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PubMed1995

Concern, perceived risk and attitudes towards HIV/AIDS in Scottish prisons.

Four hundred and eighty male prisoners and 500 male staff from 7 Scottish prisons took part in a study assessing perception of risk and attitudes towards HIV/AIDS. Prison staff were found to perceive prison as a higher-risk environment for HIV/AIDS than outside prison, whereas prisoners perceived the opposite. Prisoners perceived less personal risk of HIV/AIDS inside prison than staff. Staff and prisoner concern towards HIV/AIDS was greater than perceived risk of HIV/AIDS, and concern was found to be associated with a number of demographic variables, whereas perceived risk was less influenced by such variables. These findings suggest that the process of risk perception may operate on more than one level. Factor analysis of attitudes towards HIV/AIDS produced four factors for both staff and prisoners: 'Interacting with people with HIV/AIDS'; 'Social control of HIV/AIDS'; 'HIV/AIDS prevention for high-risk groups'; and 'Response to HIV/AIDS high-risk behaviour'. For both staff and prisoners, greater concern and perceived risk towards HIV/AIDS was associated with a lower tolerance for interacting with people with HIV/AIDS and more support for strict social control measures against people with HIV/AIDS.

Adult↗
PubMed1992

Diabetes in prison: can good diabetic care be achieved?

OBJECTIVE: To investigate the clinical characteristics and metabolic control of diabetic patients given structured diabetic care in prison. DESIGN: Survey of diabetic men serving prison sentences during a 22 month period in a large British prison. SETTING: HM Prison, Walton, Liverpool. SUBJECTS: 42 male diabetic prisoners, of whom 23 had insulin dependent and 19 non-insulin dependent diabetes. MAIN OUTCOME MEASURES: Episodes of diabetic instability, glycated haemoglobin concentrations, body mass index. RESULTS: No serious diabetic instability occurred. Between the initial assessment by the visiting consultant diabetologist and a second assessment 10 weeks later glycated haemoglobin concentrations had fallen from 10.8 (SD 2.9)% to 9.8 (2.4)% (p less than 0.05) in prisoners with insulin dependent diabetes and from 8.7 (1.9)% to 7.6 (1.2)% (p less than 0.05) in those with non-insulin dependent diabetes. Good glycaemic control continued, a mean glycated haemoglobin concentration of 7.6 (1.5)% being recorded in seven men remaining in prison for six to 18 months. Mean body mass index (weight (kg)/(height(m))2) did not change during the study (insulin dependent prisoners 23.3 (SD 2.1), non-insulin dependent prisoners 27.9 (3.8)). CONCLUSIONS: Good diabetic metabolic control is usual in prison, probably due to the rigid dietary regimen, no alcohol, and compliance with treatment. Many younger men had defaulted from their home diabetic clinics, and imprisonment allowed screening for diabetic complications and reassessment of treatment. Structured diabetic care should be offered in all prisons.

Adult↗
PubMed2002

Alternatives to current HIV/AIDS policies and practices in South African prisons.

Prisoners in South Africa face problems of overcrowding, violence and poor nutrition. Added to this burden in recent times is the increased threat from HIV. The HIV epidemic has been relatively late in coming to South Africa but infection rates are now 20% in the adult population. However, there is no data available on the level of HIV infection in the prison population. Overseas studies suggest that the characteristics of prisoners place them at much greater risk of HIV infection. Factors which contribute to increased levels of HIV infection include poor health care facilities, lack of condoms and lack of disinfectants. Current policies and practices on HIV in prison attempt to balance the constraints of limited resources with the need to preserve prisoner human rights. The outcomes include: mass testing not freely available, HIV education is limited, and early release of prisoners with advanced AIDS is not allowed. Constraints on the implementation of effective HIV prevention strategies include: bureaucratic inefficiency, lack of resources, and a reluctance by prison authorities to address the issue of HIV in prison. These problems can possibly be overcome by addressing the issue from both management and prisoner perspectives. On the management side, increased resources, increased training of prison officials, and increased political commitment to address the issue are required. Outside partnerships are probably required for an effective response. Prisoners require better nutrition, better living conditions, better health care, freely available condoms and disinfectants.

