Reconsidering the public health failings of the criminal justice system: a reflection on the case of Scott Ortiz

Throughout most of the world, the primary response to the health and social impacts of illicit drug use has been to intensify the enforcement of drug laws. The consequences of this policy approach include an unprecedented growth in prison populations and increasing concerns regarding drug-related harms within prisons and without, including increased risk of HIV and hepatitis C (HCV) infection. This has led to calls from public health and prisoner advocacy groups to prison authorities to improve health services available in the community and those available to prisoners. While considerable progress has been made with respect to the growing implementation of HIV and HCV prevention measures within some nations' prisons, the case of Scott Ortiz illuminates a new set of challenges for prisoners and their advocates as judges often have a faulty understanding of public health arguments and data. In this case we see one such instance where a judge acts in ways not rooted in sound public health evidence or practice to produce a perverse outcome that violates both sound medical and judicial objectives.     

Prisoner healthcare co-payment policy

Cost-effective provision of adequate healthcare to prisoners is a core problematic issue in contemporary correctional healthcare settings. An increasingly popular policy for reducing prison healthcare costs is prisoner co-payment systems for health services. Advocates of this policy assert that it facilitates efficient healthcare delivery in prison settings. This article examines the appropriateness and consequences of prisoner healthcare co-payment systems in US prisons. In conclusion, the policy has a strong potential to compromise prisoners' access to healthcare, while not significantly reducing prison healthcare costs. Alternative approaches for improving the efficiency of prison healthcare services are suggested, and implications for Australia are considered.     

Study urges prisons to consider condoms, drug needles

A study of sexual activity and intravenous drug use in U.S. correctional facilities reveals that condoms, dental dams, and sterile needles should be made available to inmates. The rate of AIDS is 7 times higher among prisoners than among the general population. The study revealed that sexual activity and drug use occurs frequently and usually without the use of measures that would protect inmates from HIV transmission. Focus group participants disclosed that prisoners often exchange sex for drugs, and protection. Drug use is common and inmates reportedly use dirty syringes and use makeshift syringes from unsafe material. An editorial accompanying the study indicates that current measures to prevent HIV transmission in prisons are ineffective and do not recognize the diverse nature of inmates' needs and behavior. It is also noted that making condoms available to male prisoners might be challenging since most male inmates will not acknowledge that they have sex with other men. Female prisoners, however, freely admit to having consensual sex with other female inmates.     

HIV/AIDS prevention in prisons: experience of participatory planning

Objetive: To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program.Methods: Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates) in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center's male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center's health professionals and management as well as to health promotion experts.Results: Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those directed at the prisoners themselves: increasing preventive mesures in material used in injection and in sexual relationships; b) those directed at the prison management: increased distribution of condoms, safety razors and bleach and the introduction of sterile injection material. In the personal interviews, agreement on a future prevention program was high among the female inmates and the other key informants. Preferred measures were the acquisition of information on the mechanisms of HIV transmission and prevention and on the differences between HIV carriers and those suffering from AIDS and the acquisition of skills for disinfecting material used for drug injection and in negotiating the use of condoms with partners. The preferred methodology was based on groups that would allow for an interchange of experience and would deal with the difficulties of putting preventive measures into practice.Conclusions: The participation of the prison's inmates and staff supplied information that facilitated the design (choice of aims, measures, methods and resources) of an HIV prevention program adapted to the needs and preferences of all the interested parties.     

HIV in prison: what are the risks and what can be done?

Prisons are recognised worldwide as important sites for transmission of blood-borne viruses (BBVs). There are two reasons why transmission risks in prison are higher than in the community. First, in most western countries, many prison entrants have histories of injecting drug use, and thus already have high prevalences of BBVs. Second, the lack or under-supply of preventive measures (such as clean needle and syringes or condoms) in most prisons, combined with extreme social conditions, creates extra opportunities for BBV transmission. HIV prevalence in prisoners in more developed countries ranges from 0.2% in Australia to over 10% in some European nations. There are case reports of HIV being transmitted by sharing injecting equipment and sexual activity. Tattooing has been reported as a risk factor for the transmission of BBVs in prison. Access to condoms and needle and syringe programmes in prisons is extremely limited, despite success when they have been introduced. The vast majority of prison inmates are incarcerated for only a few months before returning to the community--thus they are, over the long term, more appropriately regarded as 'citizens' than 'prisoners'. Public health policy must involve all sections of the community, including prison inmates, if we are to reduce transmission of HIV and other BBVs.     

