HIV prevalence, incidence and mortality
in prison: A global overview
School of Public Health and Community Medicine
Professor Kate Dolan and Babak Moazen
Program of International Research and Training
National Drug and Alcohol Research Centre
UNSW, Sydney, Australia
Background
Prison settings have characteristics that increase HIV transmission
Elevated levels of HIV, HBV, HCV, TB & mental illness
Widespread risky behaviour, few prevention/treatment measures
Unless HIV is controlled in prison it may be uncontrolled in the
community
Yet prison settings are a practical point of HIV prevention and treatment
Background
Drug dependence key factor in prison growth
US popn up 13%
prison popn up 33%
PWIDs prisoners up 43%
1/3 of 200,000 heroin users in US imprisoned annually
60% of PWIDs in a 12-city study been in prison
Re-incarceration rates very high for PWIDs- In Australia, 84% of PWIDs
inmates were re-incarcerated in 2 yrs of release versus 44% of all
prisoners. They had a mean of 5 imprisonments.
Aim
Global systematic review of the HIV situation in prisons on
A. Imprisonment rates
B HIV prevalence
C HIV incidence
D AIDS related mortality
E Services provided in prison
The time period under observation January 2008 to April 2013.
Methods
• A multilingual (English, German, Spanish, Croatian, French, Arabic,
Portuguese and Russian) desk review of the literature
• A survey of UN staff and experts
• List of Countries from
http://www.unaids.org/en/regionscountries/countries/
Imprisonment rates from the International centre for prison studies
http://www.prisonstudies.org/info/worldbrief/
Results
Identified 4,640 peer reviewed papers and 8,292 documents
Total number of documents used was 261
10 million prisoners - 3 million on pre trial remand in the world
BUT 30 million individuals enter and leave prison - 90% male
The world average rate of incarceration was 144 per 100,000
Imprisonment rates for each Region per 100,000 adult popn
Region
No. of countries
Imprisonment rate
East/ Southern Africa
20
182
West/Central Africa
25
68
Asia and Pacific
35
129
Caribbean
16
332
Eastern Europe and Central
Asia
30
220
Latin American
17
210
Middle East and North African
21
128
Other Countries
22
127
Total
196
144
Data located on HIV prevalence for each region and key populations
Region
No. of
countries
HIV prevalence among inmates
All
Male
Female
PWIDs
MSM
1
East/ Southern Africa
20
10
6
6
1
West/Central Africa
25
12
2
2
1
Asia and Pacific
35
8
4
5
1
16
1
30
12
6
6
3
17
3
4
3
21
7
4
3
2
22
6
2
1
1
2
196
58
28
26
9
3
Caribbean
Eastern Europe and
Central Asia
Latin American*
Middle East and North
African
Other Countries
Total
Range of HIV prevalence for each Region by sex and all prison popn
Region
Male %
female %
% All
East/ Southern Africa
0 - 50
2 – 75
6 – 34
West/Central Africa
3-5
0 – 17
1 – 19
Asia and Pacific
0-2
0 – 30
0 – 29
Caribbean
--
--
4
Eastern Europe and Central
Asia
1 - 33
1 - 38
0 – 15
Latin American
0 - 18
1–4
0 – 12
Middle East and North African
0-1
0–4
0-4
1-2
0-8
Other Countries
1-4
Range of HIV prevalence in prison populations
East and Southern Africa
%
Ethiopia
8
Kenya
6 – 27
Malawi
41 - 42
Mauritius
23
Mozambique
17
Rwanda
South Africa
2-8
16
Swaziland
0 - 75
