Drug use is prevalent in prison systems across the globe, and the rates of HIV and hepatitis C—both viruses can be transmitted via injection drug use and sex—are also higher among people in prison than among the general population. Yet prisons are often overlooked in efforts to tackle these epidemics.

People in prison need access to lifesaving harm reduction services as well as HIV prevention and treatment, urges the Joint United Nations Programme on HIV/AIDS (UNAIDS) in a call to action issued earlier this month to coincide with International Harm Reduction Day, marked each May 7.

“Access to health care, including harm reduction services, is a fundamental human right, and no one should be denied that right because they are incarcerated,” said Eamonn Murphy, UNAIDS regional director for Asia Pacific and Eastern Europe and Central Asia, in a press release. “Prisons are too often ignored in countries’ efforts to respond to HIV. A multisectoral, multifaceted approach is urgently needed to save lives, which includes access to clean needles and syringes, effective treatment for dependence on opioid drugs and reducing stigma and discrimination.”

Data reported by UNAIDS in the call to action underscore the importance of reaching the prison population:

  • In 2021, the estimated number of people in prisons increased by 24% since the previous year, to an estimated 10.8 million people.

  • People in prison are 7.2 times more likely to be living with HIV than adults in the general population.

  • HIV prevalence among people in prisons increased by 13% since 2017, reaching 4.3% in 2021.

  • It is estimated that around one in four of the total prison population has hepatitis C.

  • Both drug use and HIV infection are more prevalent among women in prison than among imprisoned men (women who use drugs and sex workers are overrepresented in prisons).

Among the countries reporting on prisons to UNAIDS in 2019:

  • 6 of 104 countries had needle and syringe programs in at least one prison.

  • 20 of 102 countries had opioid substitution therapy programs in at least one prison.

  • 37 of 99 countries had condoms and lubricants in some prisons.

To illustrate the progress a nation can make in its prison system, UNAIDS highlights the programs of Moldova, an Eastern European country near Romania and Ukraine. Today, all of the country’s 17 penitentiaries provide harm reduction (including syringe exchange and opioid agonist therapy) as well as HIV testing, prevention and treatment.

For a profile on Moldova’s success, watch the video at the top of this article or on YouTube.

In related news, see “To Access Meds, Russian Prisoners With HIV Join War Against Ukraine” and  “How Many People in U.S. Prisons are Living With HIV.”

Both HIV and hepatitis C are viruses than can be transmitted via injection drug use and sex. Hepatitis refers to inflammation of the liver. When untreated, it can lead to scarring of the liver (cirrhosis), liver cancer, the need for a liver transplant and death. Hepatitis can be caused by several factors, including toxins, excess alcohol use, autoimmune diseases, fat in the liver and viruses, including the three most common ones: hepatitis A, B and C. According to “Hepatitis C Transmission and Risk,” part of Hep magazine’s Basics of Hepatitis, hep C is most easily spread through:

  • Sharing needles and other equipment (paraphernalia) used to inject drugs,

  • Blood transfusions and organ transplants before July 1992,

  • Sexual contact with someone who has hep C,

  • Having a mother who had hep C when you were born.

HIV, in contrast, is a virus that attacks the immune system. Over several years, the immune system becomes depleted, and the body isn’t able to fight infections, leading to an AIDS diagnosis. Although there is no cure for HIV, many safe and effective treatments—often just one pill a day—are available. The medications help people living with HIV enjoy long and healthy lives and keep them from transmitting the virus to others. For more, see the Basics of HIV/AIDS in POZ.com, a sister publication of HepMag.com, RealHealthMag.com, CancerHealth.com and TuSaludMag.com.