Limited access to HIV prevention in French prisons (ANRS PRI2DE): implications for public health and drug policy

BMC Public Health

Research Article

Christine Calderon¹  Olivier Maguet¹  Laurent Michel²  Julien Cohen³  Jerôme Blanche³  Patrizia M Carrieri³  Marie Jauffret-Roustide⁴ 

[1] CCMO Conseil, 3 rue des déportés, 28150, Ymonville, France;Health and Medical Research National Institute, Research Unit 669, Paris, France;Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France;AP-HP, Emile Roux Hospital, Centre de Traitement des Addictions, Limeil-Brévannes, France;INSERM, U912 Economic & Social Sciences, Health Systems & Societies, Marseille, France;IRD, Aix Marseille Université, Faculté de Médecine, UMR-S912, Marseille, France;Southeastern Health Regional Observatory (ORS-PACA), Marseille, France;Infectious Diseases Department, National Institute for Public Health Surveillance, Saint-Maurice, France;CERMES3, UMR CNRS 8211, University Paris Descartes, U988, InsermParis, France;

关键词: Buprenorphine;    Harm Reduction;    Prison Setting;    Opioid Substitution Therapy;    Prison Health;   

DOI  :  10.1186/1471-2458-11-400

 received in 2011-02-09, accepted in 2011-05-27,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundOverpopulation, poor hygiene and disease prevention conditions in prisons are major structural determinants of increased infectious risk within prison settings but evidence-based national and WHO guidelines provide clear indications on how to reduce this risk. We sought to estimate the level of infectious risk by measuring how French prisons adhere to national and WHO guidelines.MethodsA nationwide survey targeting the heads of medical (all French prisons) and psychiatric (26 French prisons) units was conducted using a postal questionnaire and a phone interview mainly focusing on access to prevention interventions, i.e. bleach, opioid substitution treatment (OST), HBV vaccination and post-exposure prophylaxis (PEP) for French prisoners. Two scores were built reflecting adherence to national and WHO international guidelines, ranging from 0 (no adherence) to 10 (maximum adherence) and 0 to 9 respectively.ResultsA majority (N = 113 (66%)) of the 171 prisons answered the questionnaires, representing 74% coverage (46,786 prisoners) of the French prison population: 108 were medical units and 12 were psychiatric units. Inmate access to prevention was poor. The median[IQR] score measuring adherence to national guidelines was quite low (4.5[2.5; 5.5]) but adherence to WHO guidelines was even lower 2.5[1.5; 3.5]; PEP was absent despite reported risky practices. Unsuitable OST delivery practices were frequently observed.ConclusionsA wide gap exists between HIV prevention policies and their application in prisons. Similar assessments in other countries may be needed to guide a global policy reform in prison settings. Adequate funding together with innovative interventions able to remove structural and ideological barriers to HIV prevention are now needed to motivate those in charge of prison health, to improve their working environment and to relieve French prisoners from their currently debilitating conditions.

【 授权许可】

CC BY   
© Michel et al; licensee BioMed Central Ltd. 2011