'War on Drugs' pushing world towards HIV, TB, hepatitis epidemics

The War on Drugs, mass incarceration of drug users and the failure to provide proven harm reduction and treatment strategies have driven up global epidemics of HIV, tuberculosis and hepatitis B and C, reveals a new study.

According to the major six-part Series on HIV and related infections in prisoners, levels of these three diseases among inmates are far higher than in the general population.

With an estimated 30 million people passing in and out of prisons every year, prisoners will be key to controlling HIV and tuberculosis epidemics worldwide, as per the study.

"Prisons can act as incubators of tuberculosis, hepatitis C, and HIV and the high level of mobility between prison and the community means that the health of prisoners should be a major public-health concern. Yet, screening and treatment for infectious diseases are rarely made available to inmates, and only around 10 percent of people who use drugs worldwide are being reached by treatment programmes," said lead author Chris Beyrer of the John Hopkins Bloomberg School of Public Health, Baltimore, USA.

He added, "The most effective way of controlling infection in prisoners and the wider community is to reduce mass imprisonment of injecting drug users."

Data presented in the Series show that with growing numbers of injecting drug users in prison, the prevalence of infectious diseases has also increased.

Levels of HIV infection are 20 times higher among prisoners in Western Europe than the civilian population and around three times higher among prisoners in eastern and southern Africa and North America.

While most prisoners are men, women and girls are the fastest growing imprisoned group worldwide, and in most regions of the world, levels of HV infection are higher in female inmates than male prisoners including Eastern Europe and central Asia.

High rates of hepatitis C are also seen among prisoners, with 1 in 6 inmates in parts of Europe and the USA carrying hepatitis C virus.

Prevalence of active tuberculosis is higher in prisons than the general population in all settings. One study demonstrated that prevalence was 40 times higher in one prison in Brazil than the general population.

Moreover, new estimates produced for the Series suggest that up to half of all new HIV infections over the next 15 years in eastern Europe will stem from increased HIV transmission risk among inmates who inject drugs; and imprisonment could be responsible for three-quarters of new tuberculosis infections among people who inject drugs, and around 6 percent of all yearly tuberculosis infections.

The Series brings together a wealth of evidence to show that countries can reduce and even reverse infectious disease transmission by scaling up proven harm reduction and treatment strategies in prisons like opioid agonist therapy (OAT), antiretroviral therapy (ART), hepatitis B vaccination, condom distribution, and sterile needle and syringe exchange.

Modelling conducted for the Series suggests that reducing mass incarceration of people who use drugs, in this case lowering the number of prisoners who inject drugs by 25 percent, could result in a 7-15 percent drop in new cases of HIV among injecting drug users in the community over 5 years. Similarly, scaling up OAT (eg, methadone and buprenorphine) to all those in need in prison, and after release, could prevent over a quarter of new HIV cases in people who inject drugs in just 5 years.

The study is published in The Lancet.