Rebecca Jane Bosworth, Rohan Borschmann, Frederick L. Altice, Stuart Alistair Kinner, Kate Dolan and Michael Farrell
People in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)…
Abstract
Purpose
People in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) than those in the community. The extent of infectious disease-related mortality within the prison setting remains unclear. The purpose of this paper was to collate available information on infectious disease-related mortality, including the number of deaths and calculate the person-time death rate.
Design/methodology/approach
The authors searched databases between 1 January 2000 and 18 November 2020 for studies reporting HIV, HBV, HCV, TB and/or HIV/TB-related deaths among people in prison.
Findings
The authors identified 78 publications drawn from seven Joint United Nations Programme on HIV/AIDS’ regions encompassing 33 countries and reporting on 6,568 deaths in prison over a 20-year period. HIV/AIDS (n = 3,305) was associated with the highest number of deaths, followed by TB (n = 2,892), HCV (n = 189), HIV/TB (n = 173) and HBV (n = 9). Due to the limitations of the available published data, it was not possible to meta-analyse or in any other way synthesise the available evidence.
Research limitations/implications
To inform targeted efforts to reduce mortality, there is a need for more, better quality data to understand infectious disease-related mortality in custodial settings. Increased investment in the prevention and management of infectious diseases in custodial settings, and in documenting infectious disease-related deaths in prison, is warranted and will yield public health benefits.
Originality/value
To the authors’ best knowledge, this is the first scoping review focussed on deaths due to these infections among people in prison internationally. The gaps identified form recommendations to improve the future collection and reporting of prison mortality data.
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Xingzhong Jin, Stuart Alistair Kinner, Robyn Hopkins, Emily Stockings, Ryan James Courtney, Anthony Shakeshaft, Dennis Petrie, Timothy Dobbins, Cheneal Puljevic, Shuai Chang and Kate Dolan
This paper aims to determine whether a single session of a motivational interview (MI) reduces smoking relapse amongst people released from smoke-free prisons.
Abstract
Purpose
This paper aims to determine whether a single session of a motivational interview (MI) reduces smoking relapse amongst people released from smoke-free prisons.
Design/methodology/approach
This study sought to recruit 824 ex-smokers from 2 smoke-free prisons in the Northern Territory, Australia. Participants were randomised to receive either one session (45–60 min) face-to-face MI intervention 4–6 weeks prior to release or usual care (UC) without smoking advice. The primary outcome was continuous smoking abstinence verified by exhaled carbon monoxide test (<5 ppm) at three months post-release. Secondary outcomes included seven-day point-prevalence, time to the first cigarette and the daily number of cigarettes smoked after release.
Findings
From April 2017 to March 2018, a total of 557 participants were randomised to receive the MI (n = 266) or UC (n = 291), with 75% and 77% being followed up, respectively. There was no significant between-group difference in continuous abstinence (MI 8.6% vs UC 7.4%, risk ratio = 1.16, 95%CI 0.67∼2.03). Of all participants, 66.9% relapsed on the day of release and 90.2% relapsed within three months. On average, participants in the MI group smoked one less cigarette daily than those in the UC within the three months after release (p < 0.01).
Research limitations/implications
A single-session of MI is insufficient to reduce relapse after release from a smoke-free prison. However, prison release remains an appealing time window to build on the public health benefit of smoke-free prisons. Further research is needed to develop both pre- and post-release interventions that provide continuity of care for relapse prevention.
Originality/value
This study is the first Australian randomised controlled trial to evaluate a pre-release MI intervention on smoking relapse prevention amongst people released from smoke-free prisons.
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Behnam Farhoudi, SeyedAhmad SeyedAlinaghi, Omid Dadras, Mehrzad Tashakoriyan, Mohammad Nazari Pouya, Mohammad Mehdi Gouya and Kate Dolan
The aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based…
Abstract
Purpose
The aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based Active Health Services Provision (PAHSP).