AIDS Serodiagnosis↗
PubMedDate not supplied

Coercion and informed consent in research involving prisoners.

Prison-based research has been limited due to concern that prisoners may represent a vulnerable population secondary to possible coercion and limited capacity for voluntary informed consent. This study was designed to assess decisional capacity and susceptibility to coercion in prison research subjects. Subjects were 30 mentally ill prisoners and 30 healthy controls. The groups were compared on ability to provide informed consent to a hypothetical drug trial, susceptibility to possible coercion, neuropsychological functioning, and psychiatric symptoms. Results indicated that all controls and all but one of the prisoners demonstrated adequate capacity to consent to the hypothetical drug trial. However, when decisional capacity was measured quantitatively, prisoners performed significantly worse regarding two aspects of this ability. Regarding possible coercion, prisoners' main reasons for participating in research included avoiding boredom, meeting someone new, appearing cooperative in hopes of being treated better, and helping society. Neuropsychological functioning was strongly positively correlated with decisional capacity and negatively correlated with susceptibility to possible coercion, whereas psychiatric symptoms were only weakly correlated with these variables. In conclusion, a very high percentage of particularly vulnerable, mentally ill prisoners demonstrated adequate capacity to consent to research. Lower scores on a quantitative measure of decisional capacity suggest that extra care should be taken during the consent process when working with these subjects. The reasons prisoners gave for participating in our research indicated that the prison setting may have influenced their decision to participate, but that they were not actually coerced into doing so. Despite serious past incidents, ethicists will need to consider the possibility that prisoners have become an overprotected population.

Adult↗
PubMed2003

Does ethnicity affect need for mental health service among New Zealand prisoners?

OBJECTIVE: The National Study on Psychiatric Morbidity in New Zealand Prisons identified undiagnosed mental illness and unmet treatment needs for mentally disordered offenders. As approximately 50% of prisoners are of Maori and 8.3% Pacific Island ethnicity, we analyzed the data to determine if there were any differences in the rates of major mental disorders between ethnic groups. METHOD: A census of all female prisoners, all remand male prisoners and an 18% random sample of the sentenced male prisoners were interviewed employing the diagnostic interview for mental illness (CIDI-A), screening diagnostic interview for relevant personality disorders (PDQ) and suicide screening questions. Self-identified ethnicity was recorded. Ethnic groups were compared for sociodemographic variables, morbidity for mental disorder, treatment experience and suicidality. RESULTS: The ethnic groups were largely similar in age and current prevalence for mental disorders, although there was some evidence of differing sociodemographic factors, especially younger age among the Maori prisoners. Maori report fewer suicidal thoughts, but acted suicidally at the same rate as non-Maori. Treatment for mental disorder was less common among Maori and Pacific Island prisoners than others, both in prison and in the community. CONCLUSION: Criminogenic factors present in the developmental histories of prisoners might also increase the risk of mental disorders. Ethnic groups were not different in the rate at which they manifest mental disorders in the face of such factors. Younger prisoners were disproportionately more likely to be of Maori or Pacific Island ethnicity. Both prior to and after entry to prison, services must improve responsiveness to Maori and Pacific Island people.

Adult↗
PubMed2006

Mental disorders in Australian prisoners: a comparison with a community sample.

