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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 22; 335(7620): 583.
PMCID: PMC1988962

Prisoners are developing resistance to HIV drugs because their care is fractured

The chaotic nature of prison is detrimental to the health care of inmates, delegates at the Health Protection Agency's conference in Warwick this week were told. The frequent transfer of prisoners around the system has led to a lack of continuity in care.

“HIV patients are transferred from one prison to another, but their retroviral drugs don't go with them,” delegate Tim Moss, a consultant at Doncaster Royal Infirmary, told the conference. Discontinuous treatment meant that these patients were developing resistance to their antiretrovirals. “It is nothing short of negligence,” he said.

It was not just prisoners with HIV who experience this breakdown in care but also those with hepatitis C and tuberculosis. Many patients were lost to follow-up or did not complete their treatment, because of transfer to another prison or early release. Healthcare workers were often not told about these changes so were unable to make the proper referrals.

Hepatitis B affects about a fifth of the 80 000 strong prison population and hepatitis C a third, with injecting drug use one of the biggest causes. The prevalence of HIV remains relatively low. “Prison health is public health,” said Andrew Fraser of the Scottish Prison Service. “They don't choose to come to us, but we have a 24 hour duty of care to them.”

Scotland is to pilot a needle exchange system in its prisons, and in a closely argued debate the delegates voted in favour of such a provision in English prisons too. Rick Lines of the International Harm Reduction Association said that needle exchange schemes in prisons had been rigorously evaluated and shown to be effective in reducing the harm caused by needle sharing, yet they remained controversial. He said that this was due “to the prejudice and stigma against prisoners and drug users.”

Eamonn O'Moore, a consultant in communicable disease at the Department of Health, argued against a needle exchange system in prison. “About two thirds of injecting drug users will spend some part of their lives in jail. These periods of imprisonment represent a unique opportunity to engage with [them] to improve their health,” he said. “We focus on empowerment of prisoners: teaching skills and behaviour that bring about positive outcomes.”

• Our genetic make-up may influence the incubation period for variant Creutzfeldt-Jakob disease or may protect us completely from the disease, John Collinge, professor of neurology at University College London, told the Health Protection Agency conference. Research was under way to determine this genetic influence. Giving the annual Turnburg lecture, Professor Collinge said that other developments in the field of prion disease included a wash for surgical instruments that “dramatically reduced any prion activity,” but this had yet to be implemented in the NHS. “We are under pressure to do translatable medicine, and we do want this translated,” he said.

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