudes towards OST. Our findings suggest that concerns about OST medication diversion and the co-consumption of illegal drugs, insufficient staff capacity, and difficulties in ensuring continuity of care post-release posed barriers to prison-based OST. Additionally, the prison setting, an adequate personnel infrastructure, and the availability of technical equipment were perceived as facilitating the implementation of OST. The participants highlighted the need for an increase in medical personnel capacities and for improved transition management between intra- and extramural treatment settings. CONCLUSIONS: To improve drug using prisoners’ health, intramural OST needs to be adapted more to the particularities of­­ the prison setting such as offering less-divertible medication options and ensuring continuity of care after imprisonment. Research is needed on the acceptance of new OST medications among incarcerated populations and actionable treatment approaches.

Preparing for outbreaks of vaccine preventable diseases: why are prisons invisible?

Abstract From 1 March 2023 to 29 February 2024, 30 EU/EEA Member States reported a total of 5 770 cases of measles, 4 864 (84.3%) of which were laboratory-confirmed. Th7e highest number of cases were reported by Romania- at the time of writing, 11,397 confirmed cases, including 12 deaths from 1 January 2023 to 7 April 2024. Measles is a highly infectious disease. The best mitigation is vaccination which is highly effective. Outbreaks in many countries have been driven by decreases in vaccine coverage with a two-dose measles-containing vaccine (MCV), especially evident since the COVID-19 pandemic. In many countries, vulnerable migrant populations, ethnic groups and communities experiencing social deprivation have been over-represented in cases and under-covered by vaccine programmes. We know that prisons contain such populations. Historic seroprevalence studies of prison populations, which themselves are scant, show that prison populations are under-vaccinated. Prisons are a setting that can cause disease amplification. Given these facts, it is perhaps surprising that many countries in Europe cannot provide specific surveillance data on either cases in prisons or vaccine coverage specifically in prison populations. Further, that prisons are not often cited as specific settings for vaccine catch-up programmes in national or regional programmes. This is despite evidence of measles cases and outbreaks historically and currently in several European countries. In the presentation we will ask why this ‘blind spot’ in national and international disease surveillance continues and what Member States could and should do to prevent the risk of mass outbreaks of measles in prisons, causing pressures on justice and health systems and risking wider community outbreaks. Finally, we will reflect on how this experience should alert us to the risk of other infectious diseases going undetected, unprevented, and under-studies in prisons, threatening our collective health security.

Assessing vaccine hesitancy and vaccine literacy in the European prison population: a multicenter repeated cross-sectional study

Abstract The study aimed to quantify vaccine hesitancy and vaccine literacy in prison populations and assess their correlation prior and after the implementation of training and information activities targeting PLP. A repeated cross-sectional observational study was conducted in 13 prisons of 4 European countries prior and after the implementation of a co-developed training package. The study sample included 847 people living in prison in the baseline round. The second round is currently ongoing. Through a structured questionnaire vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal history and socio-demographic characteristics of participants were assessed. Exploratory factor analysis was used to extract three independent components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; multiple linear regression was applied to assess the association between vaccine hesitancy and vaccine literacy and general health literacy. All analyses were adjusted for socio-demographic variables. In the baseline round, we identified three independent components of vaccine hesitancy explaining 49% of the total variance: Mistrust (proportion of the variance explained, 27%), Concern (14%) and Conspiracy (8%). All the components were associated with previous vaccine refusal (p-value <0.001) and presented very good internal consistency. Young participants presented the highest levels of vaccine hesitancy; migrants had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of academic education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were associated with general health literacy (all p-values <0.001).

8.D. Scientific session: Equitable Immunization: Leveraging Prisons for Vaccination Equity in Europe

