Monitoring of HIV, HCV, TB in Prison: National Report on Ireland

23rd June 2016

Improving Prison Conditions by Strengthening the Monitoring of HIV, HCV, TB and Harm Reduction

Authors: Catherine MacNamara, Lorraine Varley, Patricia Mannix McNamara | ISBN 978-0-9573037-8-2

This report, published April 2016, forms part of the EU co-funded project ‘Improving Prison Conditions by Strengthening Infectious Disease Monitoring’ implemented under the lead of Harm Reduction International in 2015 and 2016. The project aims to reduce ill-treatment of persons in detention and improve prison conditions through improved and standardised monitoring and inspection mechanisms on HIV, HCV and TB. The current report, written by Catherine MacNamara, Lorraine Varley and Patricia Mannix McNamara, presents the mapping situation in Ireland.

The report is available for download here.

Photos of the launch event on 23rd June 2016 in the Wood Quay Venue can be viewed here.

Prisons and other places of detention are high-risk environments for the transmission of these diseases. This is related to the over-incarceration of vulnerable and disadvantaged groups who carry a disproportionately high burden of disease and ill-health; the criminalisation of drug users and high levels of injecting drug use; overcrowded and substandard prison conditions; inadequate health care; and the denial of harm reduction services.

Over the past 20 years, from an Irish perspective, there has been significant improvement in medical services for the prison population. The Irish Prison Service (IPS) has made significant investment since 1999 in better healthcare facilities for prisoners. In 2001 the IPS introduced drug treatment plans and healthcare plans, Hep B vaccine was made accessible to prisoners, nurses were employed, drug free units were expanded, and methadone treatment was implemented. In 2006 the IPS published a drugs policy Keeping drugs out of prison. However, there still remains a lack of information available that would assist public authorities in making decisions with regards to these services.

While some progress has been made in the adoption of monitoring mechanisms for infectious diseases in Irish prisons, this progress is arguably less than sufficient or consistent in meeting the standards of human rights-based prison monitoring. The absence of adequate medical services in prisons can contribute to, or even constitute, conditions that meet the threshold of ill treatment.

Presently, to our knowledge, inspection of infectious diseases is not formally included in the criteria for inspection of places of detention. Prison monitoring is often separated from health care inspection guidelines, leaving gaps in terms of coherent recording and monitoring. This separation is less than optimal in terms of services being positioned to provide an effective and coherent national response to prisoner need.This report is part of a larger international project that seeks to address this gap.

The report is available for download here.

Erratum: On pp. 31-32, the report omits mention of the complaints remit of the prison visiting committees, as provided for under the Prisons (Visiting Committees) Act 1925, whereby committee members hear complaints from individual prisoners.

Key Findings ~ Ireland:

• The social impact of the recession in Ireland has been devastating for individuals, families and communities. Nearly one third of Ireland’s population are experiencing deprivation or poverty. Those who experience incarceration are more likely to emanate from lower socioeconomic groupings.
• The criminalisation of drug possession in Ireland has not acted as a deterrent for those involved in the illicit drugs trade in Ireland. This reflects the global failure of the ‘War on Drugs.’ Incarceration of mainly low-level offenders on long sentences has served to expand the prison population further.
• The link between sex work and Hepatitis C and HIV are well documented. This has implications for reception to prison upon incarceration and makes the case for routine screening of all entrants to prison. It also has implications for health care provision amongst detainees who have been sex workers.
• Prisons as settings and prisoners as a population group have been omitted from certain health policies and strategies in Ireland. There is strong representation of Irish prisons in the current National Drugs Strategy (2009 – 2016). Improvements have been made in the area of drug treatment and rehabilitation of offenders.
• The healthcare of prisoners is outside the remit of the Department of Health, with responsibility for the health and wellbeing of prisoners in the hands of the Irish Prison Service. In certain areas of healthcare, the Irish Prison Service has the opportunity to provide a health service that goes beyond that of equivalence with the community.
• Prisoners have diverse and complex health needs. Compared to general adult populations, prison populations have poorer physical, mental and social health and experience considerable social exclusion. The prison environment can further compound these inequalities, thus impacting the health and human rights of those incarcerated in Ireland.
• High prevalence rates of drug usage have been reported in international literature in relation to Irish prisons. Harm reduction measures in Irish prisons include OST and Addiction Counselling. Currently, needle exchange programmes are not available in Irish prisons, which the authors deem a violation of the principle of equivalence.
• While it was possible to access some data in relation to prevalence rates of infectious diseases in Irish prisons via published research studies, the Irish Prison Service failed to respond to a Freedom of Information request in relation to infectious diseases and monitoring procedures in Irish prisons. A study conducted in 1999 identified Hepatitis B prevalence at 9%, Hepatitis C at 37% and HIV at 2% among the prisoner population. When these statistics were disaggregated by injecting drug use, it is noteworthy that prevalence rates of Hepatitis B among IDU’s were 18.5%, Hepatitis C is 81.3% and HIV is 3.5%.173 A 2014 study identified prevalence of Hepatitis B at 0.3%, Hepatitis C at 13% and HIV at 2%.
• Ireland has yet to ratify the OPCAT, and does not have an NPM. These failures area threat to the protection of human rights of prisoners in Ireland.
• Monitoring mechanisms for Irish prisons include the Inspector of Prisons, Prison Visiting Committees and the European CPT.

Recommendations

• There is an urgent need for national collation of data in relation to infectious disease prevalence amongst the prison population in Ireland. While such prevalence data may indeed exist, transparent access to such data is a necessity. Additionally, such data should be disaggregated along the prohibited grounds of discrimination.
• It is imperative that specific work be undertaken to challenge the current situation with regard to monitoring in Irish prisons. Information on specific screening procedures on reception to prison could not be garnered for this report, thus the authors recommend the development of a transparent operational policy for the monitoring of infectious diseases within Irish prisons.
• Given the transient nature of the prisoner population, both within the prison system and indeed upon release back to the community, there is need to ensure continuity of care. The inextricable links between the health of prisoners and communities cannot be denied, thus every attempt must be made to provide continuity of care for those diagnosed with infectious diseases.
• In order to meet the challenges of infectious diseases and ensure respect for prisoners’ human rights, including the right to humane treatment and the highest attainable standard of health, expansion of current harm reduction measures in all Irish prisons, based on specific need, is recommended. While improvements in this area have been noted in this report, further efforts in the area of syringe exchange and Naloxone should be addressed. This is essential in order to meet the principle of equivalence.
• Implementation of the recommendations of the CPT is necessitated as a matter of urgency.
• Further research in the following areas is needed as a matter of urgency:
  - The health of the Irish prisoner population, including prevalence rates of infectious diseases.
  - Specific and transparent monitoring tools for infectious diseases in Irish prisons are required.
  - A survey of available health services within the Irish Prison Service, to include a needs assessment for further future expansion of such services.

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More info about the project can be found on the Harm Reduction International website: www.ihra.net

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This project is co-funded by the European Union under the Criminal Justice Programme.The contents of this publication are the sole responsibility of the project and can in no way be taken to reflect the views of the European Commission.