School of Public Health and Community Medicine
HIV prevalence, incidence and mortality in prison: A global
overview
Professor Kate Dolan and Babak MoazenProgram of International Research and TrainingNational Drug and Alcohol Research Centre UNSW, Sydney, Australia
Background
Prison settings have characteristics that increase HIV transmission
Elevated levels of HIV, HBV, HCV, TB & mental illness
Widespread risky behaviour, few prevention/treatment measures
Unless HIV is controlled in prison it may be uncontrolled in the community
Yet prison settings are a practical point of HIV prevention and treatment
Background
Drug dependence key factor in prison growth
US popn up 13%prison popn up 33%PWIDs prisoners up 43%
1/3 of 200,000 heroin users in US imprisoned annually60% of PWIDs in a 12-city study been in prison
Re-incarceration rates very high for PWIDs- In Australia, 84% of PWIDs inmates were re-incarcerated in 2 yrs of release versus 44% of all prisoners. They had a mean of 5 imprisonments.
Aim
Global systematic review of the HIV situation in prisons on
A. Imprisonment rates
B HIV prevalence
C HIV incidence
D AIDS related mortality
E Services provided in prison
The time period under observation January 2008 to April 2013.
Methods
• A multilingual (English, German, Spanish, Croatian, French,
Arabic, Portuguese and Russian) desk review of the
literature
• A survey of UN staff and experts
• List of Countries from
http://www.unaids.org/en/regionscountries/countries/
Imprisonment rates from the International centre for prison
studies
http://www.prisonstudies.org/info/worldbrief/
Results
Identified 4,640 peer reviewed papers and 8,292 documents Total number of documents used was 261
10 million prisoners - 3 million on pre trial remand in the world
BUT 30 million individuals enter and leave prison - 90% male
The world average rate of incarceration was 144 per 100,000
Imprisonment rates for each Region per 100,000 adult popn
Imprisonment rate No. of countries Region
182 20 East/ Southern Africa
68 25 West/Central Africa
129 35 Asia and Pacific
332 16 Caribbean
220 30 Eastern Europe and Central Asia
210 17 Latin American
128 21 Middle East and North African
127 22 Other Countries
144 196 Total
Data located on HIV prevalence for each region and key populations
HIV prevalence among inmates No. of countries Region
MSM PWIDs Female Male All
1 1 6 6 10 20 East/ Southern Africa
1 2 2 12 25 West/Central Africa
1 5 4 8 35 Asia and Pacific
1 16Caribbean
3 6 6 12 30Eastern Europe and Central Asia
3 4 3 17Latin American*
2 3 4 7 21Middle East and North African
2 1 1 2 6 22Other Countries
3 9 26 28 58 196Total
Range of HIV prevalence for each Region by sex and all prison popn
% All Male % female% Region
6 – 34 0 - 50 2 – 75 East/ Southern Africa
1 – 19 3 - 5 0 – 17 West/Central Africa
0 – 29 0 - 2 0 – 30 Asia and Pacific
4 -- -- Caribbean
0 – 15 1 - 33 1 - 38 Eastern Europe and Central Asia
0 – 12 0 - 18 1 – 4 Latin American
0 - 4 0 - 1 0 – 4 Middle East and North African
0 - 8 1 - 4 1 - 2 Other Countries
Range of HIV prevalence in prison populations
East and Southern Africa
%
Ethiopia 8
Kenya 6 – 27
Malawi 41 - 42
Mauritius 23
Mozambique 17
Rwanda 2 - 8
South Africa 16
Swaziland 0 - 75
Uganda 11 - 13
Tanzania 5 - 15
Zambia 26 - 42
Range of HIV prevalence in prison populations
West and Central African Region
%
Burkina Faso 5
Cameroon 5-8
Cape Verdi 2
Cote d’Ivoire 3 – 17
DR Congo 8
Ghana 10-20
Mali 0 - 3
Mauritania 4
Niger 3
Nigeria 2
Senegal 3
Togo 7
Range of HIV prevalence in prison populations
Asia and Pacific %
Australia 0
Cambodia 3
China 0 – 30
India 6 – 10
Indonesia 1 – 30
Malaysia 6
Pakistan 2
Sri Lanka 0
Thailand 3
Range of HIV prevalence in prison populations
Eastern Europe and Central Asia
%
Azerbaijan 3
Estonia 1 - 38
Georgia 0 - 5
Hungary 1
Kazakhstan 2 - 12
Latvia 6
Lithuania 4
Moldova 1 - 3
Romania 1 – 10
Tajikistan 6 - 18
Ukraine 12 - 33
Range of HIV prevalence in prison populations
Latin America %
Argentina 3
Brazil 10
Chile 2
Mexico 1 - 12
Range of HIV prevalence in prison populations
Middle East and North African Region
%
Afghanistan 1 – 4
Egypt 0
Iran 0 – 2
Lebanon <1
Morocco < 1
Oman < 1
Saudi Arabia < 1
Range of HIV prevalence in prison populations
Other Countries Region %
Italy 4
Luxembourg 1
Netherlands 0
Portugal 6
Spain 6 – 11
USA 1
Outbreaks of HIV transmission in prison populations and in IDU prisoners
Country incidence
Thailand 35/per 100
Lithuania300 inmates infected in 6 months
Doubled number of HIV cases
Russia 400 inmates infected in a few months
Iran Two outbreaks with hundreds infected
Australia At least 4 up to 12
Scotland 12
Afghanistan 17
HIV incidence in prison
Country Year % among males
% among females
% of total prisoners
Number of cases
Mozambique 2008-12 0.23 0.26 0.24 Kazakhstan
2008 772009 752010 43
Latvia
2008 0.2 2009 0.16 2010 0.17
Lithuania
2008 12009 102010 282011 0.4
Romania
2008 0.18 2009 0.15 2010 0.11 2011 0.11 2012 0.16
HIV incidence in prisonCountry Year % among
males% among females
% of total prisoners
Number of cases
Spain
2008 0.09 2009 0.0 2010 0.0 2011 0.04 2012 0.02
Moldova 2012 12
Russia 2008 229
Tajikistan 2009 258 (m)2010 279 (m) 21 (f)2011 475 (m) 28 (f)2012 514 (m) 29(f)
Ukraine 2008 0.9 9612009 0.8 23182010 11.2 36902011 10.4 28192012 10.6
Afghanistan
2008 1 (M) 0 (F)2009 21 (M) 0 (F)2010 6 (m) 1(F)2011 0 (M) 1(F)2012 7 (M) 0 (F)
AIDS related mortality in prison populationsCountry Year % among
malesNumber of cases among males
Republic of Moldova
200820092011
12.7%10.5%22.9%
Romania 20082009201020112012
31033
Russian Federation
2008
128
Ukraine 20082009201020112012
85169180388313
Conclusions and Recommendations
Good prisoner health is good public health: High turnover of
inmates mean diseases contracted inside leave prison.
High imprisonment rates in regions- non custodial sentences
Few data on prevalence, incidence and mortality
Low prevalence in Latin & MENA time to intervene
increase ARV, OST, condomsReduce prison populations: OST in community, divert PWIDsLegal obligation to medical treatment same level as in the
community. Compassionate release from prison for inmates in final stages
of AIDS.