WHO Updates Recommendations for HIV, Hepatitis, STI Interventions in Prisons

People in prison are disproportionately affected by HIV, viral hepatitis, sexually transmitted infections (STIs) and tuberculosis. As such, the World Health Organization has released updated recommendations for prevention, diagnosis, treatment, and care of this key population.

The policy brief, which is an update to broader 2022 guidance, offers a recommended package of interventions for the prevention, diagnosis and treatment of HIV, viral hepatitis, and STIs among people in prisons and other closed settings.

Prisons represent an intersection of risk factors, including high rates of poverty, low education levels, sexual violence, and substance use. Overcrowding, poor ventilation, inadequate nutrition, and poor infection control practices in prisons also contribute to higher exposure to tuberculosis.

“Assuring equitable access to TB services for all people in prisons, regardless of HIV status, is critical for reducing the increased burden of TB among people in prisons,” the guideline authors wrote.

Prisoners face lack of access to items such as condoms and sterile needles for prevention, along with inadequate diagnostics, treatment ,and continuity of care.

“For impact on HIV, viral hepatitis, TB and STIs, the package of interventions which prevent, diagnose ,and treat these diseases is essential, and should be provided within prisons and other closed settings, with continuity of services during inter- and intra-prison transfers and after release,” the update says. “Given that drug use and sexual activity are common in prisons, this package should include condoms and lubricant and harm reduction interventions (needle and syringe programs, opioid agonist maintenance therapy [OAMT], and naloxone for overdose management).”

The update calls for comprehensive health services for prisoners, including mental health services, drug and alcohol screening and treatment, and cancer screening and treatment. It also calls for the removal of laws that contribute to the disproportionate rate of key populations in prisons, including laws against drug use or possession, gender identity, or sexuality and sex work.

The report also highlights a need for alternatives to incarceration, such as diversion into treatment, interventions to reduce violence, and efforts to address stigma and isolation.

The update lists interventions under 3 categories:

• Those that reduce barriers to health care, such as removing punitive laws, reducing stigma, and addressing violence.
• Those that have a direct impact on HIV, viral hepatitis, and STIs, such as access to condoms, pre-exposure prophylaxis, vaccination, testing, and treatment.
• Those that address broader health for key populations, such as sexual and reproductive health care, mental health, and alcohol and substance use screening and treatment.

The recommendations provided are consistent with research. Investigators in the United Kingdom found that decriminalizing drugs and investing the savings into programs that improve antiretroviral therapy and opioid agonist therapy would save money and reduce HIV transmission. Their model, published in The Lancet HIV, included 4 scenarios, ranging from a baseline scenario following current practices to a scenario including full-scale decriminalization and fully-funded ART and opioid agonist therapy for prisons and the community.

Cooper University Healthcare was selected as a site for a transitional care coordination program to connect incarcerated individuals with HIV to care. The program allowed many inmates to continue care after release.