Testing, treatment and comprehensive prevention – how a nurse-led program is dealing with hepatitis in prisons in Luxembourg

A prison sentence may not feel like a stroke of luck, but it can mark an opportunity for testing vulnerable populations and providing care to detainees to prevent potentially life-threatening diseases.

Since 2013, 4218 people have been tested for hepatitis and other infectious diseases, such as syphilis, HIV and tuberculosis, on arrival at one of Luxembourg’s two state prisons. This testing is part of a comprehensive program to test, treat and reduce harm with measures, such as providing condoms, needle exchanges and even a nurse-supervised safe tattooing room to minimize the risk of a disease being transmitted during the tattooing process.

In Luxembourg, approximately 1% of the population has tested positive for hepatitis C antibodies. This represents more than 4000 people and it is estimated that 77% of them have active infection. Without treatment, the hepatitis C virus (HCV) can lead to liver cancer and death but many people do not realize they are infected.

Injecting drugs is the main way people in Luxembourg contract HCV and a study in 2015 estimated that 75% of people who inject drugs in Luxembourg would be positive for HCV if tested. One-third of the prison population has been given a custodial sentence because of drug-related offences and/or has suffered from substance misuse disorders. This makes arrival at a prison an especially important opportunity to offer prevention measures, diagnosis and treatment of hepatitis C, among other health services.

Nurses tackling hepatitis in prisons

Nurses oversee a prison’s specialized medical program, working closely with the National Service of Infectious Diseases. The program is funded by the Ministry of Justice as part of the general health care of people in prison and is featured in WHO/Europe’s “Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region”.

When an inmate tests positive on arrival, an appointment is organized for them with an infectious disease specialist in the prison clinic in order to perform further tests and start the right treatment. It’s also an opportunity to vaccinate against hepatitis A and B. The nurses fulfil a particular role in running the program: When a person is released from prison, the nurses organize counselling and follow-up appointments on the outside. Working closely with wardens, nurses also play a central role in making condoms available and ensuring needles and syringes can be exchanged to minimize the transmission of diseases in prison.

Innovative safe tattoo project

Nurse Mike Conrath has worked in Luxembourg’s Penitentiary Centre for 14 years and supervises the safe tattooing workshop in which some 850 nurse-supervised hours of tattooing have been performed since 2017 and 30 detainee tattoo artists have received training. It is the longest-running established project of its kind. He is part of a team of 20 nurses who take charge of aspects of the harm reduction program.

“I take care of logistics for the safe tattooing project along with three other colleagues. It’s an Erasmus Plus project in collaboration with the SES (Service d’Education a la Sante,Belgium) and the Prison des Beaumettes de Marseille,France,” he explains.

“It’s not an institutional project requested by the management; it really began with the nurses and we were the ones who got it up and running,” Conrath continues. “Previously, clandestine tattooing was common; it was not unusual for the wardens to find improvised tattooing tools made using a motor, for example, from a shaver or a CD player. For ink, people would use cigarette ashes mixed with melted plastic or printer ink. It was not sterile and on top of that the materials being used were frankly dangerous.”

Education is an important role fulfilled by nurses in the prison that covers many aspects of risk behaviour relating to sex and drugs as well as tattoos. “Detainees learn all about infectious diseases, the difference between clean and sterile, how they should work, how to wash and disinfect their hands, and how to protect themselves and others from infectious disease. It’s delivered at their level. We also have a service for drug addiction: It’s training in groups of 10 or 15 where they learn about infectious diseases and risks,” adds Conrath.

Conrath laughs as he explains that he himself has no tattoos and was never very interested in tattooing before the project. He is, however, passionate that detainees have a right to care and harm reduction, and seeing that every aspect of the testing, treatment and harm reduction program has a role to play in reducing the incidence of hepatitis in prisons.

“There should not be a difference between a prison or a clinic or hospital, these are human beings and should be treated like any other patient. Nurses are the closest people to the patients and have more and more of a responsibility for harm reduction. Nowadays our training has become increasingly demanding and we work with more responsibility and autonomy. A huge number of problems can be avoided if people are educated about their behaviour and about risks. This is a nurse’s work,” says Conrath.

Original source WHO/Europe

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