Reducing imprisonment rates among people who inject drugs will be crucial to preventing a global explosion of HIV, hepatitis C, hepatitis B and tuberculosis over the next 15 years, including in the Asian Pacific Region, a UNSW Professor has warned.
Professor Kate Dolan (pictured) from the National Drug and Alcohol Research Centre at UNSW and an expert in global prisoner health and injecting drug use is calling for fewer prison sentences for people who inject drugs to prevent a dramatic increase in infectious diseases.
Of greatest concern in Australia is the spread of hepatitis C and hepatitis B.
While Australia successfully contained HIV in prisons compared with other regions such as Western Europe, our rates of hepatitis C and hepatitis B were worryingly high, says Professor Dolan.
Professor Dolan is the lead author of a paper on the Global burden of HIV, viral hepatitis and tuberculosis in prisoners and detainees published today in international medical journal The Lancet . The paper is the first in a six-part Lancet series on HIV and related infections in prisons which will be launched at the 21st International AIDS Conference in Durban, South Africa, next week.
“Hepatitis C infection levels in Australian prisons range from 22% to 31% which are much higher than Western Europe where it ranges from 12% to 19%,” says Professor Dolan.
“Studies of transmission of Hep C in prisons show high rates in Australia with an annual incidence of 14.1%, much higher than Scotland (0.9%), USA (0.4%) and Spain (1.7%),” says Professor Dolan.
Rates of hepatitis B in Australian prisons were similarly higher, ranging from 11% to 28%, compared with 5% to 30% in Western Europe.
Professor Dolan is one of an international panel of experts, who have authored The Lancet series, and argue against the mass incarceration of drug users. In a separate paper accompanying the series, the authors write: “Prison is an unacceptably expensive, ineffective and inhumane approach to drug dependency. Mass incarceration has had disastrous consequences for individuals, families and communities particularly among ethnic and racial minorities (in the US and elsewhere) and among other marginalised groups.”
The public health risk is not isolated to prisoners themselves but to the communities, from which they come and return, says Professor Dolan. “Prisons can act as an incubator of HIV and hepatitis and with the high level of mobility of prisoners – an estimated 100,000 people in Australia go through prison each year – so infection transmission in prison is a major public health concern.”
While NSW is leading the way in Australia in the treatment of prisoners with hepatitis C, other states such as Queensland have a poor approach to providing drug treatment for prisoners, she says.
“We have a high rate of hepatitis C among people who inject drugs in Australia and we have a higher proportion of people who inject drugs among our prison population.
“The wealth of evidence from around the world and presented in this series is that not only do we need to consider alternatives to prison sentences, we need to scale up harm reduction and treatment strategies,” says Professor Dolan.
“These include opioid agonist therapy (OAT), antiretroviral therapy (ART), hepatitis B vaccination, condom distribution and sterile needle and syringe programs.
“Providing these evidence-based treatments in the community and in prison will not only reduce the size of the prison population, it will control the spread of infectious disease inside and outside of prison.”
Professor Dolan and colleagues write that mathematical modelling produced for The Lancet series suggests that reducing the imprisonment of people who inject drugs will significantly control these infections in prisons and the wider community. The authors also warn that women and girls are among the fastest growing group imprisoned for drug offences.
“Australia has one of the highest rates of injecting among prisoners in the world,” says Professor Dolan. “In Australia, around half of prison inmates have injected drugs, compared with around 38% in Europe – an already unacceptably high figure.
“Our work shows that these very high rates of imprisonment come at an enormous social and human cost when there is little evidence that imprisonment of injecting drug users has either a deterrent effect or assists with rehabilitation,” says Professor Dolan.
This series will be launched at the AIDS 2016 meeting in Durban, South Africa, on Tuesday 19th July 2016 http://programme.aids2016.org/Programme/Session/87. A media briefing will be held on Tuesday 19th at 21st International AIDS Conference in Durban, South Africa.
For the research full paper, visit Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees http://press.thelancet.com/HIVprisoners1.pdf
COMMENTS:
http://press.thelancet.com/HIVprisonersCOM.pdf
www.thelancet.com/series/hiv-in-prisons
Media contacts:
Marion Downey: P: (02) 9385 0180 | 0401 713 850 | m.downey@unsw.edu.au
Leanne Mezrani: P: (02) 9385 0124 | 0432 894 776 | l.mezrani@unsw.edu.au
