The prison as breeding ground for infections

"If there is one thing, more than anything else,, which should be done, it is that health in prisons must come under the responsibility of the public health authorities. The link between health in the community and health in prisons must be made as strong as possible. "
Professor Tim Harding, University Institute for Legal Medicine, Geneva.

AIDS, hepatitis and tuberculosis can be caught everywhere but as various statistics show, this possibility often is greater in prison than on the outside. In 1995, approximately 13% of the prisoners in Italy were found to be HIV positive. That year, in a prison in Porto (Portugal), over 15% of prisoners were infected with HIV. In French prisons, the spread of HIV is 10 times higher than outside the prison walls. The occurrence of tuberculosis is three times higher. In Ireland, 300-500 of the estimated 1600 HIV-infected individuals have been least once. In the USA, 5.2 AIDS cases per 1000 prisoners were found in 1994. This is almost six times the country's average. What turns a prison into a breeding ground for infectious diseases?

Lack of hygiene

In many European prisons, sanitary conditions are inadequate. This results in an increased risk of hepatitis A, infections, abscesses, and lice, fleas and scabies.

Overcrowding

In a large prison in Eastern Europe, sometimes 35 prisoners share one single cell. However, other European prisons too have problems with overcrowding. Overcrowding creates containment problems and at the same time promotes bad hygienic conditions and infectious diseases.

Violence

According to a prisoner in Mountjoy Prison: "There is a lot of tension - we are just waiting for another riot." Violence creates extra dangers in terms of direct blood contact and therefore infections such as HIV, or hepatitis B and C.

Unsafe drug use

Of the 1442 prisoners which were sent to Lisbon's Central Prison (Portugal) between 1994 and 1996, 63% were found to be drug users. A study in a German women's prison showed that approximately one third of the women were intravenous injectors. One out of twenty was HIV positive. Among the non-intravenous drug users, one out of two hundred was found to be HIV positive.

Though forbidden in the whole of Europe, the use of drugs within the prison walls continues, often in dangerous conditions. Due to the lack of needles, syringes are shared or even contrived out of ball-point pens. The sharing of nonsterile needles is the quickest way to transmit HIV and the hepatitis C virus. Unsafe sex

In prison, sex between men is not uncommon. However, the men involved will not easily admit to it, and research statistics therefore mostly give a distorted picture. Research findings from prisons in Zambia, Australia, Canada and England show figures between 6 and 12%. A 1993 study from Rio de Janeiro (Brazil), however, showed that 73% of the men had sex with each other. Sex in prisons often is anal intercourse, whereby men penetrate the partner'; anus. Rapes take place as well. Anal sex without condoms, and rapes create additional infection risks because often not only semen but blood as well, is involved.

Blood brotherhood

In spite of the AIDS risk, life-threatening rituals surrounding blood brotherhood are still very popular in prison.

Tattooing

Tattooing and piercing are also still very much in demand 'inside'. Here, the infection risk is the shared use of non-sterile needles.
Source: UNAIDS, Point of view, April 1997