No condoms for prisoners: accumulating risks of HIV, STI but also Hepatitis transmission
Butler and colleagues report convincing results confirming that the availability of HIV prevention tools such as condoms in prisons does not increase sexual activity among inmates but rather increases safe sex. These results represent a major step towards negating the widespread belief that the general availability of prevention measures in prisons increases at-risk practices associated with HIV, Hepatitis and other sexually transmitted infections (STI). Indeed similar ad hoc studies regarding the availability of needles and syringes programs in prisons (NSP) showed no increase in injection but an increase in safe injecting practices. Despite such evidence, NSP continues to be banned in prisons in several countries.
Recommendations by the authors about breaking down the last barriers to condom availability in prisons are particularly significant and timely for several reasons. First, condoms are not always available in prisons and, paradoxically, this is particularly true in countries with a high prevalence of HIV among inmates. When "potentially" available, inmate access to condoms is not always easy both due to a lack of condom machines, and because inmates are reluctant to ask for them out of fear of stigmatization. Moreover, a French study has already shown that HIV post-exposure prophylaxis is neither known nor prescribed to prisoners and this is perhaps the case for many other correctional institutions. Second, the need for condoms in prisons is justified by the recent increase in industrialized countries of HCV permucosal transmission in HIV -positive men who have sex with men (MSM). This increase is concomitant with increased drug use and high risk sexual practices in this population. Additionally, HIV and other STI, which are frequent in prisoners, appear to be important cofactors in onward transmission of permucosally acquired HCV. Third, the criminalization of drug users and MSM in several countries contributes to promiscuity in prisons, facilitating transmission of HIV and Hepatitis B and C from one group to another. Though sexual violence was infrequent and underreported in the study by Butler et al., this may not be the case for other prisons where overpopulation may amplify such risks.
Assuring the same prevention interventions for prisoners as those enjoyed by the general population is not only a human right but a public health need.
1. Butler T, Richters J, Yap L, et al. Condoms for prisoners: no evidence that they increase sex in prison, but they increase safe sex. Sex Transm Infect. 2013 Jan 7.
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3. Michel L, Jauffret-Roustide M, Blanche J, et al. Limited access to HIV prevention in French prisons (ANRS PRI2DE): implications for public health and drug policy. BMC Public Health. 2011;11:400.
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