Chapter 3 Preventing the spread of HIV/Aids and hepatitis B/C in prisons 3.1 Epidemiological background In contrast to the worldwide decrease in the incidence of new HIV infections and Aids‑related deaths over the last decade, there has been an increase of more than 25% in new HIV infections and Aids‑related deaths during the same period in eastern Europe and Central Asia. The number of people with HIV infections in this region has tripled since 2000 and the dynamic of the epidemic is predominantly driven by transmission among people who inject drugs: at least one quarter of the estimated 3.7 million people who inject drugs in this region have HIV infection.1 Hepatitis C virus infection rates in injecting drug users are reportedly 40‑90%.2 The increased prison population in many countries has largely been the result of intensifed law enforcement against the supply, possession or use of illicit drugs and is being accompanied by an increase in the number of prisoners who consume and inject drugs. Up to 30% of prisoners have a history of injecting drugs. This is the main reason why HIV and hepatitis C and B prevalence rates among prisoners are up to 30 times higher than among people of comparable age living in the community. Hence, prisons must be regarded as epidemio‑ logical epicentres for such parenteral transmissible infections as blood‑borne and/or sexually transmissible infections, for several reasons. X Prisons have a concentration of persons with risk behaviour for infections from intravenous drug use (IDU), sharing of injection instruments, 1. UNAIDS: Report on the global AIDS epidemic 2010 (November 2010). 2. EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). Page 51