1. Global burden of HIV, viral hepatitis and TB in prisoners
Kate Dolan, Andrea Wirtz, Babak Moazen, Martial Ndeffo-mbah, Alison Galvani, Stuart Kinner, Ryan Courtney, Martin McKee, Joe Amon, Lisa Maher, Margaret Hellard, Chris Beyrer & Fredrick L Altice

2. Aims and methods Global number of inmates with HIV, HCV, HBV & TB
Pooled estimated prevalence by region and incidence (new cases)
Model impact of incarceration and OAT on HIV incidence
Comprehensive review 196 countries
Studies with biological markers of HIV, HCV, HBV and TB
Prisons, jails and Compulsory Drug Detention Centres
HIV and related infections in prisoners

3. Results: Of 10 million inmates *
Infection
Number of inmates infected
% infected
HIV
389,000
3.8
HCV
1,546,500
15.1
HBV
491,500
4.9 TB
286,000
2.8
* ~30 million enter and leave prison each year
HIV and related infections in prisoners

4. HIV HCV HBV & TB prevalence by region
HIV and related infections in prisoners

5. HIV prevalence in prisoners n=74 countries
HIV and related infections in prisoners

6. HCV prevalence in prisoners n=46 countries
HIV and related infections in prisoners

7. HBV prevalence in prisoners n=43 countries
HIV and related infections in prisoners

8. TB prevalence in prison n=25 countries
HIV and related infections in prisoners

9. HIV, HCV & HBV incidence in prison n=5 countries

10. Model: Incarceration and OAT on HIV transmission
Contribution of incarceration
↓ PWID in prison by 25% will ↓ HIV rate by 7-15% Contribution of OAT
↑ OAT in prison by 20% will ↓ HIV rate by 28%
Modelled various scenarios to reduce HIV incidence
HIV and related infections in prisoners

11. Compulsory Drug Detention Centres
Suspected drug users held in 27 countries
East/South East Asia, 600,000 ppl in 1,000 centres Latin America & sub-Saharan Africa unknown number
Extra-judicial & forced labour as “drug treatment”
Inhumane conditions are common [skin on the cable]
Evidence-based prevention & treatment are rare
HIV and related infections in prisoners

12. Limited data on TB and incidence for all infections
Conclusions
Limited data on TB and incidence for all infections
Millions of prisoners are infected
High HIV in African Regions reflects community epidemic High HCV in six regions
West Central Africa, MENA, Asian/Pacific, East & West Europe & Nth America
High HBV in West Central Africa & East Europe
Over representation of PWID going to prison
Levels much higher inside prison than outside
HIV and related infections in prisoners

13. Introduce alternatives to imprisonment
Recommendations
Expand harm reduction, drug treatment, ART, PrEP HBV vaccinations, HCV treatment in the community
Introduce alternatives to imprisonment
Improve prison health care to community levels
Test and treat and prevent infections in prisoners
Lobby Govts close Compulsory Drug Detention Centres and provide effective treatment
Collect more data esp Caribbean
HIV and related infections in prisoners

14. Acknowledgements UK: Lancet
USA: National Institute on Drug Abuse, National Institute of Health, MACAIDS, Gates Foundation, Open Society Foundations
Australia: National Drug & Alcohol Research Centre, Cancer Institute
NSW, National Health & Medical Research Council
Germany: Deutscher Akademischer Austauschdienst United Nations Population Fund, UNODC, EMCDDA
HIV and related infections in prisoners

15. Affiliations
Australia: Program of International Research and Training (PIRT)
University of New South Wales,
Griffith Criminology Institute, Burnet Institute
USA: Johns Hopkins School of Public Health, Yale University, Human Rights Watch
UK: London School of Hygiene & Tropical Medicine
Iran: Tehran University of Medical Sciences
HIV and related infections in prisoners

16. infections in prisoners
HIV and related
infections in prisoners
Thank you