BACKGROUND: The plight of those with mental health problems and the possible role of prisons in "warehousing" these individuals has received considerable media and political attention. Prisoners are generally excluded from community-based surveys and to date no studies have compared prisoners to the community. OBJECTIVE: The objective was to examine whether excess psychiatric morbidity exists in prisoners compared to the general community after adjusting for demographics. METHOD: Prison data were obtained from a consecutive sample of reception prisoners admitted into the state's correctional system in 2001 (n = 916). Community data were obtained from the 1997 Australian National Survey of Mental Health and Wellbeing (n = 8168). Mental health diagnoses were obtained using the Composite International Diagnostic Interview and a number of other screening measures. Weighting was used in calculating the 12-month prevalence estimates to control for demographic differences between the two samples. Logistic regression adjusting for age, sex and education was used to compare the prison and community samples. RESULTS: The 12-month prevalence of any psychiatric illness in the last year was 80% in prisoners and 31% in the community. Substantially more psychiatric morbidity was detected among prisoners than in the community group after accounting for demographic differences, particularly symptoms of psychosis (OR = 11.8, 95% CI 7.5-18.7), substance use disorders (OR = 11.4, 95% CI 9.7-13.6) and personality disorders (OR = 8.6, 95% CI 7.2-10.3). Mental functioning and disability score were worse for prisoners than the community except for physical health. CONCLUSIONS: This study found an overrepresentation of psychiatric morbidity in the prisoner population. Identifying the causes of this excess requires further investigation.

Adolescent↗
PubMed2000

Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections.

OBJECTIVE: To investigate the facilities for inpatient care of mentally disordered people in prison. DESIGN: Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published by the Prison Service or the NHS. SETTING: 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. MAIN OUTCOMES MEASURES: Appraisals of quality of care against published standards. RESULTS: The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had completed specialist psychiatric training. 24% of nursing staff had mental health training; 32% were non-nursing trained healthcare officers. Only one prison had occupational therapy input; two had input from a clinical psychologist. Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of seclusion. The average length of an episode of seclusion was 50 hours. CONCLUSION: The quality of services for mentally ill prisoners fell far below the standards in the NHS. Patients' lives were unacceptably restricted and therapy limited. The present policy dividing inpatient care of mentally disordered prisoners between the prison service and the NHS needs reconsideration.

England↗
PubMed2001

Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey.

OBJECTIVES: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in entrants to Irish prisons and to examine risk factors for infection. DESIGN: Cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing. SETTING: Five of seven committal prisons in the Republic of Ireland. PARTICIPANTS: 607 of the 718 consecutive prison entrants from 6 April to 1 May 1999. MAIN OUTCOME MEASURES: Prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in prison entrants, and self reported risk factor status. RESULTS: Prevalence of antibodies to hepatitis B core antigen was 37/596 (6%; 95% confidence interval 4% to 9%), to hepatitis C virus was 130/596 (22%; 19% to 25%), and to HIV was 12/596 (2%; 1% to 4%). A third of the respondents had never previously been in prison; these had the lowest prevalence of antibodies to hepatitis B core antigen (4/197, 2%), to hepatitis C (6/197, 3%), and to HIV (0/197). In total 29% of respondents (173/593) reported ever injecting drugs, but only 7% (14/197) of those entering prison for the first time reported doing so compared with 40% (157/394) of those previously in prison. Use of injected drugs was the most important predictor of antibodies to hepatitis B core antigen and hepatitis C virus. CONCLUSIONS: Use of injected drugs and infection with hepatitis C virus are endemic in Irish prisons. A third of prison entrants were committed to prison for the first time. Only a small number of first time entrants were infected with one or more of the viruses. These findings confirm the need for increased infection control and harm reduction measures in Irish prisons.

Adolescent↗
PubMed2006

Mental health consultations in a prison population: a descriptive study.

