At any given time, over two million people are imprisoned in penal
institutions in Europe. Prisons are extremely high-risk environments for
the transmission of infectious diseases because of a high number of risk
factors, such as overcrowding, poor nutrition, limited access to health
care, continued illicit drug use and unsafe injecting practices,
unprotected sex and tattooing. If prisons are not to become a breeding
ground for infectious diseases, health and medical care, and prevention
and treatment must be an integral part of the penal system. Prison health
policy should be integrated into national policy and prison health should
be closely linked to the public health service. This applies to all health
issues but is particularly important in the case of communicable diseases.

The unintentional punishment

A prison sentence is not always over on release from prison. Individuals
who are healthy on entry have a high risk of leaving prison infected with
HIV or tuberculosis (TB) or with an addiction to drugs. Added to the
stigma of a prison sentence, this hampers their reintegration into society
and makes a normal family and social life difficult. The post-release
period is very important, as ex-prisoners are at greater risk of dying
within the first weeks after release from prison, primarily as a result of
an overdose of illicit drugs. An effective throughcare plan must be
developed between prisons and public health systems.

“Rather than rehabilitating inmates, a prison sentence often makes matters
worse,” says Dr Marc Danzon, WHO Regional Director for Europe. “It is
unacceptable that we allow prisons to encourage unhealthy practices,
meaning that people leave prison in poorer health than when they arrived.
This lowers their chances of reintegrating into society and spreads
infectious diseases beyond the prison walls. Work by countries to protect
the health of prisoners helps not only individuals but the whole of
society.”

The health of prisoners affects the rest of society

Overcrowding, the high turnover in the prison population and the intensive
interaction between prison and society encourages the spread of
communicable diseases. Neglecting the health of prisoners impacts on the
wider public, putting them at risk of infection from diseases like TB and
HIV.

The Madrid Recommendation

An international conference on prison health protection is taking place in
Madrid from 29 to 31 October 2009. Health experts from over 50 countries
have agreed on a set of recommendations to tackle the issue of
communicable diseases in prisons. The aim of the Madrid Recommendation is
to ensure that, rather than making matters worse, prisons are a setting
where health and health behaviour are improved and the risk of reoffending
is reduced. These cost-effective measures include:

— treatment programmes for infectious diseases, including HIV/AIDS,
hepatitis C and TB;
— treatment programmes for drug users;
— harm reduction measures;
— guidelines on hygiene requirements;
— guaranteed throughcare for prisoners on entry to and after release from
prison, in close collaboration with stakeholders;
— mental health support for prisoners suffering from communicable
diseases; and
— training for all prison staff in the prevention, treatment and control
of communicable diseases.

Source
World Health Organization