Insufficient access to harm reduction measures in prisons in 5 countries (PRIDE Europe): a shared European public health concern

Laurent Michel, Caroline Lions, Sara Van Malderen, Julie Schiltz, Wouter Vanderplasschen, Karina Holm, Torsten Kolind, Felice Nava, Nadja Weltzien, Andrea Moser, Marie Jauffret-Roustide, Olivier Maguet, Patrizia M Carrieri, Cinzia Brentari, Heino Stöver, Laurent Michel, Caroline Lions, Sara Van Malderen, Julie Schiltz, Wouter Vanderplasschen, Karina Holm, Torsten Kolind, Felice Nava, Nadja Weltzien, Andrea Moser, Marie Jauffret-Roustide, Olivier Maguet, Patrizia M Carrieri, Cinzia Brentari, Heino Stöver

Abstract

Background: Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations.

Methods: Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison.

Results: A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08).

Conclusions: Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community.

Figures

Fig. 1
Fig. 1
Mean, median, min and max values and interquartile range of the global score per country (E4 analysis)
Fig. 2
Fig. 2
Mean, median, min and max values and interquartile range of the global score used in the 2009 French survey per country (E5 analysis)

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Source: PubMed

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