BACKGROUND: The psychiatric morbidity among prison inmates is substantially higher than in the general population. We do, however, have insufficient knowledge about the extent of psychiatric treatment provided in our prisons. The aim of the present study was to give a comprehensive description of all non-pharmacological interventions provided by the psychiatric health services to a stratified sample of prison inmates. METHODS: Six medium/large prisons (n = 928) representing 1/3 of the Norwegian prison population and with female and preventive detention inmates over-sampled, were investigated cross-sectionally. All non-pharmacological psychiatric interventions, excluding pure correctional programs, were recorded. Those receiving interventions were investigated further and compared to the remaining prison population. RESULTS: A total of 230 of the 928 inmates (25 %) had some form of psychiatric intervention: 184 (20 %) were in individual psychotherapy, in addition 40 (4 %) received ad hoc interventions during the registration week. Group therapy was infrequent (1 %). The psychotherapies were most often of a supportive (62 %) or behavioural-cognitive (26 %) nature. Dynamic, insight-oriented psychotherapies were infrequent (8 %). Concurrent psychopharmacological treatment was prevalent (52 %). Gender and age did not correlate with psychiatric interventions, whereas prisoner category (remanded, sentenced, or preventive detention) did (p < 0.001). Most inmates had a number of defined problem areas, with substance use, depression, anxiety, and personality disorders most prevalent. Three percent of all inmates were treated for a psychotic disorder. Remand prisoners averaged 14 sessions per week per 100 inmates, while sentenced inmates and those on preventive detention averaged 22 and 25 sessions per week per 100 inmates, respectively. Five out of six psychiatric health services estimated the inmates' psychiatric therapy needs as adequately met, both overall and in the majority of individual cases. CONCLUSION: Our results pertain only to prisons with adequate primary and mental health services and effective diversion from prison of individuals with serious mental disorders. Given these important limitations, we do propose that the service estimates found may serve as a rough guideline to the minimum number of sessions a prison's psychiatric health services should be able to fulfil in order to serve the inmates psychiatric needs. The results rely on the specialist services' own estimates only. Future studies should take other important informants, including the inmates themselves, into consideration.

Adult↗
PubMed1997

A path analysis on prisoners' health behavior and medical utilization.

In this thesis, Korean prisoners' health behavior and the characteristics of their medical utilization were surveyed and analysed. Because prisoners are inclined to be mediators of communicable diseases or unhealthy behaviors between prison institution and the outside world, health care for prisoners is directly related to the national population. Data were collected through a self-administered survey of 5 Korean prisons out of a total of 38 correctional facilities and analysed in accordance with a causal model based on a path frame, by serial multiple regressions on health behavior, health status, and medical utilization, etc. According to the survey analysis, while prisoners were generally concerned with their health much more than they were before imprisonment, they perceived that their health status had deteriorated after imprisonment, and that their need for health services was increasing gradually during their time in prison. In the path analysis on the causal relations among variables related to the prisoners' health status and medical utilization, the prisoners' characteristics affected their health concern and health behavior, and subsequently affected their health status and medical utilization, respectively. To sum up these exploratory studies on prisoners' health behavior and health service utilization, some efforts to organize a health care system embracing the correctional institution and health care administration should be made on the level of establishing a health care delivery system for special social groups like prisoners.

Adult↗
PubMed2004

Management and evolution of insomnia complaints among non-substance-misusers in a Swiss remand prison.

QUESTIONS UNDER STUDY: Insomnia is a frequent though rarely investigated problem among prisoners. The study's aim was to examine the clinical management of insomnia complaints in non-substance-misusing (NSM) prisoners (quality of medical consultation, effectiveness of drug prescription), and the risk of leaving prison with ongoing hypnotic prescription which might provoke withdrawal symptoms and encourage further hypnotic use outside prison. METHODS: Retrospective study of the medical records of 112 NSM prisoners complaining of insomnia at medical consultation over a one year period at the outpatient-service of the Champ-Dollon remand prison (Geneva, Switzerland). We examined insomnia management by the general practitioners (anamnestic and clinical evaluation documented in the record), type, duration and effectiveness of treatment. RESULTS: The 112 records show a prescription of hypnotics to 111 patients (80% benzodiazepines or Zolpidem), a limited documented insomnia work-up (anamnestic information about sleep habits, sleep latency and previous hypnotic use for less than a third of the patients, about the impact of insomnia, such as fatigue, on daily activity in only 7%). In more than 60% of the patients, insomnia complaints persisted for more than 3 weeks. In 41 (37%) patients, improvement (defined subjectively based on patients' complaints) was complete, in 20 (18%) absent, and in 34 (30%) incomplete while taking the prescribed hypnotics. Patients without or with only partial improvement of insomnia received the highest number of hypnotics (mean 2.4, vs. 1.4 for patients with total improvement, 95% CI of the difference: 0.7-1.4). 55% of the 112 prisoners left prison with hypnotics still being prescribed. CONCLUSIONS: Our results show that prison physicians' evaluation for insomnia was incomplete. Drug prescription did not seem to have been an effective treatment for insomnia complaints in a sizeable number of patients. Many prisoners leave the prison with benzodiazepine prescription still ongoing and could be at risk for continued hypnotic use following imprisonment.

