HIV and Prisons
A Freedom of Information request was made to the Ministry of Justice asking and the MOJ response made in January 2011.
1. How many prisoners in prison/custody are known to be HIV+ which are accessing support/care within the United Kingdom?
2. Are you able to provide the total numbers by locality/area e.g. London/major city or area's?
I can confirm that the Ministry of Justice does not hold this information. This is because since April 2006, commissioning responsibility for healthcare services in prisons has been fully devolved to NHS Primary Care Trusts. For further information, please visit the Department of Health website:
Further information about health care within the HM Prison Service (HMPS) can be found on the HMPS website via the following link:
A request was made to Positive East seeking additional information on HIV and Prisions. Today I received a response, thank you.
"I apologise for the delay in coming back to you with the figures in question. This was because I have been awaiting information regarding the release of a very recent paper by the HPA: Health Protection in Prisons (2009-2010).
I have now been able to acquire this report and I attach it for you. I particularly refer you to section 2.3.2. on HIV figures in UK prisons. These are the most recent figures available, although these will already be somewhat out of date. For instance, this report states that in 2008, 55,520 people in England had had a diagnosis of HIV. Figures from the National AIDS Trust state that by 2009, there were 86,500 in the UK (with an estimated 22, 520 undiagnosed cases). This increase would also be reflected in the prison population, and, of course, the figures have continued to increase in subsequent years. Also the prison figures do not account for those prisoners with undiagnosed HIV.
I also attach the 2005 report from the NAT and the Prison Reform Trust: HIV and hepatitis in UK prisons<: addressing prisoners’ healthcare< needs. Although produced in 2005, it is still very informative reading about HIV transmission in prisons.
Prison Hepatitis B Vaccination Monitoring Programme
Hope VD, Ncube F, Hickman M, Judd A, Parry JV. Hepatitis B vaccine uptake among injection drug users in England 1998 to 2004: is the prison vaccination programme driving recent improvements? Journal of Viral Hepatitis 2007; 14:653-660<
Injecting Drug Users
Infectious diseases in Prison
Anderson C, Story A, Brown T, Drobniewski F, Abubakar I. Tuberculosis in UK prisoners: a challenge for control. Journal of Epidemiology and Community Health 2010.<
The 136 prisons and young offender institutions (YOIs) in England and Wales have a population of over 80,000 people at any one time. The prison population is transient, with nearly 200,000 prisoners passing through the system annually. Prisons represent an important opportunity to access hard-to-reach groups that may otherwise have poor contact with health services.
Prisoners are entitled to the same standard of healthcare and treatment as the general public. For the past four years, Offender Health has commissioned the Health Protection Agency (HPA) to develop and jointly deliver a programme to survey and prevent infectious diseases in prisons.
The work programme for 2009-2010 covered three key areas: improving infectious disease surveillance, the hepatitis B vaccination monitoring programme, and information and communication. This report outlines the progress made in meeting the objectives of the work programme in these key areas.
Globally, an estimated 9 million people are incarcerated per year. Prisons form high risk settings because:
- of higher rates of HIV in prisons than in the community (Hepatitis C rates even higher)
- high prevalence of risk behaviours
- injecting drug use and sharing of injecting equipment
- sexual activity
- outbreaks of HIV in prisons have been documented
- high turnover of populations
The main conclusion is that prisons are key points of contact with millions of individuals living with or at risk of HIV. A comprehensive review of the evidence of effectiveness of interventions to address HIV in prisons was published in 2007.
“All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community” (WHO, 1993)
It is time to act: Universal access to HIV prevention, treatment and care should also include prisoners.
Interventions to address HIV in prisons:
Evidence for action technical papers
Effectiveness of interventions to address HIV in prisons 2007
Prevention of sexual transmission 2007
Needle and syringe programmes and decontamination strategies 2007
Drug dependence treatments 2007
HIV care, treatment and support 2007
Interventions to address HIV in prisons:
Evidence for action policy brief
Reduction of HIV transmission in prisons 2004
The Lancet Interventions to reduce HIV transmission related to injecting drug use in prison
- Volume 9, Issue 1, 2009. The high prevalence of HIV infection and drug dependence among prisoners, combined with the sharing of injecting drug equipment, make prisons a high-risk environment for the transmission of HIV.
