Across the EU the spread of HIV in the prison population varies from 1-2% in the UK and Denmark to 17% and 20% (WHO, 2000) in Spain and Portugal respectively. Even within the European Community, which has a goal of harmonising many health standards, the treatment in prisons of HIV, Hepatitis and TB remains a loosely stitched patchwork of approaches.

One approach has been the controversial introduction of sterile injecting gear into prisons. Use of contaminated cutting or piercing instruments has been shown to be a high-risk behaviour for transmitting HIV in prisons, particularly in the case of sharing needles for IV drug use. Distributing sterilisation tablets, or bleach, to prisoners is a policy that is gaining popularity in countries where IV drug use is a primary means of transmission.

At Hindlebank women’s prison in Switzerland, a one year experimental project provided sterile needles to the 100 inmates, most of who were convicted of drug offences. The sterile needles were available from dispensing machines in accessible locations, such as toilets, showers and storage areas. Prisoners were not permitted to keep more than one needle and were required to store their injecting equipment in a designated cabinet. An evaluation of the project found that there were no new cases of HIV, prisoner health had improved, needle-sharing decreased, drug use remained stable, and there were no instances of needles being used as weapons. At the end of the year, the project was considered a success and was continued. (UNAIDS Technical Update p5)

Rather than provide sterile needles, a more popular approach to the problem of shared IV drug use equipment is to provide sterilisation materials for the inmates. This policy meets with similar arguments as the condom distribution policy, citing the principle that providing bleach or other disinfectants implies approval of illegal or prohibited activities. Nonetheless, an increasing number of prison systems are introducing bleach distribution programmes. In Spain, a bottle of bleach is provided to each prisoner upon entry into prison and each month thereafter, in addition to being available as needed. Other countries which distribute bleach to a similar extent include Australia, Belgium, Canada, France, Germany, the Netherlands, and Luxembourg (Jurgens).

The arguments against providing disinfectant materials for prisoners are that it is not necessary or that the disinfectant will be used as a weapon or in some other manner that would constitute a threat to security. After a bleach distribution pilot project in Canada, an evaluation questionnaire found that 99% of respondents felt that having bleach available to inmates was “very important” and all but one injecting drug user responded that they would use bleach to sterilise injecting equipment. According to Ralf Jürgens of the Canadian HIV/AIDS Legal Network, “There are no reported incidents of any negative consequences of making bleach available. This is consistent with the Canadian experience.”

The following selection highlights the differing approaches to the control of blood-borne infections in prisons. The issue of TB/HIV co-infection is addressed in the Russian section.