Adult↗
PubMed1987

Evidence of hepatitis virus infection among Australian prisoners of war during World War II.

A sample of Australian male veterans of World War II was surveyed after 40 years. One hundred and seventy veterans had been held by the Japanese as prisoners of war and 172 veterans had served in southeast Asia but had not been taken captive (non-prisoners of war). A medical history was obtained and a physical examination undertaken. Blood was drawn and analysed for standard liver biochemistry and serological markers of hepatitis A and B virus (HAV, HBV) infections. The prevalence of immunoglobulin (Ig)G class antibodies to HAV was 95.2% in non-prisoners of war and 93.3% in prisoners of war. Only three cases of hepatitis B surface antigen (HBsAg) seropositivity were identified (two cases from the prisoner-of-war group). Thirty-six (21.8%) prisoners of war were seropositive for the presence of antibodies to HBsAg (anti-HBs) and 34 (20.0%) prisoners of war for that of antibodies to hepatitis B core antigen (anti-HBc), compared with 16 (9.8%) and eight (4.7%) of the non-prisoners of war, respectively (P = 0.002 and P = 0.0001, respectively). Those veterans who reported jaundice during World War II had a higher prevalence of antibodies to HBV. Among prisoners of war who were forced to work on the Burma-Thailand railway, 24.1% were seropositive for anti-HBc compared with 11.1% of the remaining prisoners of war (P = 0.048). It would appear that hepatitis B was common in prisoners of war but that those who survived 40 years were able to clear the virus and do not appear to have significant liver disease.

Asia, Southeastern↗
PubMedDate not supplied

[Mass antibiotic prophylaxis against cholera in the New Bell central prison in Douala during the 2004 epidemic].

In early January 2004, cases of severe watery diarrhea were reported in Douala, the economic capital of Cameroon (estimated population: 2.4 million inhabitants). Three stool samples examined at the Cameroon National Reference Laboratory grew Vibrio cholerae serogroup O1, later identified by the Pasteur Institute in Paris, France, as serotype Inaba. On 19 January, the provincial health authorities declared an outbreak of cholera. The epidemic lasted until that September. In all, 5,020 cholera cases were reported, and 69 deaths from cholera among hospital patients. The overall attack rate for Douala was 209 cases per 100,000 inhabitants, with a case-fatality ratio of 1.37%. New Bell Central Prison, the sole penitentiary facility for Douala, is situated in the center of the town, near the biggest market. It was originally built in 1930 for 700 prisoners but now houses an average of roughly 3,100 inmates. Living and sanitary conditions in the prison are deplorable. Half of the cells house more than 150 inmates with a surface area of less than 0.20 m2 per inmate. Approximately 400 people--visitors, new admissions, and discharged prisoners--enter and leave the prison. In February 2004, five suspected cases of cholera were reported in the prison's hospital ward. Immediate measures were taken to prevent an explosive spread of cholera within the prison: a) suspected cases were treated with rehydration therapy, antibiotics, and isolation; and b) preventive antibiotic treatment, consisting of a single 300-mg dose of doxycycline, was administered to all 3,036 prisoners and 164 prison staff members. No significant side effects were observed. Despite a reinforced surveillance system, no new cholera cases were reported except two suspected cases in June 2004 (four months later), and their diagnoses could not be confirmed. A cholera epidemic in an urban area mandates rigorous epidemiological surveillance system and provisions for safety stocks of therapeutic and prophylactic drugs in closed at-risk settings, such as prisons. Collective single-dose prophylaxis with an antibiotic the efficacy of which is confirmed by in vitro antibiotic susceptibility testing can provide immediate protection not available by other preventive measures (education, sanitation, immunization) against a cholera epidemic in a prison.

