November 14, 2005: Prisons Failing on HIV & Hepatitis C

Prisons provide inconsistent and often sub-standard healthcare despite high levels of HIV and hepatitis among prisoners, according to a report launched today by the Prison Reform Trust (PRT) and the National AIDS Trust (NAT).

A survey conducted by NAT and PRT among prison healthcare managers across the UK, found that a third of prisons surveyed had no HIV policy, one in five had no hepatitis C policy and well over half had no sexual health policy. The report found that some prisoners thought that HIV-positive prisoners would be subject to bullying and discrimination if their status were known. Many prisoners do not have appropriate access to condoms, disinfecting tablets, clean needles or healthcare information.

April 2006 is the completion date for the transfer of responsibility of prisoners’ healthcare to the NHS, who have pledged to provide an equivalent standard of healthcare as that in the community. Yet while there is some evidence of good practice, standards are inconsistent and many prisons could do more to protect prisoners from blood borne viruses.

9% of men and 11% of women in prison have hepatitis C (20 times higher than the rate of 0.4% in the general public). The HIV rate in prison for men is 15 times higher than the rate outside at 0.3 per cent .

Ruth Runciman, Chair of the National AIDS Trust and Deputy Chair of the Prison Reform Trust said:

"Overcrowding and the constant movement of prisoners between establishments create particularly adverse conditions in our prisons for curbing the spread of HIV and hepatitis and there is an urgent need to develop policy and practice to protect individual and public health."

Prison Reform Trust director Juliet Lyon said:

“Courts sentence people to custody not to inadequate healthcare. The prison population is marked by poor health. It is time the NHS developed good, well resourced policy and practice to tackle blood-borne disease in prison. Anything else would amount to double punishment and lead to public health risk.”

Deborah Jack, chief Executive of the National AIDS trust, said

“Good prison health is essential for good public health. The transfer of prison health to the NHS is a vital opportunity for the government to reduce HIV and hepatitis C transmission in prisons and ensure prisoners have an equal standard of healthcare to that provided to members of the public. These failings need to be addressed as a matter of urgency.”

The report is based on a survey of prison healthcare managers conducted jointly by PRT and NAT in England and Wales, and by the NAT in Scotland and Northern Ireland. The main recommendations of the report are:

• Treatment, care and support services should be equivalent to those provided in the community.
• Across the UK, prison services need to conduct regular anonymous blood tests to establish the levels of HIV and hepatitis C infection.
• A national framework for prevention, treatment, care and support followed up by a policy that enacts it in every single prison.
• Harm minimisation should be practised in prisons as it is in the community. Lower risk behaviour should be promoted to prisoners. Methadone programmes, disinfecting tablets and needle exchange should be included.
• Male and female condoms should be available, free of charge, in such a way that prisoners can obtain them without asking.
• Prisoners must have confidence that testing is confidential and that they will be completely protected against discrimination.
• All uniformed and healthcare staff need training on reducing stigma and discrimination in relation to sexual orientation, HIV status and hepatitis C status.

The Prison Reform Trust notes that these recommendations are the more urgent because they are not new. They reinforce, in large part, those made by bodies such as the AIDS Advisory Committee (1995), the European Health in Prison Project (2001), the All Party Parliamentary Group on AIDS (2001) and the National AIDS and Prison Forum (2002).