of parenteral transmissible infections in prison. Countries vary considerably
in how they punish illicit drug use and possession of illicit drugs for personal
use. Given the high risk of infection transmission, serious consideration should
be given to the negative psychosocial impact of incarceration, particularly
on young drug‑dependent persons, the lack of appropriate treatment and
rehabilitation facilities for drug dependency in prison settings, the legal
framework and sentencing practices, especially the imprisonment of drug‑
dependent ofenders. All possible alternatives to incarceration for the many
petty crimes of drug users should be considered at all levels of the criminal
justice system – police, pre‑trial period, court, post‑trial – and various alter‑
natives to prison – diversion, alternative sanctions, release on parole – should
be sought, combined with treatment ofered in the community.8
Education and training
In line with the principles of health promotion in prison,9 continuous education
and training programmes on HIV/Aids and hepatitis B and C should include
the whole prison community: prisoners, prison staf, prison administration
and persons with or without risk behaviour. The programmes should include
information on the aetiology and pathogenesis of relevant infectious diseases,
their course, symptoms, diagnosis and treatment, and particularly the routes
and means of transmission, ways they will not be transmitted, how to protect
oneself and others, harm‑reduction measures and what to do after possible
exposure. They should also include an invitation to voluntary confdential
counselling and testing. However, information about harm‑reduction meas‑
ures and testing is only preventive if they are also provided and accessible in
prison. The training programmes must take into account the high prevalence
of illiteracy, learning difculties and language barriers in the prison population.
The frequency of regular education and training events on this issue should
consider the turnover rate of inmates and staf, as well as the importance of
keeping knowledge and awareness of the topic alive.
It is the obligation of health‑care professionals that, as well as providing infor‑
mation individually, face to face, during medical consultations on admission
(see above, Medical consultation on admission), they ensure education and
8. UNODC: From coercion to cohesion: treating drug dependence through health care not pun‑
ishment, Discussion paper of a scientifc workshop, 28‑30 October 2009 (Vienna 2010);
EMCDDA: Alternatives to imprisonment — targeting ofending problem drug users in the EU
(Lisbon 2005).
9. Møller L. et al: Health in prisons: a WHO guide to the essentials in prison health (Geneva 2007).
Prison health care and medical ethics Page 54
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