In order to estimate 'environmental' infectious risk, an electronic/postal survey questionnaire focusing primarily on the availability of HIV-HCV preventive measures and HBV vaccination for prisoners was sent to the heads of medical units in all the prisons in all 5 countries (in 2009–2010 for France, in 2013–2014 for the other 4 countries). A previous survey in France was conducted between November 2009 and May 2010 and targeted all French prisons (170 prisons). The study’s secondary objective was to identify which particular characteristics of prison settings and penitentiary policies are correlated with non-adherence to WHO/UNODC recommendations.Ī nationwide survey targeting all prisons in each of the following 4 European countries was conducted between June 2013 and April 2014: Belgium (35 prisons), Austria (28 prisons), Denmark (50 prisons) and Italy (205 prisons). We also aimed to create a 5-country comparison, in order to include France, by creating a second adherence score. This measurement was achieved by computing an adherence score which was modified to take into account the latest international recommendations. The main objective of this international survey was to compare the levels of environmental infectious risk in prisoners between 4 different countries, by measuring to what extent prisons in these countries adhere to international recommendations for HIV prevention. Data on health policy implementation in general in the prison setting are sparse, and conducting research to explore related issues is difficult. For example, although France adopted the principle in 1994, the ANRS-PRI 2DE survey (2009–2010), which measured the level of adherence to national and WHO/UNODC guidelines, revealed a gap between the official recommendations and their application in French prisons.

Despite being adopted in several countries, the principle of equivalence in health, including prevention, between the prison system and the general community is rarely implemented in reality. National strategies to control transmission risks should include prisons. The risk of prisoners transmitting disease is high as they are in constant contact with the general community through visitors, staff and because a considerable proportion of them can cycle in and out of prison. The burden of illnesses, particularly infectious diseases, is heavier in the prison population than in the general population, with high prevalences of HIV, HCV and tuberculosis, as well as higher rates of mental disorders, including drug/alcohol use disorders. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community. Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08). These results were confirmed when using the second score which included France in the inter-country comparison. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level.

ResultsĪ majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison. It ranged from 0 (no adherence) to 12 (full adherence). A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. Methodsįollowing the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners.

The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations. Prisoners constitute a high-risk population, particularly for infectious diseases.

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