Prison Health in Prisons Project WHO Regional Office

Prison Health in Prisons Project WHO Regional Office for Europe Riga 29 April 2008 Dr Lars Moller, Ph. D World Health Organization Regional Office for Europe

Health in Prisons Project WHO Regional Offices PAHO EURO AFRO EMRO SEARO WPRO Americas, Europe, Africa, Eastern Mediterranean, South East Asia, Western Pacific

Member States involved Ø 14 from West Europe: Health in Prisons Project • Austria, Belgium, Finland, France, Greece, Iceland, Ireland, Malta, Netherlands, Norway, Portugal, Spain, Switzerland, United Kingdom (England, Wales and Scotland Ø 13 from Central Europe: • Albania, Croatia, Czech Republic, Estonia, Hungary, Kosovo (observer), Lithuania, Latvia, Moldova, Poland, Romania, Serbia, Slovakia, Slovenia Ø 9 from East Europe: • Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan, Ukraine, Uzbekistan

International organizations involved Health in Prisons Project • • • American Public Health Association Pompidou Group, Council of Europe AIDS Foundation East-West WHO Collaborating Centre for Promoting Prison Health, Department of Health, England Wales International Centre for Prison Studies, Kings College, London International Committee of the Red Cross Cranstoun Drug Services European Monitoring Centre for Drugs and Drug Addiction United Nations Office on Drugs and Crime KNCV Tuberculosis Foundation Sainsbury Centre for Mental Health, United Kingdom The Prison Health Expert Group of The Northern Dimension Partnership in Public Health and Social Well-being

Prison population Health in Prisons Project Source: International Centre for Prison Studies

Health in Prisons Project HIV prevalence (%) in selected countries

Health in Prisons Project New cases of HIV 26% 12% 16% 32%

Health in Prisons Project Prisons are a breeding ground for HIV/AIDS epidemics, because: • Unprotected sexual relations: voluntary (circumstances), prostitution, rapes • Injection of drugs in the absence of sterile syringes • Tattooing, piercing, scarifications, brother blood sharing rituals • Accidental punctures with infected needles: searches in the cells • Safety of medical equipment (dental, medical, gynecological) • Fights • Transmission from mother to child • Sharing other injection equipment (water, spoons, etc. ) and razors, toothbrushes: hepatitis C & B

Health in Prisons Project HIV prevalence in Spanish prisons

New TB cases in prisons; EUR, 2004 § 37/52 (71%) countries reported to WHO-EURO on Health in Prisons Project new TB cases by penal and civilian system

Health in Prisons Project New TB cases in prisons; EEUR+, 2004

Health in Prisons Project Mental Health Problems • Of the two million prisoners in Europe, at least 400, 000 suffer from a significant mental disorder, and a larger number suffers from common mental health problems such as depression and anxiety. • There is often co-morbidity (dual diagnosis) with conditions such as personality disorder, alcoholism and drug dependence. • Overall the percentage of prisoners who suffer from a mental health problem and/or a drug dependence has been estimated to 60 -65%. • There is evidence that the most common form of mental health problem in prisons is personality disorder; a substantial part of the remaining prison population suffers from psychosis-related problems. • The lifetime prevalence of psychiatric co-morbidity among drug users in prison is 2 -3 times higher than in the general population.

Health in Prisons Project The WHO Health in Prisons Project Actual activities • Best Practice award • Prison Health Database • Guide on prison health • Status Paper on Prisons and Tuberculosis • Prisons and Mental Health • Prisons and Women • Country work

Web site: Health in Prisons Project http//: www. euro. who. int/prisons Contact Lars Moller: lmo@euro. who. int