Insufficient access to harm reduction measures in prisons in 5 countries (PRIDE Europe): a shared European public health concern.
BACKGROUND
Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations.


METHODS
Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison.


RESULTS
A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08).


CONCLUSIONS
Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community.
Inserm U1178, Paris, France. laurent.michel@croix-rouge.fr.|Univ Paris-Sud and Univ Paris Descartes, UMRS1178, Paris, France. laurent.michel@croix-rouge.fr.|Centre Pierre Nicole, French Red Cross, Paris, France. laurent.michel@croix-rouge.fr.
Laurent
L
Michel
Inserm U912 (SESSTIM), Marseille, France. caroline.lions@inserm.fr.|Univ Aix Marseille, IRD, UMR-S912, Marseille, France. caroline.lions@inserm.fr.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France. caroline.lions@inserm.fr.
Caroline
C
Lions
Penitentiary administration, Brussels, Belgium. s.vanmalderen@gmail.com.
Sara
S
Van Malderen
Department of Special Education, Ghent University, Ghent, Belgium. julie.schiltz@ugent.be.
Julie
J
Schiltz
Department of Special Education, Ghent University, Ghent, Belgium. wouter.vanderplasschen@ugent.be.
Wouter
W
Vanderplasschen
Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark. kh.crf@psy.au.dk.
Karina
K
Holm
Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark. tk.crf@psy.au.dk.
Torsten
T
Kolind
Federserd, Padova, Italy. felnava@tin.it.
Felice
F
Nava
Penitentiary administration, Vienna, Austria. nadjaweltzien@hotmail.com.
Nadja
N
Weltzien
Penitentiary administration, Vienna, Austria. andrea.moser-riebniger@justiz.gv.at.
Andrea
A
Moser
Inserm U988, Paris, France. m.jauffret@invs.sante.fr.
Marie
M
Jauffret-Roustide
Médecins du Monde, Paris, France. olivier.maguet@medecinsdumonde.net.
Olivier
O
Maguet
Inserm U912 (SESSTIM), Marseille, France. pmcarrieri@aol.com.|Univ Aix Marseille, IRD, UMR-S912, Marseille, France. pmcarrieri@aol.com.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France. pmcarrieri@aol.com.
Patrizia M
PM
Carrieri
University of Applied Sciences, Frankfurt, Germany. cinziabrentari@hotmail.com.
Cinzia
C
Brentari
University of Applied Sciences, Frankfurt, Germany. hstoever@fb4.fh-frankfurt.de.
Heino
H
Stöver
D000328:Adult; D001317:Austria; D001530:Belgium; D003140:Communicable Disease Control / Q000379:methods* / Q000706:statistics & numerical data*; D003718:Denmark; D005060:Europe / Q000453:epidemiology; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D040261:Harm Reduction; D006801:Humans; D038622:Internationality; D007558:Italy; D008297:Male; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014480:United Nations; D014944:World Health Organization