Limited access to HIV prevention in French prisons (ANRS PRI2DE): implications for public health and drug policy

Abstract

BackgroundOverpopulation, poor hygiene and disease prevention conditions in prisons are major structural determinants of increased infectious risk within prison settings but evidence-based national and WHO guidelines provide clear indications on how to reduce this risk. We sought to estimate the level of infectious risk by measuring how French prisons adhere to national and WHO guidelines.MethodsA nationwide survey targeting the heads of medical (all French prisons) and psychiatric (26 French prisons) units was conducted using a postal questionnaire and a phone interview mainly focusing on access to prevention interventions, i.e. bleach, opioid substitution treatment (OST), HBV vaccination and post-exposure prophylaxis (PEP) for French prisoners. Two scores were built reflecting adherence to national and WHO international guidelines, ranging from 0 (no adherence) to 10 (maximum adherence) and 0 to 9 respectively.ResultsA majority (N = 113 (66%)) of the 171 prisons answered the questionnaires, representing 74% coverage (46,786 prisoners) of the French prison population: 108 were medical units and 12 were psychiatric units. Inmate access to prevention was poor. The median[IQR] score measuring adherence to national guidelines was quite low (4.5[2.5; 5.5]) but adherence to WHO guidelines was even lower 2.5[1.5; 3.5]; PEP was absent despite reported risky practices. Unsuitable OST delivery practices were frequently observed.ConclusionsA wide gap exists between HIV prevention policies and their application in prisons. Similar assessments in other countries may be needed to guide a global policy reform in prison settings. Adequate funding together with innovative interventions able to remove structural and ideological barriers to HIV prevention are now needed to motivate those in charge of prison health, to improve their working environment and to relieve French prisoners from their currently debilitating conditions.

HCV seropositivity in inmates and in the general population: an averaging approach to establish priority prevention interventions

“…This is because prevention initiatives regarding drug use in prisons are implemented from a repressive perspective and not from a public health perspective. 30 However, our results showed the importance for decision-makers to introduce more harm reduction interventions in prison, especially interventions targeting HCV transmission.…”

“… 28 This fact strongly suggests the need for tailored preventive programmes to combat the HCV epidemic, as current access to NEP is inadequate in the general population and largely (or totally) absent in prisons in France. 29 30 …”

Prevalence and Incidence of HCV Infection among Prisoners in Central Brazil

“…Unfortunately, Brazilian prisons have not yet recognized the importance of access to effective prevention strategies to reduce the transmission of blood-borne infections in the facilities. This is because drug use prevention initiatives in prisons are implemented from a repressive perspective and not from a public health one [45]. …”

Prevalence of human immunodeficiency virus and hepatitis C virus among French prison inmates in 2010: a challenge for public health policy

“…Nearly 2.5% of prison inmates in France have viraemic HCV, and the risk of HCV transmission to other prisoners is exacerbated by widespread risk behaviours such as tattooing and the sharing of shaving equipment [3,37]. It is important that prison establishments maximise efforts to limit the spread of HCV by introducing prevention and harm reduction measures [38,39]. The moment of incarceration provides an ideal opportunity for testing and treating HIV and HCV in order to limit the spread of HCV and to improve the prognosis of infected patients.…”