Management of prisoners with HIV infection

Editor—Edwards et al point out that the main cause of HIV in prisoners is injecting drug use.¹ Work done in Scottish prisons indicates that 4% of the male prison population have continued their previous community injecting practices and 8% of male prisoners start injecting in prison.²,³

Measures for reducing viral transmission in the community, such as needle exchange, are not available in British prisons. It is possible, therefore, that many of the prisoners referred internally had contracted HIV by sharing injecting equipment while incarcerated. The recommendation by Edwards et al that HIV status should be confirmed in all prisoners should therefore be qualified with a recommended frequency. Although, as Edwards et al point out, prison provides an opportunity for inmates to receive care for bloodborne viral disease, which is provided, it also provides an opportunity for prevention which is not provided beyond advice and bleach tablets. I demonstrated the feasibility of a behavioural technique by using buprenorphine in a secure delivery device successfully to prevent injecting in a Scottish prison in 2000; further evaluation of this (or any other harm reduction measure) has been eschewed by those who have the administrative authority to address this important issue. It is admirable that King's College Hospital provides care for prisoners with HIV, but prisoners will continue to be at risk until the government admits that prisons are state sponsored culture media for bloodborne viruses.