Abstract Addressing low vaccine coverage is a pressing public health concern in Europe, where pockets of unvaccinated individuals persist despite ongoing efforts. The European region sees an estimated 1.4 million individuals detained on any given day, with a significantly higher number passing through prisons annually due to high turnover rates. Those experiencing incarceration often come from socially marginalized and disadvantaged groups, facing a multitude of health challenges including non-communicable diseases, infectious diseases, mental illness, cognitive disabilities, and substance dependence. Despite their elevated health needs, individuals in prison frequently encounter barriers to accessing healthcare services, including preventive measures such as vaccination. Available but limited data suggest that individuals entering the prison system are often under-immunized, particularly against Hepatitis B Virus (HBV), influenza, measles, mumps, rubella (MMR), and pneumococci. Unfortunately, vaccination services within prisons are often insufficient, typically being provided according to national schedules or in response to outbreaks of vaccine-preventable diseases (VPDs). It’s crucial to distinguish between the availability of vaccination services and actual coverage, as the modalities of vaccination offerings vary across the region. While individuals in prison are recognized as a target group for HBV vaccination, the methods of offering vaccines may differ based on factors such as age or risk group. Nevertheless, systematic implementation of HBV vaccination in prisons has shown clear benefits for both incarcerated individuals and the wider community. Given the significance of vaccinations in preventing diseases like HBV and human papillomavirus (HPV), which are linked to cancer, initiatives like the Europe Beating Cancer Plan and the European Council Recommendation on vaccine-preventable cancer emphasize their importance. Prisons can serve as a strategic point for delivering comprehensive healthcare and vaccination services to incarcerated individuals, yet routine data on vaccination coverage at entry and uptake during incarceration are often lacking, hindering effective health planning. To address this public health challenge, the ‘Reaching the hard-to-reach: Increasing access and vaccine uptake among prison population in Europe’ (RISE-Vac) project consortium has been formed. This collaborative effort brings together diverse expertise and established networks in the field of prison health, reflecting the varied epidemiological and structural landscapes across Europe. The objective of this workshop is to showcase recent research findings, evidence-based practices, and policy recommendations aimed at enhancing vaccination equity in the European region. By sharing insights and best practices, we aim to bolster efforts to improve vaccine access and uptake among incarcerated populations, ultimately contributing to broader public health goals. Key messages • Prison health is public health: vaccination services in prison are essential to achieve immunization targets in Europe. • Maximizing inter-sectoral collaboration is crucial for bridging the gap in vaccination access and uptake among people living in prison in Europe.

10.P. Scientific session: Improving health security and preparedness: are we leaving someone behind?

Abstract Prisons are unique, high-risk, high-security, complex settings; however, the impact of emergencies on prisons is a concern not only to the prison but also to the functioning of, for example, the criminal justice system, policing and courts, as well as to the general public. Prison environments can amplify infectious diseases. In the context of emerging health threats, this risk could be made into an asset through early warning surveillance and epidemiological studies. Many global and public health actors advocated for the inclusion of prisons and custodial settings in a comprehensive response to emerging threats since the early days of the COVID-19 pandemic and again during the Mpox epidemic. The increase in risk in closed environments and the vulnerability of people living in prisons make prisons and other custodial settings potential hotspots for transmission of infectious diseases and for excess morbidity and mortality. Yet, as mentioned above, prisons have been included to only a limited extent in national preparedness and response plans. Similarly, prisons are not always explicitly mentioned in international guidance on the preparation of national plans or in measures taken in the absence of such guidance. Preventing, predicting and responding to threats to the health of prison populations require scientifically valid, evidence-based interventions and assessment of the positive and negative impact of control measures on the population, especially in view of the unequal distribution of harm and disease among people living in prison and unequal access to mitigation or therapeutic interventions. Because of a general lack of timely, good-quality, translatable evidence on prison health, guidance for the management of health threats in prisons is often based on adapting other sources to the prison setting (so-called “prisonification” of guidelines), rather than on evidence specific to prisons. Prisons and custodial settings may also be affected by other biological, chemical, radionuclear and environmental hazards, all of which must be catered for in comprehensive preparedness and response plans. Timely collection of information is essential for national preparedness and response capacity to ensure rapid identification and response to threats. Again, however, the prison population is often excluded from or not explicitly identified in national surveillance systems. As a result, cases or outbreaks may not be identified or not receive an effective response, due to lack of collaborative structures between prison and public health authorities. Inclusion of prisons in local, regional, national and international emergency planning is therefore essential to test plans and revise guidance on the basis of evidence, exercises and/or real events. This workshop aims at exploring the current landscape and deriving implications for preparedness and health security in Europe and beyond. Key messages • Prison authorities should be included as stakeholders in the development of national preparedness and contingency plans according to good governance approach. • Explicit inclusion of prisons and other custodial settings in international and national plans for preparedness and response to emerging health threats is needed.