Design/methodology/approach
On Jan 1, 2018, there were 230,000 prisoners in Iran. Timely and systematic detection and diagnosis of chronic health conditions among this population are imperative. The collaboration between healthcare providers in prison and members of the multidisciplinary team of the healthcare community outside prison initiated an active health service provision approach for HIV and tuberculosis (TB). Guidelines for the control of HIV and TB in prison were piloted, and the finalized version was named “Prison-based Active Health Services Provision” (PAHSP), which has been scaled up in 16 of 260 Iranian prisons.
Finding
The PAHSP approach emphasizes the importance of early identification of key symptoms and risk factors. This approach provides an opportunity for improved prevention and treatment, enabling prisoners identified at risk or those who have been diagnosed with a target disease to be followed up and receive the appropriate health care.
Originality/value
Initiatives such as screening for chronic health conditions coupled with treatment will reduce the burden of chronic illness among prisoners and the broader community, thereby saving on healthcare costs and lives.
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James Shearer, Alex D. Wodak and Kate A. Dolan
The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples taken from…
Abstract
The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples taken from an unsuccessful randomised controlled trial. The first sample comprised 68 participants who were randomly allocated to naltrexone treatment. The second sample comprised 47 participants who commenced opioid pharmacotherapy during the study period. Thirteen per cent of subjects started naltrexone, with only 7% retained in treatment at six months. Six‐month retention was significantly lower in naltrexone compared to methadone (p = 0.0007). Poor patient acceptability and retention did not support oral naltrexone maintenance in this treatment group.
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Nicholas Thomson, Gary Reid and Kate Dolan
Custodial settings are high‐risk environments for HIV. This paper examines publicly available data about the drug use and risk behaviours of Thai and Indonesian prisoners and…
Abstract
Custodial settings are high‐risk environments for HIV. This paper examines publicly available data about the drug use and risk behaviours of Thai and Indonesian prisoners and outlines a process used to collect new data. In 2005, the Departments of Corrections in Thailand and Indonesia requested researchers examine HIV and drug use issues but the findings are too sensitive to publish. The Departments of Corrections in Thailand and Indonesia are using the results to develop public health responses.
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Prison officers face multiple occupational hazards including needlestick injuries, which may result in the transmission of blood‐borne viral infections. This study aimed to assess…
Abstract
Prison officers face multiple occupational hazards including needlestick injuries, which may result in the transmission of blood‐borne viral infections. This study aimed to assess the prevalence of needlestick injuries, the circumstances under which needlestick injuries occur and the responses of injured prison officers. Cross‐sectional data were collected from prison officers in two Australian jurisdictions between January and May 2006, using a self‐report questionnaire. Descriptive analyses were conducted. Of 246 prison officers who completed the survey, two‐thirds had found needles and syringes in the workplace. Seventeen officers (7%) reported having experienced a needlestick injury. Most injuries occurred during searches. Serological testing for blood‐borne viral infections following injury was common, but less than half the injured officers accessed support services. Needlestick injuries appear to be a relatively rare occurrence, but may be further reduced by improving search techniques and equipment and regulating needles and syringes in prisons.
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Kate Dolan and Ana Rodas
Prisoners have a high level of drug use prior to imprisonment. Many inmates report having injected drugs and using cannabis. Prison authorities employed a range of strategies to…
Abstract
Purpose
Prisoners have a high level of drug use prior to imprisonment. Many inmates report having injected drugs and using cannabis. Prison authorities employed a range of strategies to detect drugs and drug use in prison. However, it was unclear which supply reduction strategies operated, and the prevalence and types of drugs detected in Australian prisons. The purpose of this paper is to examine supply reduction strategies in Australian prisons. Information on searches for drugs, and from inmate urinalysis was collected. The study focussed on adults in fulltime custody in Australia in 2009.
Design/methodology/approach
A representative of all corrective services departments and justice health services was asked to complete a questionnaire on supply reduction strategies, including searches for drugs and drug testing of inmates.
