Editorial

Citation

MacDonald, M., Greifinger, R., Allen, S.A. and Kane, D. (2016), "Editorial", International Journal of Prisoner Health, Vol. 12 No. 1. https://doi.org/10.1108/IJPH-01-2016-0001

Editorial

Article Type: Editorial From: International Journal of Prisoner Health, Volume 12, Issue 1.

Morag MacDonald, Robert Greifinger, Scott A. Allen and David Kane

Welcome to our first issue of 2016. As usual, we are delighted to present papers that address a range of issues including Hepatitis C, HIV screening, injecting drug use, self-harm and overcrowding, tuberculosis (TB) and alcohol use disorders, drawn from around the world.

In our first paper, Michael Mina, Lilie Herawati, Tony Butler and Andrew Lloyd report on a project aiming to describe the current status of hepatitis assessment and treatment services for those in custody in each Australian state and territory. Interviews were conducted with stakeholders from the correctional sector in each state and territory in Australia in two stages: service directors to gather quantitative data regarding rates of testing and treatment and other stakeholders for qualitative information regarding barriers and opportunities. The authors report that while the custodial sector in Australia, like in many developed countries, offers a suitable setting for HCV assessment and treatment, significant barriers exist that mitigate against improving upon the current low levels of treatment. Barriers identified include a fear of side-effects from interferon (IFN)-based treatments, short prison sentences that impact on completion of the treatment course whilst in prison and stigma associated with chronic HCV infection and the associated implication of injecting drug use. Limited availability of skilled professionals to manage the common co-morbid medical and psychiatric conditions was also identified as a key constraint.

Our second and third papers examine aspects of prisoner health in Indonesia. Nelwan et al. report on a study that compared yield and costs of routine and targeted screening in a “narcotic prison” (a prison housing individuals convicted of drug-related offences). The authors report that routine testing was accepted by prisoners with all reporting injecting drug use agreeing to be tested. However, following the switch to a targeted regime, the number of prisoners reporting injecting drug use agreeing to be tested fell. In addition, the authors note that some prisoners might have falsely denied drug use, possibly fearing stigma or discrimination. The authors note that while economic reasons are the primary driver for the introduction of targeted testing, such a regime might be a false economy given the potential costs of missed HIV infections, the development of opportunistic infections and other complications requiring treatment and hospitalisation and the likelihood of HIV transmission by prisoners unaware of their infection. While recognising the limitations of their study, the authors reaffirm the importance of HIV testing, treatment and care for prison populations.

Sawitri et al. report on a study, also in Indonesia, that investigated injecting drug use, sexual risk, HIV knowledge and harm reduction uptake. The authors conducted a cross-sectional survey of prisoners in a large prison in Bali using a structured questionnaire addressing HIV risk-related behaviour and the uptake of vocational and harm reduction programmes. Data from the survey provided strong evidence that injecting drug use was taking place within the prison despite a well-established prison methadone programme and in an environment with an already high HIV prevalence. Results also indicated a variation in risk awareness. Injecting risk behaviour, for example, continued despite the awareness of HIV transmission risk. It was also apparent that while the uptake for vocational and harm reduction activities was high within the prison for general health-related interventions, it was lower for interventions directly related to HIV prevention. The authors conclude that despite the introduction of harm reduction initiatives and a well-established vocational training programme, HIV risk behaviour continues. Further efforts are required to reinforce HIV prevention messages both to risk groups within the prison and prison staff.

In our fourth paper, Hans Wolff et al. report on a study examining the association between prison overcrowding and acts of self-harm. Using a cross-sectional methodology, the authors examined occurrences of self-harm at a pre-trial prison in Geneva along with socio demographic data and information relating to overcrowding obtained from prison annual reports. A significant increase in self-harm and self-strangulation/hangings was observed over time while overcrowding was significantly associated with self-strangulation/hangings, but not with all instances of self-harm. While observing that overcrowding can have a detrimental effect on psychological and behavioural well-being, the authors acknowledge that more work is required to explain the rise in self-harm at the institution in question. They note that other factors such as life course and medical history can place prisoners at risk of self-harm and that the motivations that drive a prisoner to self-harm are often complex. It is also noted however, that there is a need to understand and investigate the interplay between individual and environment to reduce the incidence of harmful behaviour. While noting the limitations of their study, the authors note the need for an examination of factors leading to self-harm in prisoners, particularly the relationship between self-strangulation/hangings and overcrowding.

Anya Sarang et al. report on a study examining health management in Russian prisons with a focus on TB. The paper draws on 15 in-depth interviews with PWID living with HIV with current or past experience of TB and interviews undertaken with health professionals recruited from main community institutions dealing with HIV, TB and drug use. Of the sample, all but one admitted spending time in prison with seven stating that they believed contraction of TB took place in prison. Interviewees described prison conditions as conducive to the transmission of TB due to severe overcrowding, lack of fresh air and ventilation, poor hygiene, poor nutrition and lack of infection control. Doctors treating people with co-infections of HIV and TB confirmed that imprisonment was a factor in TB acquisition among their patients. Interview data also indicated that people without TB were rarely separated from those suffering from the infection even if they had HIV, which put them at greater risk of contracting TB. In addition to poor infection control, insufficient nutrition and poor diet were identified as contributing to transmission of TB and increased progression of the disease. Additionally, few measures to prevent and control HIV, an important risk factor for transmission and progression of TB, were operative in prisons. Respondents noted that the quality of TB and HIV treatment in prison was very poor, with patients often having to buy medication personally to treat their condition. A lack of information relating to HIV, TB and other infectious diseases was also identified. The authors conclude that there is an urgent need for improved provision of TB prevention and treatment in prison alongside an effort to decrease the prison population by transforming drug policy and ensuring adequate access to drug treatment, rehabilitation and alternatives to incarceration.

In our final paper, Newbury-Birch et al. report on a review of the evidence of alcohol use disorders within the stages of the criminal justice system in the UK. The methods employed were a rapid systematic review of publications between the years 2000-2014 relating to the prevalence of alcohol use disorders within the stages of the criminal justice system and a rapid review of effectiveness studies for alcohol brief interventions. The rapid review of the literature found high levels of alcohol use disorders among adults and young people at all stages of the criminal justice system in the UK – disproportionate to the levels in the general population. The authors also note that although the evidence base relating to prevalence rates in the criminal justice system in the UK is growing, there is, to date, very little evidence of the efficacy or effectiveness of alcohol brief interventions. The authors conclude that alcohol use disorders are currently high in the UK and further work is necessary to ascertain the effectiveness of alcohol brief interventions and, indeed, to identify if such an approach works.