Letters

Genitourinary medicine services are important

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6989.1264b (Published 13 May 1995) Cite this as: BMJ 1995;310:1264
  1. Richard Hillman,
  2. Anne Scoular,
  3. Sandy McMillan
  1. Consultant physician Consultant physician Genitourinary Medicine and Sexual Health, Royal Infirmary, Glasgow G31 2ER
  2. Consultant physician Genitourinary Medicine, Royal Infirmary, Edinburgh EH3 9YW

    EDITOR,—Two articles report the alarming spread of HIV in a Scottish prison.1 2 While intravenous drug use in prisons is clearly a major risk factor in the spread of HIV among inmates, we believe that the role of sexual intercourse also needs to be more thoroughly examined.

    Sexual intercourse occurs between incarcerated men,2 3 yet condoms are not freely available in Scottish prisons. Inmates often express concern regarding confidentiality, and this is particularly so with regard to sexual intercourse between men, which is subject to strong institutional disapproval. Thus the 1% of prisoners at Glenochil who admitted to anal intercourse while in prison2 may represent a considerable underestimate. Furthermore, no attempt seems to have been made to estimate the incidence of other sexual practices that may be associated with the transmission of HIV.

    It is well recognised that people in prison often have lifestyles that put them at risk of acquiring sexually transmitted infections2 and that infection of the genital tract significantly increases the rate of transmission of HIV.4 Genitourinary medicine services have a pivotal role in preventing HIV infection by education, counselling, and the management of other sexually transmissible infections. It is thus of particular concern that many prisons in Scotland have no specific genitourinary medicine services, and the few existing services may be under threat.

    Policies to reduce harm need to address all aspects of potential transmission of HIV and not to concentrate on injecting drug use to the exclusion of others. Furthermore, the provision of entirely confidential, high quality open access genitourinary medicine services to this group of people should be an important component of such policies.

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