Monday, May 4, 2015

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Breaking Down the Walls: Five Things to Help Address Hepatitis in Prisons

People in detention are particularly vulnerable to Hepatitis B and C. On World Hepatitis Day, we should consider what can be done to prevent the spread of these diseases.
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The rusty lock on the door of a former prison in Fort Ussher, Accra, Ghana. Photograph by Floris van Halm.

Hepatitis B and C are diseases that, if left untreated, can kill. It is estimated by the World Health Organisation that, worldwide, over 2 billion people have been infected by Hepatitis B and 150 million people chronically infected with Hepatitis C. Both diseases are thought to cause between 500,000 to 700,000 deaths a year globally.

Every country in sub-Saharan Africa considers viral hepatitis a serious public health issue but, due to a lack of data, its impact is not accurately known. What we do know is that the prevalence rate for Hepatitis B is estimated at 8% in West Africa and 5-7% in Central, Eastern and Southern Africa. The rate for the more virulent Hepatitis C is even higher and may be as much as 10%.

One of the groups most vulnerable to Hepatitis B and C, as well as HIV, are those held in detention. Both Hepatitis B and C may be spread through exposure to blood, especially during unsafe practices such as sharing injecting equipment and tattooing, as well as through unprotected sexual relations.

To respond to HIV in prisons, the UN Office on Drugs and Crime and other UN organisations have developed a comprehensive package of 15 key interventions that includes the vaccination, diagnosis and treatment of viral hepatitis. All of these interventions are essential, but I would suggest five other ways we can further enhance their effectiveness.

Five recommendations

First, of the 30 million people held annually in detention globally, most leave within a few months or a year and return to their communities. For this reason, let’s tear down the concept of “prison walls” when it comes to Hepatitis B and C, and in doing so, acknowledge that prisoners may return home with a communicable disease. Good prison health is an essential element of public health.

Second, people living in prisons must have access to medical treatment and prevention measures to stop the spread of diseases like Hepatitis B and C. Access to health is guaranteed by international law. Detainees must receive the same healthcare opportunities as those offered in the wider community. For the sake of public health, and for everyone’s human rights, we cannot afford different health standards for different social groups.

Third, the issue of gender must be addressed. Women experience detention differently to men and have a higher vulnerability to sexual violence and abuse. The services offered in prison should be tailored to their needs and concerns. Let’s also do the same for other groups in detention such as injecting drug users, those living with HIV, and young people.

Fourth, overcrowding, violence, the absence of protection from the climate, poor lighting and ventilation are all associated with detention in some parts of the world. When these conditions are combined with poor diets, low access to clean drinking water, and inadequate personal hygiene, they exacerbate health problems in detention.

Fifth, prison should be the final and not the first option for a range of defendants. Pre-trial detainees comprise one third of all those held in detention and many are accused of lesser crimes. Safe, community-based alternatives to pre-trial detention can help stem the spread of disease and relieve overcrowded detention centres.

Every one of our efforts to increase access to health should also be connected to wider reforms addressing living and working conditions in prisons. The above is not an exhaustive list, but on World Hepatitis Day it marks a move in the right direction. So much of our work is rightly based on protection; however, we must also accept that, in some areas, potential barriers to success exist. Our duty is to tear down these barriers. Health is far too important to leave these walls standing.

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