need, in countries where needle/syringe‑exchange and opiate‑substitution programmes for injection drug users are available in the community, they should be made available in prisons as well. In 2012 there were 74 prisons in eight countries (with well‑funded and severely underfunded prison systems) – Switzerland, Germany, Spain, Republic of Moldova, Kyrgyzstan, Romania, Luxembourg and Tajikistan – where needle/syringe‑exchange programmes were running in prisons for men and women, of all security levels and sizes, and in some cases had been running for more than 10 years. Various ways of distributing and collecting injection para‑ phernalia were used: health‑care professionals, NGO staf, automated dispensing machines or carefully selected peer inmates. Despite these diversities, the results of these programmes have been remarkably consistent. They have improved prisoners’ health, reduced needle sharing and undercut fears of violence. At the same time, there has been no evidence of increased drug consumption or other negative consequences.22 In countries with high prevalence of HIV among drug users in the community and in prisons, the implementation of needle/syringe‑exchange programmes in prison must be regarded as a mat‑ ter of high priority.23 Achieving this goal will require leadership and skill to convince the public and politicians of the importance of this harm‑reduction method in prison, for the beneft of general public health. Prevention of other possible causes of blood‑borne infections that might prevail in prisons, such as sharing and re‑using of tattooing and piercing instruments or razors, and blood‑sharing brotherhood rituals, should also be addressed in educational training and/or by appropriate provisions. Provision of condoms and prevention of sexual violence International prison research provides evidence that sexual activity in prisons happens all over the world. Most sexual contacts are, understandably, of same‑sex nature; they may be consensual or coerced (in the coercive envi‑ ronment of a prison often not clearly distinguishable) and 1‑3% of prisoners 22. Prison Needle Exchange: Lessons from a comprehensive review of international evidence and experience, 2nd edn, Canadian HIV/AIDS Legal Network (2006); WHO/UNAIDS/UNODC: Guide to starting and managing needle and syringe programmes: needle and syringe programmes in closed settings (Geneva 2007). 23. WHO/UNAIDS/UNODC: Guide to starting and managing needle and syringe programmes: needle and syringe programmes in closed settings (Geneva 2007). Preventing the spread of HIV/Aids and hepatitis B/C in prisons Page 59