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Background
Prisons are high-risk settings for the transmission of blood-borne and airborne infections due to several factors: over-incarceration of vulnerable populations (e.g., people who use drugs), risky behaviours (e.g., unsafe injecting practices), inadequate healthcare, delayed diagnoses, poor ventilation, overcrowding, and frequent transfers.
Methods
Each year, 27 EU Member States, plus Norway and Türkiye, submit data to the European Union Drugs Agency (EUDA) on drug-related infectious diseases (HIV, HCV, HBV) and harm reduction interventions in prison. A 2023-24 project identified effective models of care in the area prison harm reduction. The Montpellier prison in France serves as a case study, emphasising continuity of care between custody and the community.
Results
A significant proportion of people who inject drugs pass through prisons. Prevalence rates vary widely: HIV (0.06% Ireland – 15% Spain), HCV (3% Slovenia – 84% Greece), HBV (0% Hungary – 81% Sweden). Recommended harm reduction measures include opioid agonist therapy (OAT), sterile injecting equipment, vaccination, testing, treatment, and care continuity post-release. While most countries offer OAT in prisons, others, such as needle and syringe programmes and naloxone distribution remain rare.
Montpellier’s prison has implemented a person-centred approach to eliminate HCV. All entrants are tested via HCV-RNA. Those diagnosed are promptly linked to specialist care and offered direct-acting antiviral (DAA) treatment regardless of fibrosis stage. Multidisciplinary follow-up includes medical exams, psychological support, pharmacy consultation, and diagnostic assessments. The same model applies to HIV and HBV care. The prison has successfully eliminated HCV and improved infectious disease control.
Conclusions
European data on infectious diseases in prison and information from the model of care implemented in the Montpellier’s prison has shown that harm reduction is both feasible and effective in prisons, particularly when person-centred models ensure continued care post-release.
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