Infections in Prison in Low and Middle Income Countries: Prevalence and Prevention Strategies

Abstract

Prisoners throughout the world are at a greater risk of infectious diseases compared to communities outside. Hepatitis C (HCV), human immunodeficiency virus (HIV) and tuberculosis (TB) have attracted great attention because of their potential to cause great morbidity and mortality in prison populations.

However, prisons are not closed worlds. Many people enter and leave prisons every day and many prisoners themselves stay only a short period in prison and return to their families. Giving prisoners adequate treatment for infectious diseases is good medical practice and provides public health benefits to the community.

There are several factors that may fuel the highly infectious environment in prisons and include: 1) poor health services; 2) overcrowding and congestion; 3) high risk behaviors; 4) security vs public health concerns and 5) lack of public empathy for prisoners. This paper looks at the challenge of infectious diseases in prisons in low and middle income countries (LMICs).

Three percent of the world’s population is infected with HCV but in prisons the prevalence appears to be much higher ranging from 4% in Indian prisons to 12.3% in prisoners in Nigeria. A review of HIV prevalence in 152 LMICs found information on HIV prevalence in only 75 (50%) of these countries. HIV prevalence was greater than 10% in prisons in 20 countries. TB infection rates in prison are equally high and may be up to 100 times those outside prison.

Overcrowding is a major problem and non-custodial sentences must be considered in order to decongest prisons. Furthermore, standard medical treatment and prevention measures for HCV, HIV and TB must be provided to prisoners in order to reduce the burden of infections in prisons. Linkages between prison health and national health services would go a long way in addressing the threat of infections to prison populations.

Prisoners go to jail to be punished for offending society and not to get infectious diseases. Health care equivalent to that found outside prison must be provided to these individuals.