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Letters

What about the WHO guidelines?

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6989.1265 (Published 13 May 1995) Cite this as: BMJ 1995;310:1265
  1. Timothy Harding
  1. Professor of legal medicine University of Geneva, 1211 Geneva 4, Switzerland

    EDITOR,—An editorial, two papers, and news from a dozen countries: the issue of 4 February certainly brings to readers' attention the major public health problem of transmission of HIV in prison. The reporting has one or two oddities: Switzerland is apparently reduced to a province of France, being included in Alexander Dorozynski's report from Paris and excluded from the summary table.1 Dorozynski's napoleonic view of Europe troubles me less than the failure to recognise the pioneering work from 1985 onwards of the Swiss Federal Office of Public Health and prison doctors in several Swiss cantons in promoting the equivalence of measures to prevent AIDS in prisons to those in the community: condoms, non-discrimination, bleach, methadone maintenance, and recent trials of needle exchange. These initiatives are worthy of recognition. The report from Israel is also perplexing: “every prisoner is tested on arrival … voluntarily,” and HIV carriers are segregated while results of tests are kept confidential.1 How do they do it? Or is the editor just a little gullible?

    My main criticism of these contributions, however, is the failure to mention the World Health Organisation's guidelines published in 1993, which provide a comprehensive, public health based approach to managing HIV infection and AIDS in prison while respecting human rights.2 3 This omission is all the more surprising because the BMJ has subjected the WHO to intense critical scrutiny recently.

    Policy concerning HIV infection and AIDS in prisons is part of a wider problem of health care in prison, as the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment has repeatedly emphasised after its visits to various countries, including Britain. The committee has condemned segregation of prisoners infected with HIV and non-respect of confidentiality as unnecessary and a violation of basic human rights.4

    Sensible policies on HIV infection and AIDS will come about only when prison health services are independent of prison administrations and the principle of equivalence of health care including preventive measures is recognised.

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