new report by the Health Protection
Agency (HPA), published this September,1
says: “There still remains a significant number of people passing through the
prison estate without being tested for blood-borne viruses, and this situation
needs to change.”
particular, they say that current surveillance systems, necessary to develop
HIV and hepatitis C services, are “inadequate”.
Azad, Director of Policy at the National AIDS Trust (NAT), agrees: “There is a
significant and worrying gap in the data which is essential to close if we are
to get a proper understanding of how many prisoners remain undiagnosed, or at
risk of infection. NAT has been calling for a new anonymous survey of
blood-borne viruses in prisons for several years.”
there has been movement. The 2010 HPA report includes – for the first time
since 1997/98 – unlinked anonymous surveillance figures for prisoners with hepatitis
C and HIV. But they tell a complex story.
last time there was a specific survey of HIV prevalence in prisoners was back
in 1997. In this survey, from a sample of 3942 prisoners drawn from eight of
130 or so prisons, 7% tested positive for hepatitis C and 0.4% for HIV.2
2010 data set consisted of results from prisoners who were tested for hepatitis
C (but not HIV) as part of their routine health care. This covered the period
2005 to 2008 and included 39 prisons (30% of the prison estate). Of the 10,723
tested for hepatitis C antibodies, 24% tested positive.
apparently large increase may be due to the fact that these were prisoners
assessed specifically for healthcare problems and may also be partly due to
different prisons being included: in the big prisons in north-west England,
hepatitis C prevalence is known to be above average. But it also appears partly
Prison can be a safe and even a good place to be diagnosed and treated. We have
experience of women managing to turn their lives around after diagnosis, having
established stability in prison.
Sophie Strachan, Positively UK
assess HIV prevalence, the HPA looked at its existing SOPHID (Survey of
Prevalent HIV Infections) database of people accessing HIV treatment and care
services. It states that: “In 2008 171 prisoners were reported to be resident
in English prisons at the time of reporting, and an additional 82 individuals
were reported as resident in prison prior to 2008”. What this latter figures
means is “some of these may be in prison and some are not: we don’t know”.
the UK prison population numbering some 85,000, the lower SOPHID figure would
imply that HIV prevalence in prison was 0.2% - exactly the same prevalence as
in the UK general adult population aged 15 to 59. Even if you include the 82
‘possibles’, it’s still only 0.3%: lower than in 1997, against a background
where the general adult population HIV prevalence has more than doubled.
HPA says that these HIV figures are “likely to underestimate the true figure,
with under-reporting particularly affecting prisoners with shorter custodial
sentences”. Their rough estimate is that there are about 300 to 500 people with
HIV in prison- about 0.5% or double the general-population prevalence. This
means that the number of people accessing HIV care in prisons is lower than the
number who actually have the virus.
HPA adds that injecting drug use (IDU) risk is likely to be substantially under-reported
too, with the 19% of prisoners identified as injecting drug users likely to
underestimate the true total.