United Kingdom: Report on HIV/AIDS in Prisons
In June 1995, the Prison Service of England and Wales released its "Review of HIV and AIDS in Prison."[1]
The report has a long history that began in December 1991. The then Minister of Prisons announced that a review of HIV in prisons would take place, and invited concerned individuals and organizations to make submissions on HIV in prisons to the AIDS Advisory Committee of the Prison Service of England and Wales. Nearly four years later, the results of the Advisory Committee's work have been published.
One of the fundamental assumptions of the review is that prison-based work on HIV prevention and care constitutes a significant contribution to public health. Therefore, the Prison Service's strategy on HIV was developed within the context of the British government's general health strategy.
In a letter accompanying the release of the report, Rosemary J Wool, Director of the Health Care Service for Prisoners, emphasizes that HIV/AIDS is a "phenomenon which all in the Prison Service need to consider. For this reason the report addresses a broad audience including policy-makers, managers, practitioners and operational staff."
The report contains 39 recommendations in the areas of research, staff and prisoner education, prevention, risk reduction and harm minimization, counselling, psychological and social care, and medical aspects of HIV in prison. Among other things, it recommends that cleansing agents (washing-up liquid and Milton sterilizing tablets), and condoms, dental dams, and lubricant be made easily accessible to prisoners.
All of the Committee's recommendations have been accepted, with one surprising exception: condoms will not be made easily accessible, but will remain available only on prescription "if in the clinical judgment of the doctor there is a risk of HIV infection." At a time when many prison systems world-wide make condoms easily accessible to inmates – and when experience has shown that this can be done without creating any problems and with support from management, staff, and prisoners – this is hardly understandable.
The report places emphasis on multidisciplinary teamwork to address the issues raised by HIV/AIDS in prisons. It is evidence of the existing international consensus with regard to HIV/AIDS in prisons. Many of its recommendations are the same as, or at least similar to, those previously issued by other committees and by the World Health Organization, with one exception: it does not recommend setting up needle-exchange programs in prisons in England and Wales. The report fails to convincingly deal with this issue: the Committee considered recommending the setting up of needle-exchange schemes, but "felt that such an approach would be fraught with difficulty and would fit uneasily with the duty of prison authorities and staff to detect the smuggling of drugs into prison and to prevent drug misuse during custody. The conflict between encouraging prisoners to use an exchanges scheme and detecting illicit drug use would have no easy resolution." However, and in complete contradiction to this argument, the Committee goes on to say that "the probability of HIV infection amongst drugs users in prison is such that the Prison Service should make available to clandestine injectors the means of effectively sterilising needles." Admittedly, making sterile needles available in prisons is more difficult than making bleach available, but in terms of the conflict invoked by the Committee there is no difference between making needles and bleach available: both are an acknowledgment that drug use occurs in prisons, and both create a conflict between the prison system's mandate to prevent drug use and its responsibility to prevent the spread of HIV. Many committees, in Canada and internationally, have been more consistent than the English report and have recommended that both bleach and sterile needles be made available, holding that prevention of the spread of HIV needs to be the foremost priority.
Copies of the Report are available on request from the Committee Secretary, DHC, Cleland House, Page Street, London SW 1N 4LP, England.
- Ralf Jürgens
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ENDNOTE
[1]AIDS Advisory Committee. The Review of HIV and AIDS in Prison. London, England: HM Prison Service of England and Wales, 1995.