Findings
The two main supply reduction strategies identified in all Australian prisons were the use of drug detection dogs and urinalysis programs. Despite an extensive use of drug searches and urinalysis, the detection of drugs was modest for both strategies. The most commonly used drug was cannabis with the detection of drugs such as amphetamines and heroin being very low.
Research limitations/implications
Prison inmates have a history of high levels of drug use prior to imprisonment. However, the supply reduction measures of drug detection dogs and urinalysis indicate that drug use was low in Australian prisons.
Practical implications
The paper recommends that urinalysis comprises targeting testing regimes and that random testing ceases in order to be a more cost effective use of resources for drug detection.
Originality/value
The study is the first report on the range of supply reduction measures in Australian prisons and, possibly in the world. Both measures were employed extensively across the country and finds of drugs and drug use were relatively low. Two possible conclusions can be drawn; that either drug use was very low in prison or that it was well concealed from the authorities. A comparison of random testing with targeted testing of inmates, where the former yields fewer positive results shows drug use was likely to be low rather than well concealed.
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Kate Dolan, Ana Rodas and Adam Bode
– The purpose of this paper is to compare the use of drugs and alcohol by Indigenous and non-Indigenous prisoners and examine relevant treatment in Australian prisons.
Abstract
Purpose
The purpose of this paper is to compare the use of drugs and alcohol by Indigenous and non-Indigenous prisoners and examine relevant treatment in Australian prisons.
Design/methodology/approach
Prison authorities were surveyed about alcohol and drug use by prisoners prior to and during imprisonment and drug and alcohol treatment programs in prison. The literature was review for information on alcohol and drug use and treatment in Australian prisons.
Findings
In 2009, over 80 percent of Indigenous and non-Indigenous inmates smoked. Prior to imprisonment, many Indigenous and non-Indigenous inmates drank alcohol at risky levels (65 vs 47 percent) and used illicit drugs (over 70 percent for both groups). Reports of using heroin (15 vs 21 percent), ATS (21 vs 33 percent), cannabis (59 vs 50 percent) and injecting (61 vs 53 percent) were similarly high for both groups. Prison-based programs included detoxification, Opioid Substitution Treatment, counselling and drug free units, but access was limited especially among Indigenous prisoners.
Research limitations/implications
Drug and alcohol use was a significant issue in Australian prisons. Prisoners were over five times more likely than the general population to have a substance use disorder. Imprisonment provides an important opportunity for rehabilitation for offenders. This opportunity is especially relevant to Indigenous prisoners who were more likely to use health services when in prison than in the community and given their vast over representations in prison populations.
Practical implications
Given the effectiveness of treatment in reducing re-offending rates, it is important to expand drug treatment and especially culturally appropriate treatment programs for Indigenous inmates.
Originality/value
Very little is known about Indigenous specific drug and alcohol programs in Australian prisons.
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Kate Dolan, Heather Worth and David Wilson
Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory…
Abstract
Purpose
Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue.
Design/methodology/approach
The authors reviewed the literature on compulsory drug treatment in seven Asian countries.
Findings
The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantly male. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour, military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were; no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates.
Research limitations/implications
The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease.
Practical implications
Many countries are spending vast amounts of funding on ineffective treatments for drug users.
Social implications
Funding should be directed to community-based drug treatments that have been shown to work.
Originality/value
This is the largest review of compulsory treatment of drug users to date.
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Britain is undergoing its biggest change in drug policy and practice ever — and most of it without a shred of evidence to back it up. Despite mountains of evidence that community…
Abstract
Britain is undergoing its biggest change in drug policy and practice ever — and most of it without a shred of evidence to back it up. Despite mountains of evidence that community treatment works, criminal interventions, such as DTTOs, are still being extended, expanded and re‐invented across the UK — at huge cost to the UK taxpayer and at the expense of other forms of treatment. Neil Hunt is part of a pan‐European research study looking at coercive treatment within the criminal justice system. We reveal what the government is not telling us about their crime agenda.