Policy and programming
HIV testing and counselling in prisons and other closed settings UNODC | WHO | UNAIDS, 2009
Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings WHO WPRO, 2009
Health in prisons. A WHO guide to the essentials in prison health WHO EURO, 2007
WHO Guidelines on HIV infection and AIDS in prisons 1993
HIV and AIDS in places of detention: a toolkit for policymakers, programme managers, prison officers and health care providers in prison settings UNODC | WHO | UNAIDS, 2008
AIDS prevention, care, treatment and support in prison settings: a framework for an effective national response UNODC | WHO | UNAIDS, 2006
Promoting the health of young people in custody WHO EURO, 2003
Inside out: HIV harm reduction education in closed settings WHO WPRO, 2007
HIV prevention in prisons in Eastern Europe
UNODC toolkit for HIV situation and needs assessment in prisons
The Toolkit was launched at the 2010 International AIDS Conference. It provides information and guidance on conducting situation and needs assessments for the prevention and treatment of HIV infection and tuberculosis in prisons. The document aims to help governments set more specific targets for achieving the universal access of prisoners to evidence-based HIV prevention, treatment, care and support interventions.
The launch of the Toolkit supports the aim of the AIDS 2010 conference calling for "Rights Here, Right Now" since the rights of prisoners are often overlooked by public health authorities.
Some of the core issues and findings to come out of the Toolkit are:
- From the limited data available, it is evident that HIV, hepatitis C and TB rates in prisons are particularly high, and always higher than in the community at large. In Mauritius for instance the rate is up to 50 times higher. In the absence of appropriate measures, outbreaks can occur - for example in Australia, Lithuania, Russia, Scotland and Thailand;
- Women in prisons are at higher risk than men in prisons. In the US state of Connecticut in the year 2006 for example, HIV prevalence for women prisoners was at 16 per cent compared to 5 per cent among male prisoners;
- Annually 30 million men, women and children spend time in prisons and are therefore at risk for HIV, hepatitis C and TB and may continue their spread after they leave prison;
- Effective policies to prevent HIV and hepatitis inside prisons and other correctional institutions are often hampered because of the denial of the existence of factors contributing to the spread of HIV such as men having sex with men, drug use or tattooing;
- The people at greatest risk of contracting HIV are also those who are at greater risk of committing crime and facing incarceration, such as drug dependent people or the mentally ill;
- Effective action to address HIV and AIDS must be undertaken in substandard or antiquated prison conditions. Overcrowding, violence, corruption, inadequate natural lighting and ventilation, violence and malnutrition, are common in many prisons across the world and undermine the implementation of effective responses to HIV and AIDS;
- All HIV prevention, treatment and care interventions, including harm reduction interventions, available in prisons, must be available both to prisoners and prison staff. There is evidence that all HIV prevention and treatment interventions are effective in prisons. Health care in prisons should be at least equivalent to that in the community;
- Detained persons living with HIV are often stigmatized and at increased risk of isolation, violence, and human rights abuses from both prisoners and prison staff.
Read the full toolkit.
HIV in Prisons: a reader with particular relevance to newly independent states
HIV in Prisons was published by WHO regional office for Europe with contributions from PRI
Nigel Evans< (Ribble Valley, Conservative)
The information requested is not collected. The last major study of HIV, hepatitis B and hepatitis C prevalence in prisoners in England and Wales found that of 3,942 prisoners surveyed in 1997 and 1998, 0.4 per cent. were infected with HIV, 8 per cent. with hepatitis B and 7 per cent. with hepatitis C.
Weild A.R., Gill O.N., Bennett D., Livingstone S.J.M., Parry J.V., Curran L. (2000). Communicable Disease and Public Health 2000;3:121-6.
See comment list at http://www.ukcab.net/forum/index.php?topic=906.0<