Anti-Bacterial Agents↗
PubMed1995

U.S. prisoners' access to experimental HIV therapies.

PURPOSE: To examine Department of Corrections (DOC) policies prohibiting prisoner participation in research studies and to assess the variables associated with state policies and practices relating to access by inmates in U.S. prisons to HIV-related clinical studies and experimental therapies. METHODS: A telephone survey conducted in 1994-95 of DOC medical directors from 32 states throughout the United States to obtain information about state DOC policies and practices relating to HIV clinical studies. RESULTS: State policies governing prisoner participation in clinical trials and access to new therapies vary widely. States with high AIDS incidence rates, a large number of AIDS-related deaths in prison, and high concentrations of minorities in the correctional system were more likely to allow prisoners to enroll in clinical studies and to receive experimental medications. Overall, a relatively small number of prisoners in state prisons have enrolled in clinical studies. Participation of a prison representative on the board reviewing a clinical study was identified as an important factor in allowing prisoner participation in studies. CONCLUSIONS: Barriers to prisoner participation in clinical studies are numerous but not insurmountable. Results from this study have led to efforts in Minnesota to revise current policy in order to permit prisoner participation in studies if appropriate guidelines are followed.

Antiviral Agents↗
PubMed1997

Psychical difficulties in former prisoners of detention camps.

The war imprisonment is a traumatic experience which is generally considered to have a potential to cause various psychical difficulties, in particular the posttraumatic stress disorder (PTSD). During the aggression on Croatia, several thousands of Croatian soldiers and civilians were held in Serbian detention camps where they were tortured to extent of extreme stress. In this paper, the authors researched psychical effects of stress in former war prisoners. Examinees were observed in three separate groups. The first group was formed of all former prisoners of war (a total of 1458) that went through several medical examinations, including psychiatric one, after their release from detention camps. Examinations were performed at the University Clinic for Infectious Diseases "Dr. Fran Mihaljević" in Zagreb, in period from November 1991 to September 1992. The second group consisted of 82 former prisoners randomly chosen from a total of 735 prisoners released from the "Sremska Mitrovica" camp in August 1992. The third group contained 37 prisoners from "Manjaca" camp out of 100 invited to the control examination 6 months after their release. A classic psychiatric diagnostic interview was performed in all of the examinees immediately after their release, and in the 2nd and the 3rd group the modified Watson's PTSD questionnaire was also used in addition. In the 2nd group, prisoners were questioned immediately after they were released. Using classical psychiatric interview, a specific psychiatric diagnosis could have been established in 20% cases. Psychiatric symptoms were observed in 30-40% examinees (in 36% of former "Manjaca" camp prisoners). Through the use of Watson's questionnaire, a PTSD diagnosis was established in 85.7% (70 out of 82) prisoners of the 2nd group, and in 27% of the 3rd investigated group of prisoners. Former prisoners examined after release (the 2nd group) showed significantly higher prevalence of PTSD symptoms. All PSTD symptoms were found in more than 50% cases of the 2nd group, while in the 3rd group none of the symptoms were found in more then half of examinees. Results are discussed and one among the direct conclusions is that former prisoners of war, expecting their problems to disappear spontaneously, are unwilling to seek for psychiatric help.

Adult↗
PubMedDate not supplied

Tuberculosis case detection in a state prison system.

