Data and statistics

HIV/AIDS

• Statistics shows that in most countries in Europe and central Asia, rates of HIV infection are much higher among prisoners than the outside population. Studies in European countries have found great variation in the rates of HIV infection among prisoners.
• Prisons are a breeding ground for HIV/AIDS and other infectious diseases, because of:
• • injection of drugs in the absence of sterile syringes;
  • sharing other injection equipment (water, spoons, etc.) and razors, toothbrushes: hepatitis C and B;
  • tattooing, piercing, scarification;
  • unprotected sexual relations: voluntary (circumstances), prostitution, rape;
  • accidental punctures with infected needles: searches in the cells;
  • limited access to health care;
  • safety of medical equipment (dental, medical, gynecological).
• By far, most HIV/AIDS epidemics in developing or transitional countries started among injecting drug users (IDU), a population which is overrepresented in prisons and pre-trial detention centres.

Tuberculosis (TB)

• Since the early 1990s, TB outbreaks in prisons have been reported in many countries in eastern Europe, and TB strains transmitted in prisons are more likely to be drug-resistant or associated with HIV co-infection.
• Rates of multidrug-resistant (MDR) TB are higher among prisoners than people outside prison.
• Due to overcrowding and poor nutrition, the tuberculosis notification rate in prisons ranges from 11 to 81 times higher than in the community outside prisons.

Drugs

• A high proportion of IDUs in prison share needles, with a high risk of transmitting HIV and other infectious diseases.
• Illicit drug use among prisoners varies widely in Europe. Data from 17 European Union (EU) countries indicate a lifetime prevalence of illicit drug use of between 16% (Romania) and 79% (the Netherlands and the United Kingdom [England and Wales]).
• Rates of ever-injecting drugs are substantially higher among prisoners than among the general population. Between 5% and 38% of prisoners in European countries reported ever injecting drugs prior to imprisonment.
• Although most prisoners reduce or stop their drug use while incarcerated, data from studies in 15 EU countries show that between 2% and 56% of prisoners reported ever having used drugs while incarcerated.
• Of the people imprisoned for drug-related crimes and not treated during their incarceration, the majority relapse within the year following release.
• The higher prevalence of HIV and hepatitis in prisons is often related to injecting drug use, and individuals in prison are more likely to share injecting equipment than drug users in the community. Needle and syringe exchange programmes have been shown to be effective in reducing the spread of HIV and hepatitis and have been introduced in over 70 prisons in countries such as Germany, Kyrgyzstan, Luxembourg, the Republic of Moldova, Romania, Spain, Switzerland and Tajikistan.
• Substitution treatment reduces heroin use and is more effective in retaining drug users in treatment than detoxification on its own. Substitution treatment has many benefits, including stabilizing drug users, interrupting chaotic lifestyles and improving the levels of social functioning and employment.
  
• As of 2010, 74 countries worldwide had opioid substitution therapy available in the community. Of these countries, 39 also had this therapy available in prisons.
  
• Released prisoners are at a significantly heightened risk of drug-related death relative to other residents in the general population. These overdose deaths result from many factors, including decreased tolerance after a period of relative abstinence during imprisonment and the concurrent use of multiple drugs.
  

Mental health

• A high proportion of prisoners suffer from mental health problems (such as depression and anxiety), addiction problems and personality disorders.
• Prevalence studies in many countries show that 10–15% of the prison population suffer from severe and enduring mental illnesses, such as such as schizophrenia, bipolar disorder and autism disorders.

• Although women constitute a very small proportion of the total prison population (2–9% on average worldwide), the number of women in prison is increasing rapidly. Most offences for which women are imprisoned are non-violent, property or drug related.
• Incarcerated women are far more likely to have had traumatic experiences in early childhood than incarcerated men, such as early sexual, mental and physical abuse. Half will also have experienced domestic violence.
• Many women in prison are mothers and usually the primary or sole caregivers for their children. Around 10 000 babies and children in Europe are estimated to be affected by their mother’s imprisonment. In most European countries, babies and young children can stay in prison with their mothers: 3 years is the most common age limit. Facilities vary widely between countries.
• At least 75% of women entering European prisons are estimated to have problems with drug and alcohol use. Further, women prisoners are more likely than male prisoners to inject drugs.  
• Women in prison are more likely to have mental health problems than both the general population and male prisoners, including high rates of post-traumatic stress disorders. Women prisoners are more likely to harm themselves and commit suicide than male prisoners, while suicide is more common among men outside prison.
• The prevalence of HIV and other infectious diseases is often higher among women prisoners.
• Women prisoners have specific needs related to reproductive health issues such as menstruation, pregnancy and menopause. This includes access to regular showers and a greater need for adequate nutrition and personal care products.

Co-morbidity and mental health

• Co-morbidity (dual diagnosis) of conditions, such as personality disorder, alcoholism and drug dependence, is common in prisons.
• Co-morbidity patients are sensitive to depression and anxieties. A substantial number of them have a history of emotional, physical and sexual abuse.

Young offenders

• Young offenders are likely to become adult offenders without early intervention and care. The diversion of young, vulnerable people is therefore particularly important and relevant, both morally and economically.
• The prevalence rates of poor mental health for young people in prison are very high, including over half with conduct disorders and around a third of young girls having a major depression.

Overcrowding

• In many countries the prison population has steadily increased over recent years, and the capacity of prison services has not kept pace. Overcrowding is an obvious cause or contributing factor to many of the health problems in prisons, most notably communicable diseases and mental health issues, including the use of psychoactive substances.
• At any given time, over 2 million people are imprisoned in penal institutions in Europe. While overcrowding is a health issue all over Europe, the situation is particularly serious in the countries of central and eastern Europe and central Asia, where overcrowding goes hand in hand with massive health problems. Imprisonment rates in the EU and Norway vary from 60–70 per 100 000 population in Denmark, the Netherlands, Norway, Slovenia and Sweden to over 200 in the Czech Republic, Estonia, Latvia, Lithuania and Poland. These figures are lower than in some large countries, for example 620 in the Russian Federation.