2005年泰安市监狱看守所羁押劳教人员HIV感染状况调查

[目的]了解监狱看守所羁押劳教人员艾滋病病毒(HIV)感染状况,为制定防治对策提供依据.[方法]采取整群抽样的方法,对泰安市1所监狱羁押人员、5处看守所劳教人员进行HIV感染等高危行为调查,并采集血标本进行HIV血清学检测.[结果]调查监狱及看守所羁押劳教人员3 408人,其中男性3 363人,女性45人,男性占98.68%,女性占1.32%;年龄14～78岁,20～39岁占68.10%,20岁以下占8.36%;泰安市监狱看守所羁押劳教人员来自全国24个省(市)自治区,山东省及本市人员占92.75%,总检出抗-HIV阳性1例,感染率为0.03%.[结论]监狱看守所羁押劳教人员是一特殊人群,虽然检出1例抗-HIV阳性者,但这一人群存在HIV感染高危险因素.应加强对这一人群宣传教育和干预,控制疾病传播,是艾滋病等疾病防治工作不容忽视的群体.     

Hepatitis C transmission through tattooing: a case report

Abstract: We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high-risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment.     

瑞丽市2004年～2009年监管场所羁押人员HIV监测分析

[目的]了解瑞丽市看守所新入所羁押人员艾滋病感染状况,控制HIV在监管场所中传播与蔓延。[方法]定期对瑞丽市监管场所羁押人员进行调查,按统一调查表填写,使用EpiData录入并进行统计分析。[结果]共监测5134例羁押人员,检出226例HIV阳性者,阳性检出率为4.4%,2004年～2009年HIV阳性率有逐年下降趋势,25岁～34岁年龄组的HIV阳性率高于其他年龄组,缅甸籍人口HIV阳性率高于本地和外地人口,HIV阳性率随着文化程度的上升有逐步下降趋势。[结论]瑞丽市羁押场所HIV感染率较高,应加强监管场所羁押人员尤其是缅甸籍人员HIV感染的监测、健康教育及行为干预,防止HIV在监管场所中蔓延。     

Together we can make a difference: the case for transnational action for improved health in prisons

In spite of international differences in the treatment of incarcerated persons, as a group, they are vulnerable to poor health status and lack of access to quality health care. The health care of prisoners is affected by knowledge and commitment to ideas of human rights and social justice, as well as economic conditions. Prisoners are at increased risk of both acute and chronic diseases, and may constitute a threat to the health of other prisoners, their attendants or outside communities upon release. Mental illness and related problems of substance abuse are prevalent in prison populations, with many US prisons serving as modern asylums. Public health workers and organizations can stimulate and implement action to improve health in prisons. The World Federation of Public Health Associations can play a leadership role in co-ordinating and facilitating collaborative international action and research to enhance the health of prisoners and their communities worldwide.     

AIDS spread most rapid in South Africa

Between the end of 1993 and the end of 1994, the prevalence of HIV infection increased 70% (4.3-7.6%) in South Africa, the largest increase of HIV in Africa and perhaps even the world. HIV seroprevalence is highest in Kwa/Zulu (20%). Complacency is more common place in South Africa than in other African countries. In a survey, 75% of Black women in Johannesburg wanted to use condoms, but only 2% used them. People in South Africa have a higher standard of living and are healthier so they may remain healthy longer after HIV infection than those in other African countries. UNAIDS is focusing its attention on sub-Saharan Africa, largely because Africa does not have its own financial resources to fight against AIDS. Physicians in developing countries tend to not know that they can use locally-made drugs to treat opportunistic infections. Some recent beneficial publications on AIDS are the new issue of The AIDS Handbook, the latest booklet in ActionAid's Strategies for Hope series, and the Cote d'Ivoire's Filling the Gaps. The handbook presents information on transmission and symptoms of AIDS and prevention as well as advice on counseling.     

AIDS spread most rapid in South Africa [letter

Between the end of 1993 and the end of 1994, the prevalence of HIV infection increased 70% (4.3-7.6%) in South Africa, the largest increase of HIV in Africa and perhaps even the world. HIV seroprevalence is highest in Kwa/Zulu (20%). Complacency is more common place in South Africa than in other African countries. In a survey, 75% of Black women in Johannesburg wanted to use condoms, but only 2% used them. People in South Africa have a higher standard of living and are healthier so they may remain healthy longer after HIV infection than those in other African countries. UNAIDS is focusing its attention on sub-Saharan Africa, largely because Africa does not have its own financial resources to fight against AIDS. Physicians in developing countries tend to not know that they can use locally-made drugs to treat opportunistic infections. Some recent beneficial publications on AIDS are the new issue of The AIDS Handbook, the latest booklet in ActionAid's Strategies for Hope series, and the Cote d'Ivoire's Filling the Gaps. The handbook presents information on transmission and symptoms of AIDS and prevention as well as advice on counseling.     