OBJECTIVE: This study was designed to describe the epidemiology of tuberculosis ((TB) among inmates in the Georgia state prison system; to evaluate the effectiveness of the TB case detection methods used; to evaluate the use of contact tracing for inmate TB cases; and to determine rates of completion of therapy. METHODS: Using a standardized form, the authors abstracted data from reports to the Centers for Disease Control and Prevention, prison hospital medical charts, and county health department records for all patients with TB treated in the Georgia Department of Corrections prison system from 1991 through 1995. RESULTS: A total of 142 cases of tuberculosis were treated in the prison during five-year period. Approximately two-thirds were detected by active case finding,either at the county jail prior to transfer to the prison system (31%) or at the prison intake evaluation (37%). Routine screening procedures at entry, following Centers for Disease Control and Prevention guidelines, had a sensitivity of 96%. Contact investigations were carried out in county jails or in the community for only 25% of cases detected at entry to prison. For those released from prison still on treatment, 38% were lost to follow-up before completion of therapy. CONCLUSIONS: The Georgia prison system is doing an effective job of TB case detection and treatment among incarcerated inmates. Closer cooperation between the prison system and local health departments is needed to improve contact tracing and completion of therapy for this high risk population. Some cases detected at entry to prison appear to have been missed in the county jails

Adult↗
PubMedDate not supplied

[Primary health care in a prison environment, the Cameroon experience].

People isolated from their families, such as prisoners, are the most vulnerable to the consequences of the economic crisis in Africa. Some non-governmental organizations are taking action to improve health care conditions in prisons. We describe herein such a project, conducted in the town of Ngaoundéré, Adamaoua Province, Cameroon. The prison houses 400 prisoners, mostly men. Catholic missionaries have been involved in improving conditions since 1988, at the request of a magistrate from the local tribunal. They have introduced a community store, handicrafts and the teaching of reading and writing, carried out by the prisoners themselves. The Catholic Health Service was asked to join the project in October 1992. Its participation was part of the provincial policy of collaboration between private and public organizations for the improvement of health institutions. Meetings between health workers and prisoners first created an opportunity for the prisoners to talk about their concerns and what they wanted. A health committee, consisting of about 10 prisoners took several initiatives related to hygiene. Access to curative care was then improved by increasing the stock of medicines to include 37 drugs, standardizing the therapeutic recommendations (including those of the national program against tuberculosis) and increasing the prisoners' access to health care by making the pharmacy self-sufficient. The pharmacy's prices are low and the wardens and their families are encouraged to use it. Any profit made goes towards a "solidarity fund" managed by the prisoners, which enables them to buy their own drugs (3 to 5 patients are seen each day by the nurse). The link between money entering the system and the supply of drugs was studied. Most of the diseases reported between July 1994 and July 1995 were infectious, including scabies infections and acute respiratory infections (mean of 5 cases per month). Fifteen cases of tuberculosis were diagnosed and treated. AIDS was not a major problem in the prison although its incidence is likely to rise in Ngaoundéré. The budget of the infirmary for this time period was 65% that of the smallest private health center in Adamaoua. The solidarity fund paid for 212 medical prescriptions. The cooperation between authorities and health workers made the system sustainable. Self-management of health care was also essential to the project's success. Local control of the budget made everyone involved much more aware of the costs, the need for efficiency and avoiding waste.

Cameroon↗
PubMed1994

The extent of injecting and syringe sharing in prison reported by Edinburgh drug clinic attenders.

68 outpatient attenders at Edinburgh's Community Drug Problem Service who reported a history of drug injecting and who had spent 1 week or more in prison between March 1987-March 1990 were interviewed about drug injecting behaviour and syringe sharing before and during each prison episode they reported. One-third of those injecting prior to prison continued to do so in prison, most doing so twice weekly or more. 80% of prison injectors shared syringes in prison. No subjects commenced their injecting career in prison, and being imprisoned did not cause past injectors who had stopped to resume injecting in custody. Being imprisoned tended to cause non-sharing injectors to resume sharing in prison. Prison injectors tended to have started both their oral and their injecting drug use careers at an earlier age, and to have been sharing syringes in the community prior to custody. Half of prison sharers used unofficially acquired bleach or disinfectant to sterilise injecting equipment. Continuing involvement with the courts and thus risk of reimprisonment was common. The findings support the case for harm reduction policies in Scottish prisons, and diversion from custody and into treatment for this high risk group.

Journal Article↗