![]() ![]() We also collected the following data from the council of Europe’s annual penal statistics (Space project - ) which reflect penal policy at the national level: average national levels for penitential density for 100 places (this provides a measure of prison overpopulation), percentage of prisoners who were sentenced primarily for drug offences, prisoner security staff member ratio, and the ratio between prisoners and other professionals working in prison. Data on prison characteristics included: 1) type of structure (remand centre, prison, security prison and juvenile prison – some prisons included several types of structures) 2) gender of the prison population (male and/or female inmates) 3) number of prisoners on the day of the study 4) total numbers of sanitary staff, doctors, nurses, security staff, and social workers working in the prison 5) number of full-time doctors and nurses working in the prison 6) existence of consultation service for HIV, HCV/HBV and psychiatric consultation, and frequency of consultation (every week, every 2 weeks, etc.) 7) presence of any non-governmental organization (NGO) involved in harm reduction (HR) and care for drug users in the prison. The dimensions explored were related to the 10 following interventions recommended by WHO/UNODC : Bleach, Condoms and lubricants, Opioid Substitution Treatment (OST), Information-Education-Communication (IEC), Blood-borne virus (BBV) testing, HBV vaccination, Post-exposition Prophylaxis (PEP), Needle/syringe exchange programs (NEP), access to ARV and prevention measures for tattooing/piercing. More specifically, the questionnaire collected data about the structural characteristics of the prisons and assessed the availability of different specific prevention measures. In order to estimate "environmental" infectious risk, an electronic/postal survey questionnaire focusing primarily on the availability of HIV-HCV preventive measures and HBV vaccination for prisoners was sent to the heads of medical units in all the prisons in all 5 countries (in 2009–2010 for France, in 2013–2014 for the other 4 countries). A previous survey in France was conducted between November 2009 and May 2010 and targeted all French prisons (170 prisons). The study’s secondary objective was to identify which particular characteristics of prison settings and penitentiary policies are correlated with non-adherence to WHO/UNODC recommendations.Ī nationwide survey targeting all prisons in each of the following 4 European countries was conducted between June 2013 and April 2014: Belgium (35 prisons), Austria (28 prisons), Denmark (50 prisons) and Italy (205 prisons). We also aimed to create a 5-country comparison, in order to include France, by creating a second adherence score. This measurement was achieved by computing an adherence score which was modified to take into account the latest international recommendations. The main objective of this international survey was to compare the levels of environmental infectious risk in prisoners between 4 different countries, by measuring to what extent prisons in these countries adhere to international recommendations for HIV prevention. Data on health policy implementation in general in the prison setting are sparse, and conducting research to explore related issues is difficult. For example, although France adopted the principle in 1994, the ANRS-PRI 2DE survey (2009–2010), which measured the level of adherence to national and WHO/UNODC guidelines, revealed a gap between the official recommendations and their application in French prisons. Despite being adopted in several countries, the principle of equivalence in health, including prevention, between the prison system and the general community is rarely implemented in reality. National strategies to control transmission risks should include prisons. The risk of prisoners transmitting disease is high as they are in constant contact with the general community through visitors, staff and because a considerable proportion of them can cycle in and out of prison. The burden of illnesses, particularly infectious diseases, is heavier in the prison population than in the general population, with high prevalences of HIV, HCV and tuberculosis, as well as higher rates of mental disorders, including drug/alcohol use disorders.
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