Pregnancy and childbirth in English prisons: institutional ignominy and the pains of imprisonment

With a prison population of approximately 9000 women in England, it is estimated that approximately 600 pregnancies and 100 births occur annually. Despite an extensive literature on the sociology of reproduction, pregnancy and childbirth among women prisoners is under-researched. This article reports an ethnographic study in three English prisons undertaken in 2015-2016, including interviews with 22 prisoners, six women released from prison and 10 staff members. Pregnant prisoners experience numerous additional difficulties in prison including the ambiguous status of a pregnant prisoner, physical aspects of pregnancy and the degradation of the handcuffed or chained prisoner during visits to the more public setting of hospital. This article draws on Erving Goffman's concepts of closed institutions, dramaturgy and mortification of self, Crewe et al.'s work on the gendered pains of imprisonment and Crawley's notion of ‘institutional thoughtlessness’, and proposes a new concept of institutional ignominy to understand the embodied situation of the pregnant prisoner.     

Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey

Prisoners in eight of the 135 prisons in England and Wales were surveyed in 1997 and 1998 to study the prevalence of and risk factors for transmission of bloodborne viruses in prison. Subjects voluntarily completed a risk factor questionnaire and provided oral fluid specimens for unlinked anonymous testing for the presence of antibodies to HIV, hepatitis C virus (HCV), and the core antigen of hepatitis B virus (HBc). Almost 8% (4778) of the total of 60,561 prisoners were eligible and four fifths (3942) of those eligible took part. Among all those tested (3930) 0.4% (14) were positive for anti-HIV, 8% (308) for anti-HBc, and 7% (293) for anti-HCV (the anti-HBc and anti-HCV prevalences were not adjusted for assay sensitivities of 82% and 80%, respectively). Twenty-four per cent (777/3176) of adult prisoners reported ever having injected drugs, 30% of whom (224/747) reported having injected in prison. Three quarters of those who injected in prison (167/224) shared needles or syringes. Among adult injecting drug users, 0.5% (4/775) had anti-HIV, 31% (240/775) anti-HCV, and 20% (158/775) anti-HBc. The presence of anti-HCV and anti-HBc was associated with injecting inside prison and number of previous times in prison. The results suggest that hepatitis viruses are probably being transmitted in prisons through sharing non-sterile injecting equipment and that a risk of HIV transmission exists. Harm minimisation measures for the 6% of prisoners who continue to inject while in prison should be strengthened.     

HIV epidemiology and risk behavior promoting HIV transmission in Austrian prisons

In 1989, 1990 and 1992, 19%, 15% and 10%, respectively, of all prisoners newly admitted to prisons and penitentiary institutions in Austria underwent HIV antibody tests. Based on the HIV test outcome in prisons in which more than 80% of the newly admitted inmates were tested, annual HIV prevalences among prison inmates in Austria were determined. These were 0.5% (11/2,223), 1.3% (19/1,466) and 0.9% (14/1,509) in 1989, 1990 and 1992, respectively. The prevalence rates among prison inmates in Austria are thus 5 times higher than those in the general Austrian population. About 5% of all inmates belong to the high-risk group of intravenous drug users. Inquiries into HIV risk behavior among prison inmates showed that, in Austrian prisons just like in those of many other countries, intravenous drug use and sexual contacts are common practices. As disposable needles and condoms are not available to prison inmates, these practices carry a particularly high risk of HIV transmission. The data collected can be taken as a basis for developing strategies which are designed to reduce the risk of HIV transmission in prisons and which have a major bearing on the development of the HIV pandemic.     

南京市栖霞区羁押和看守人员HIV感染状况调查

目的了解南京市栖霞区羁押和看守人员HIV的感染情况,为栖霞区的公安、司法等相关部门制定艾滋病防治工作提供依据。方法用酶联免疫吸附试验对栖霞区羁押、看守人员进行HW抗体检测。结果共检测8546名,HW抗体阳性者6例,阳性率为0．07％。6例阳性者均为性乱者,其中2例吸过毒,有共用注射器史。结论监狱、看守所羁押人员中发现有HIV感染者,应加强对这些群体的宣传教育和行为干预。     

HIV prevention in prisons and jails: obstacles and opportunities.

High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of injection drug use, and other high-risk behaviors among inmates create a prime opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the opportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have differing approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or segregated by HIV serostatus, and whether condoms, bleach, or clean needles should be made available to the prisoners, are questions hotly debated by public health and correctional officials. Even accurate assessment of risk-taking within the institutions leads to controversy, as asking questions could imply acceptance of the very behaviors correctional officials are trying to prevent. Education and risk-reduction counseling are the least controversial and most widely employed modes of prevention, but the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined.     