Uganda
11 - 13
Tanzania
5 - 15
Zambia
26 - 42
Range of HIV prevalence in prison populations
West and Central African Region
%
Burkina Faso
5
Cameroon
5-8
Cape Verdi
2
Cote d’Ivoire
DR Congo
3 – 17
8
Ghana
10-20
Mali
0-3
Mauritania
4
Niger
3
Nigeria
2
Senegal
3
Togo
7
Range of HIV prevalence in prison populations
Asia and Pacific
%
Australia
0
Cambodia
3
China
0 – 30
India
6 – 10
Indonesia
1 – 30
Malaysia
6
Pakistan
2
Sri Lanka
0
Thailand
3
Range of HIV prevalence in prison populations
Caribbean
%
Saint Vincent and the Grenadines
4
Range of HIV prevalence in prison populations
Eastern Europe and Central Asia
%
Azerbaijan
3
Estonia
1 - 38
Georgia
0-5
Hungary
1
Kazakhstan
2 - 12
Latvia
6
Lithuania
4
Moldova
1-3
Romania
1 – 10
Tajikistan
6 - 18
Ukraine
12 - 33
Range of HIV prevalence in prison populations
Latin America
%
Argentina
3
Brazil
10
Chile
2
Mexico
1 - 12
Range of HIV prevalence in prison populations
Middle East and North African Region
Afghanistan
Egypt
Iran
%
1–4
0
0–2
Lebanon
<1
Morocco
<1
Oman
<1
Saudi Arabia
<1
Range of HIV prevalence in prison populations
Other Countries Region
%
Italy
4
Luxembourg
1
Netherlands
0
Portugal
6
Spain
USA
6 – 11
1
Outbreaks of HIV transmission in prison populations and in IDU prisoners
Country
incidence
Thailand
35/per 100
Lithuania
300 inmates infected in 6 months
Doubled number of HIV cases
Russia
400 inmates infected in a few months
Iran
Two outbreaks with hundreds infected
Australia
At least 4 up to 12
Scotland
12
Afghanistan
17
HIV incidence in prison
Country
Year
Mozambique
2008-12
2008
2009
2010
% among
males
0.23
% among
females
0.26
% of total
prisoners
0.24
Number of
cases
77
75
43
Kazakhstan
Latvia
Lithuania
Romania
2008
2009
2010
2008
2009
2010
2011
2008
2009
2010
2011
2012
0.2
0.16
0.17
1
10
28
0.4
0.18
0.15
0.11
0.11
0.16
HIV incidence in prison
Country
Year
Moldova
2008
2009
2010
2011
2012
2012
Russia
2008
Spain
2009
2010
2011
2012
Ukraine
2008
2009
2010
2011
2012
2008
2009
Afghanistan 2010
2011
2012
% among males % among
females
0.09
0.0
0.0
0.04
0.02
% of total
prisoners
Number of
cases
12
229
Tajikistan
0.9
0.8
11.2
10.4
10.6
258 (m)
279 (m) 21 (f)
475 (m) 28 (f)
514 (m) 29(f)
961
2318
3690
2819
1 (M) 0 (F)
21 (M) 0 (F)
6 (m) 1(F)
0 (M) 1(F)
7 (M) 0 (F)
AIDS related mortality in prison populations
Country
Year
Republic of
Moldova
2008
2009
2011
Romania
2008
2009
2010
2011
2012
3
1
0
3
3
2008
128
2008
2009
2010
2011
2012
85
169
180
388
313
Russian
Federation
Ukraine
% among males Number of cases among males
12.7%
10.5%
22.9%
Summary of the number of countries per Region with HIV programs
Conclusions and Recommendations
Good prisoner health is good public health: High turnover of inmates
mean diseases contracted inside leave prison.
High imprisonment rates in regions- non custodial sentences
Few data on prevalence, incidence and mortality
Low prevalence in Latin & MENA time to intervene
increase ARV, OST, condoms
Reduce prison populations: OST in community, divert PWIDs
Legal obligation to medical treatment same level as in the community.
Compassionate release from prison for inmates in final stages of AIDS.
Acknowledgment
Co-authors
Atefeh Noori, Shadi Rahimzadeh, Farshad Farzadfar and Fabienne
Hariga