International Journal of Drug Policy - 2015

Volume 26 Supp 1 Feb 2015

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International Journal of Drug Policy 26 (2015) S12–S15 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Commentary People who inject drugs in prison: HIV prevalence, transmission and prevention Kate Dolan a,∗ , Babak Moazen b , Atefeh Noori b , Shadi Rahimzadeh b,c , Farshad Farzadfar b , Fabienne Hariga c a Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia b Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran c United Nations Office on Drugs and Crime (UNODC), Vienna, Austria a r t i c l e i n f o Article history: Received 18 June 2014 Received in revised form 16 October 2014 Accepted 31 October 2014 Keywords: Prison Prevalence People who inject drugs Transmission Outbreaks Prevention a b s t r a c t In 2011, over 10.1 million people were held in prisons around the world. HIV prevalence is elevated in prison and this is due to the over representation of people who inject drugs (PWID). Yet HIV preven- tion programs for PWID are scarce in the prison setting. With a high proportion of drug users and few prevention programs, HIV transmission occurs and sometimes at an alarming rate. This commentary focuses primarily on drug users in prison; their risk behaviours and levels of infection. It also comments on the transmission of HIV including outbreaks and the efforts to prevent transmission within the prison setting. The spread of HIV in prison has substantial public health implications as virtually all prisoners return to the community. HIV prevention and treatment strategies known to be effective in community settings, such as methadone maintenance treatment, needle and syringe programs, condoms and antiretroviral therapy should be provided to prisoners as a matter of urgency. © 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( Introduction Globally, in 2011 over 10 million people were held in prison (Walmsley, 2013) and of these 2.5–3 million were held in pre-trial detention (Walmsley, 2014). However, the turnover in prison popu- lations is estimated to be at least three times that with some 30 million individuals being detained and released into the commu- nity each year. Female prisoners receive even less attention than their male counterparts. Women are a minority within the popu- lation of prisoners. Typically, they make up about 5–10% of prison populations in most countries (Walmsley, 2013). Yet the prevalence of drug use among them is much higher than their male coun- terparts and drug treatment options are usually more limited for female prisoners than for males. People who inject drugs within prison populations Drug users are vastly over represented in prison populations. Internationally, 10–48% of male and 30–60% of female inmates ∗ Corresponding author. E-mail address: (K. Dolan). have used illicit drugs in the month before entering prison (Fazel, Bains, & Doll, 2006). In the US, between 24% and 36% of all heroin addicts pass through the corrections system each year, representing more than 200,000 individuals (Boutwell, Nijhawan, Zaller, & Rich, 2007). Over 60% of PWIDs in a 12-city study reported a history of imprisonment (Ball et al., 1994) and in one Australian study, PWID reported an average of five imprisonments (Dolan, Wodak, & Hall, 1999). The frequent and repetitive imprisonment of drug users is the key reason for continuous growth in the size of prison populations. From 1996 to 2006, the US population rose by 13% and the incarcer- ated population rose by 33% yet the proportion of prisoners with a drug problem rose by 43%. Furthermore, the prison population has increased in all five continents. Over the last 15 years the world imprisonment rate has risen from 136 per 100,000 to the current rate of 146 per 100,000 (Walmsley, 2014). Rates of re-incarceration are especially high for inmates with a drug problem. Drug dependent offenders are much more likely to return to prison than other offenders. In the US, over 50% of drug dependent inmates have a previous incarceration compared with 31% of other inmates. In Australia, 84% of heroin dependent inmates were re-incarcerated within two years of release compared to 44% of all prisoners (Steering Committee for the Review of Government 0955-3959/© 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (

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