Prevalence of and risk factors associated with Mycobacterium tuberculosis infection in prisoners, North West Frontier Province, Pakistan

BACKGROUND: This cross-sectional study was conducted to assess the prevalence of and identify factors associated with latent Mycobacterium tuberculosis (MTB) infection in prisoners of North West Frontier Province (NWFP). METHODS: A stratified random sampling technique was used to select a sample of 425 from a total of 6607 male prisoners aged 18-60 years from the five central prisons of NWFP, Pakistan (Peshawar, Dera Ismail Khan, Haripur, Kohat, and Mardan). The selected inmates were interviewed using a structured pre-tested questionnaire; a Mantoux tuberculin skin test (TST) was also performed. Latent MTB infection status of the prisoner was determined by the size of the induration of the TST in the presence/absence of a previous BCG scar. RESULTS: Overall prevalence of latent MTB infection among prisoners was 48% (204/425). Using multiple logistic regression, a prisoner's age, educational level, smoking status, duration of current incarceration, and average accommodation area of 60 ft(2) or less in prison barracks were found to be statistically significant (P < 0.05) predictors of latent MTB infection. CONCLUSION: The high prevalence of latent MTB infection as assessed by TST in prisoners requires immediate steps be taken to identify and confirm MTB infection, and to treat and counsel those found to be positive in this setting. Efforts to halt MTB transmission in prisons should include: routine screening of prisoners on entry using sputum smear and TST for diagnosis of tuberculosis (TB) and latent MTB infection, respectively. The isolation and treatment of TB positive prisoners and chemo-prophylactic treatment of TST positives, reduction of overcrowding, education regarding the harmful effects of smoking, and intensive monitoring of those serving longer prison terms may help reduce the MTB transmission in this setting and in the community at large.     

Sex,violence and HIV on the inside: cultures of violence,denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings

To map the context of HIV in closed settings in Papua New Guinea (PNG), semi-structured interviews were undertaken with 56 prisoners and detainees and 60 key stakeholders. The nature of HIV-related risk differs for detained women and men, and reflects important gender-based issues present in PNG society more broadly. Women in detention are vulnerable to sexual violence and exploitation and at greatest risk of HIV while detained in police holding cells, where they are typically supervised by male officers, in contrast to prisons, where they have little contact with male staff. HIV risk for men in prison is associated with consensual and non-consensual sex; this risk is perpetuated by a pervasive culture of denial and institutionalised homophobia. The illegal nature of sodomy and male-to-male sex provides Correctional Services the legal grounds by which to refuse access to condoms for prisoners. Addressing HIV risk among detained men and women in PNG requires the reform of legislation, police and prison practices and an understanding of broader structural problems of gender-based violence and stigma and discrimination.     

What happens behind bars: prevention strategies developed in civilian police stations against HIV/AIDS and other sexually transmitted diseases

Brazilian Preventive Healthcare Policy has implemented important strategies to combat the spread of HIV/AIDS. However, there are some individuals that are theoretically not part of society who are catching and transmitting disease, namely prisoners. This population interacts with the community by means of relatives, visitors, prison wardens and repeat incarceration. The scope of this research is to establish the strategies developed to prevent the transmission and dissemination of STD/AIDS in Civil Police stations. A qualitative study was conducted with interns of the public prisons of four cities of the region of Naviraí in Mato Grosso do Sul State, and analysis was applied using the collective subject discourse technique. Results showed that despite acknowledging the importance of prevention, the male condom is only used in the first sexual encounter, and condoms are not used when intercourse is with a steady partner. The lack of orientation in relation to prevention of STD/AIDS is well-known as is the lack of attention to the healthcare of prisoners, due mainly to prejudice and discrimination by society. It was revealed that a healthcare policy for prisoners also needs to be implemented in public prisons.     

北京市监狱警察艾滋病知识态度行为调查分析

目的 了解北京市监狱警察艾滋病知识、态度、行为现状以及性观念、AIDS知识来源等，为开展狱警AIDS健康教育和行为干预提供依据。方法 对北京市监狱管理局682名警察进行问卷调查，并运用EpiData3．1、SPSS13．0软件进行统计分析。结果 98．2％的警察听说过艾滋病，对AIDS的三条主要传播途径知晓率为92．2％，但对一般日常生活接触是否传播AIDS知晓率偏低，仅54．4％的警察知道蚊虫叮咬不传播艾滋病。对AIDS及HIV感染者存在恐惧和歧视心理，愿意与艾滋病人一起工作的人只有25．1％。性观念相对开放，安全套防病功能意识不足，安全套使用率低。AIDS知识来源广泛，包括广播电视、报刊杂志、单位宣传、网络等。结论监狱警察听说过艾滋病的比较高，对AIDS有一定的认知，但缺乏深入了解，存在认识误区，对AIDS/HIV感染者存在歧视现象，性观念比较开放，自我保护技能欠缺，需继续深化普及艾滋病健康教育。