Preventive Health, Care and Support for People Living in Prison with HIV/AIDS

– Building evidence

 

Introduction

Like all individuals, prisoners are entitled to enjoy the highest attainable standard of health – a right assured under international law in Article 25 of the United Nations Universal Declaration of Human Rights and also Article 12 of the International Agreement on Economic, Social, and Cultural Rights. Furthermore, the international community has actually typically accepted that prisoners maintain all rights that are not eliminated as a result of incarceration, including the right to the highest obtainable standard of physical as well as psychological health and wellness. Loss of freedom alone is the punishment, not the deprival of basic human rights. States as a result have an obligation to carry out regulations, plans, as well as programs constant with international human rights standards, and also to guarantee that prisoners are provided with a standard of healthcare equivalent to that offered in the outside community.

 

Objectives

·        Promoting an integrated healthcare approach within prisons to handle public health concerns through positive behaviour change, comprehensive health-checks and through appropriate changes in general prison conditions and management.

·        Provide prisoners with prevention, care, support and treatment for HIV/AIDS that is equivalent to that is available to general community.

·        Prevention of opportunistic infection, early detection and treatment in order to excess morbidity and mortality among these individuals.

·        Preventing transmission of HIV and other infections among prisoners, prison staff, and to the community on release.

·        Develop an evidence based prospective follow-up plan for PLHIVs getting involved in crime and being incarcerated.

 

PLHIV in a prison setting

Individuals remanded to jail live in a prison setting which are generally crowded and not designed to prevent opportunistic infections. High risk sexual practices may also be prevailing in jail setting which can add on to the problem. All the prisoners with HIV eventually return to the larger community and hence lowering the transmission of HIV and other sexually transmitted infections (STIs) in prisons is an integral part of decreasing the spread of infection in the broader society, as any illness contracted in prison, or any clinical problems made worse by poor conditions of prison, end up being concerns of public health for the bigger society when individuals are released. Access to healthcare and health seeking behaviour as well as adherence to treatment may be different while in a prison setting.

 

Correctional services as an opportunity

As Kerala State moves forward in elimination of HIV by 2025, good practices in prison settings can be an opportunity to prevent and control transmission of HIV and STIs through high risk practices. A prospective targeted follow-up of such people living with HIV will offer good results in preventing transmission of such infections of public health relevance. Incarceration can be a significant obstacle to positive health-seeking and access to preventive health, care and support, though they may be provided with medications and due doctor consultations. Thus, the criminal justice-based strategy to individuals at high risk for HIV/STI, particularly people that use illicit drugs, men having sex with men (MSM) and sex workers should consider sexual health concerns of prisoners in their comprehensive healthcare package.

 

Way forward

In view of the current design of prisons and the situations within, people who are incarcerated are exposed to an additional risk of Tuberculosis which is the leading opportunistic infection in PLHIVs which can result in higher morbidity and mortality. NACP-V prescribes at least two to three preparatory adherence counselling sessions for PLHIVs in prison. Isoniazid Preventive Therapy (IPT) that prevents new TB infection or prevent progression of latent TB to active TB is a standard of care which needs to be ensured in prison setting. A baseline profile of PLHIVs in prison and a prospective follow-up could bring in evidence that can guide intervention strategies and policies.

 

Health Profile of PLHIV

Current health profile of PLHIV in prison and follow-up in a life-course perspective will be beneficial for the AIDS Control Program as the people getting involved in crime and being incarcerated form a separate subset in the population who require additional effort to get integrated to general population. The chances for being marginalised when they contract multiple morbidities are very high compared to general population. Hence a life-course approach would be beneficial to provide care and support where maintaining a prospective targeted health data is essential.

Relevant data to understand the health profile may include (apart from demographic details) risk practices, Condom use/practice, serial investigation results, viral suppression status, adherence with medications and occurrence of other comorbidities, STIs and opportunistic infections. Serial data with an interval of 6 months could predict functional decline or declining health status where care-plan could be modified. Adherence counselling sessions could explore risk practices which has to be documented and intervened.