Introducing vaccination services in prison settings: case study from Moldova

Abstract Introducing vaccination services within prison settings presents a multifaceted challenge and opportunity, particularly evident in the case of Moldova. This Eastern European nation grapples with various socio-economic and healthcare disparities, with its prison population often experiencing heightened health vulnerabilities. Amidst such complexities, the implementation of vaccination services emerges as a crucial strategy not only to safeguard the health of incarcerated individuals but also to contribute to broader public health goals. Moldova’s journey in this regard reflects a commitment to advancing preventive healthcare within its correctional facilities. The introduction of vaccination services in prisons necessitated a comprehensive approach, encompassing policy development, infrastructure enhancement, staff training, and community engagement. Infrastructure enhancement was imperative to ensure the provision of vaccination services in a safe, efficient, and dignified manner within prison settings. This involved the establishment of designated vaccination areas equipped with the necessary medical supplies and equipment. Staff training emerged as a cornerstone of the initiative, empowering healthcare professionals working within prisons with the knowledge, skills, and confidence to deliver vaccination services effectively. Training programs encompassed various aspects, including vaccine administration, adverse event management, and communication strategies tailored to the specific needs of incarcerated individuals. Collaboration with people living in prison facilitated the dissemination of accurate information, addressed concerns, and encouraged participation in vaccination programs. During the period 2021-2023 7454 doses of antiCOVID-19, 1298 doses of anti-Flu vaccine, 3083 doses of anti-HBV vaccines were administered.

Driving policy changes: RISE-Vac lessons learnt and recommendations

Abstract The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.

The Resolution of Overcrowding as a Form of Convention against Torture Implementation to Achieve Security Stability in Prisons and Detention Centers in Indonesia

This research addressed the resolution of overcrowding as a form of implementing the Convention Against Torture to achieve security stability in prisons and detention centers in Indonesia. Errors in the calculation of prisoner numbers that did not align with the size of detention cells led to the phenomenon of overcrowding. In other words, such conditions could be deemed as torture against inmates. Despite Indonesia's ratification of the Convention Against Torture through Law Number 5 of 1998, torture in sentencing remained a major concern. The aim of this study was to examine the causes and impacts of overcrowding, analyze the phenomenon of overcrowding in Indonesian prisons and detention centers in accordance with the Convention Against Torture, and propose solutions to overcrowding as an implementation of the Convention Against Torture. The research employed a qualitative method with a normative legal approach to comprehend and interpret existing legal provisions and evaluate their implementation, thereby identifying the alignment between applicable law and its implementation. Primary data sources consisted of legislative regulations arranged according to the hierarchy of legal norms. Secondary legal materials included textbooks authored by eminent legal scholars, legal journals, academic opinions, legal cases, jurisprudence, and recent symposium outcomes relevant to the research topic. This study found that the Indonesian government endeavored to expand detention space to minimize torture and suffering that could occur in overcrowded cells, thereby facilitating the achievement of the goals of the Convention Against Torture.

Facilitators and Barriers in Palliative and End-of-Life Care in Prisons.

With an aging prison population facing various chronic diseases, the importance of palliative and end-of-life care (EOLC) in correctional facilities is heightened. This systematic review aimed to identify facilitators and barriers to palliative and EOLC in prisons. PubMed, Web of Science, Scopus, and Cochrane databases were searched for primary qualitative studies (January 2014 to December 2022) in English. Eligible studies focused on people in prison, health care professionals, administrators, and governors regarding palliative or EOLC provision within prison settings. Five studies were included, from Australia, France, the United Kingdom, and the United States, whose overall quality was moderate to high. Key facilitators included access to family, support from prison staff, specialized care availability, and cultural/spiritual support. Barriers encompassed discomfort, patient-clinician relationship constraints, time limitations, protocol uncertainty, restricted patient agency, negative attitudes, inequality, conflicting priorities, and lack of grief support. Addressing these barriers and leveraging facilitators will be crucial in ensuring equitable access to compassionate EOLC for individuals experiencing incarceration. Policymakers, health care providers, and correctional authorities must prioritize the enhancement of palliative care services within prisons, supported by further research and targeted interventions to address disparities and optimize care provision.

U.S. corrections officers’ discourse about dementia

The United States has more prisoners than any other country in the world: more than 1.5 million persons were housed in state and federal prisons in 2020. A sizeable percentage are ageing; Physician’s Weekly estimates that by 2030, people aged over 50, the age at which the incarcerated are considered to be ‘old’, will make up one-third of the U.S. prison population. That group will include a great many persons who have or are developing dementia and who are guarded by correctional officers. We can, then, consider that correctional staff as well as prisoners form an overlooked dementia care minority. Using conversation and discourse analysis, we focus on epistemic modal adverbs as discourse markers in spoken commentary by current correctional officers about prisoners with dementia, as some markers can signal an uneasiness with which they position themselves as knowledgeable about rights and duties in ageing and dementia. Officers frame their discourse to identify concerns about a prison system that deals poorly with inmate losses of cognitive ability and memory and suggest a need for additional training and support in communicating with incarcerated older prisoners who may have dementia.