Imprisonment, injecting drug use, and bloodborne viruses

A threat of transmission but an opportunity for prevention

The possibility that imprisonment is a risk factor for HIV transmission has been much debated, even though the association between imprisonment, use of injecting drugs, and the transmission of another bloodborne virus, hepatitis B, was recognised more than 20 years ago.1 In the past five years, clusters of cases of acute hepatitis B infection inimprisoned men in England and Wales have been regularly reported to Public Health Laboratory Service Communicable Disease Surveillance Centre. Nearly a fifth of 258 infections in known male adult injecting drug users reported in this time were diagnosed in prison.

Many injecting drug users have been imprisoned, and for some this will have been a repeated experience.2 In England and Wales in any year, an estimated 15 000 prisoners3—or between one in 13 and one in seven prisoners4—will have a history of injecting drug use. In Australia, more than one in three prison entrants were reported as having such a history.5 Between a quarter and two thirds of prisoners who have ever injected drugs have done so within prison, where use of injecting equipment previously used by others is the norm. The reports from Scotland and Australia in this week's journal emphasise that there is no room for complacency about the risks involved and illustrate the vulnerability of prisoners who inject drugs to infection with bloodborne viruses. At least eight HIV infections due to sharing of equipment by injecting drug users occurred within a Scottish prison during the first half of 1993,6 7 and in Australia an incidence of 41 hepatitis C infections per 100 person years in young …