Principles of condom provision programs in prisons from the standpoint of European prison health experts: a qualitative study

Abstract

Background Condom provision is one of the most effective harm reduction interventions to control sexually transmitted infections (STIs) including HIV/AIDS and viral hepatitis in prisons. Yet, very few countries around the world provide prisoners with condoms. The present study aimed to elucidate principles of effective prison-based condom programs from the perspective of European public health and prison health experts. Methods As a part of the “Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT)” twenty-one experts from the field of prison health from eight European countries were invited to discuss the principles of condom provision programs in prisons within two focus groups. The audio records were transcribed verbatim, coded, categorized, and analyzed using thematic analysis method. Results Six components emerged from the analysis as essential for successful condom programs in prisons: (1) highlighting the necessity of condom provision in prisons, (2) engagement of internal and external beneficiaries in all stages of designing and implementing the program, (3) conducting a pilot phase, (4) condom program in a comprehensive package of harm reduction interventions, (5) vending machine as the best method of condom distribution in prisons and (6) assuring the sustainability and quality of the intervention. Conclusion Results of the present study can help prison health policy makers to design and conduct acceptable, accessible and high-quality prison-based condom provision programs, and consequently to mitigate the burden of STIs in prisons. Having access to high-quality healthcare services including condom provision programs is not only the right of prisoners to health, but also is a move towards achieving the sustainable development goal 3 of “leaving no one behind.”

Sexually transmitted infections epidemiology and risk assessment at the main correctional facility in Malta (2017–2019)

“…Condom provision is one of the most effective harm reduction interventions and must be available and accessible to all prisoners who need them. 16 The combined data with statistics from CCF, and the sexual history taking indicate that substance misuse is a common factor in this population, with 75.7% of inmates admitting to illicit drug use. This correlates with other correctional facilities in Europe characterised by a large proportion of persons with substance addictions.…”

“…20 Treating HCV-infected prisoners has been proven to be highly costeffective and should be a priority of each government for the global HCV elimination effort. 16,21 Equally important is universal HBV vaccination of all non-infected prison inmates. 16,18 In our cohort, the prevalence of HBV infection was 2%, in line with other European countries, 22 nevertheless vaccination of inmates not immune to HBV has not occurred in a timely manner.…”

“…16,21 Equally important is universal HBV vaccination of all non-infected prison inmates. 16,18 In our cohort, the prevalence of HBV infection was 2%, in line with other European countries, 22 nevertheless vaccination of inmates not immune to HBV has not occurred in a timely manner.…”

“…HIV testing should be more consistent to reduce the incidence of late diagnoses and well-defined referral pathways should be established to facilitate access to care. 16,23 In Malta, inmates are offered opt-out HIV testing upon entrance into the correctional facility and people living with HIV are linked to care.…”

Public Health and Prisons: Priorities in the Age of Mass Incarceration

“…While the Centers for Disease Control and Prevention recommend opt-out testing for HIV, only 19% of prison systems utilized it in 2014 ( 134 ). Prisons should also offer evidence-based prevention measures for STIs and HIV, including condoms, syringe-service programs, and pre-exposure prophylaxis medications ( 103 , 157 ). To reduce the risk of outbreaks of respiratory-borne illnesses, such as COVID-19, prisons should adopt prevention measures including widespread vaccine delivery ( 119 ), optimized ventilation, surveillance testing, and, most importantly, significant population reductions to safely accommodate social distancing as well as humane medical isolation and quarantine ( 18 , 36 , 89 ).…”