HIV prevalence in prisons around the world

The number of prisoners living with HIV varies between countries. America has the highest prison population in the world, around 1.5 percent of whom are HIV positive. Although this figure has declined, HIV prevalence is still higher for incarcerated populations than for the general population. In fact it has been estimated that between 17 and 25 percent of people living with HIV in America pass through the correctional system.

Studies from prisons in Brazil and Argentina reveal a particularly high HIV prevalence - ranging from 3.2 to 20 percent in Brazil and 4 to 10 percent in Argentina. The prevalence rates for some sub-Saharan African countries are also high; an estimated 41.4 percent of incarcerated people in South Africa are infected with HIV. Generally, the HIV prevalence in the country reflects the prevalence in prisons. So while South Africa has a high percentage of HIV positive inmates, the HIV prevalence in the general population is also high, at an estimated 17.8 percent.

In Europe, many of the eastern countries have a high HIV prevalence among the prison population. In 2010, it was estimated that 55,000 of Russia's 846,000 inmates were infected with HIV. In Estonia, four studies revealed HIV prevalence in prisons ranging from 8.8 to 23.9 percent. In comparison, the last study in England and Wales in 1997-1998 revealed a much lower prevalence of 0.3 percent among men and 1 percent among women.

Why is there a higher HIV prevalence in prisons?

Injecting drug use and incarceration are closely linked; many injecting drug users (IDUs) pass through the correctional system because of drug-related offences. As IDUs are at a greater risk of HIV infection, this group is often more likely to be infected with HIV than other incarcerated populations. In the absence of HIV preventative measures in prisons, this can pose a greater risk of HIV transmission among inmates.

How is HIV transmitted in prisons?

As it is difficult for researchers to gain access to prisoners, there are few documented cases of HIV transmission within prisons. However, this does not mean that HIV is not a significant risk to prisoners.

"Prison conditions are often ideal breeding grounds for onward transmission of HIV infection. They are frequently overcrowded. They commonly operate in an atmosphere of violence and fear. Tensions abound, including sexual tensions. Release from these tensions, and from the boredom of prison life, is often found in the consumption of drugs or in sex." UNAIDS

Although this view from UNAIDS refers to prisons in the 1990s, it still applies to many prisons across the world today. Injecting drug use, high-risk sexual behaviour, and tattooing are common within prisons, each posing a risk of HIV transmission. According to studies, a record of incarceration is often associated with HIV infection, particularly in western and southern Europe.