PrEP in Prisons: HIV prevention in incarcerated populations

• Pages: 199-206
• DOI: https://doi.org/10.1108/IJPH-09-2019-0053
• Published date: 26 November 2019
• Date: 26 November 2019
• Author: Jordan Parsons,Chelsea Cox
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

PrEP in Prisons: HIV prevention in

incarcerated populations

Jordan Parsons and Chelsea Cox

Abstract

Purpose –The purpose of this paper is to discuss the possibility of using pre-exposure prophylaxis

(PrEP) as an HIV harm reductionintervention in prisons. PrEP is primarilydiscussed in relation to men who

have sex with men (MSM),meaning other high-risk populations, such asprisoners, are often side-lined.

The authorswanted to consider how it could prove beneficialbeyond the MSM community.

Design/methodology/approach –First, the authorsdiscuss whether the common objections to existing

HIV harm reduction interventions in prisons, such as needle exchanges, are applicable to PrEP. The

authors then applycommon objections to the provision of PrEP in the general populationto the provision

of PrEP in a prison context in orderto assess their strength. Finally, the authors discusswhat the authors

anticipateto be a key objection to PrEP in prisons: post-incarcerationaccess.

Findings –The authors argue that bothsets of common objections considered are easily refuted in the

case of PrEP in prisons. The unique setting and nature of the intervention are such that it is without

immediately apparent flaws. In addressing post-incarceration access, the authors suggest that a

longitudinalconsideration of a prisoner’s HIV risk underminesthe objection.

Originality/value –This discussion is of importance due to the significantly heightened risk of HIV

infection prisonersare subject to. Not only do effective HIV preventioninterventions in prisons contribute

to fair access to health for incarcerated individuals, but also to the widerfight against HIV. The authors

demonstratethat PrEP has potential as a new approachand call for further research in this area.

Keywords HIV, Offender health, Medical ethics, Injecting drug use, Harm reduction,Needle exchange

Paper type Conceptual paper

Introduction

Emtricitabine/tenofovir, a form of pre-exposure prophylaxis (PrEP), can significantly reduce

the risk of HIV infection in individuals who are at high risk. However, it is discussed

predominantly in relation to the risk of HIV infection from sexual contact within the men who

have sex with men (MSM) community, even though other high-risk population groups would

benefit from access.

One such population is incarcerated persons. Reports show incarcerated individuals to be

substantially more likely to be infected with HIV than the general public (Baker, 2018). This

is in large part due to an overrepresentation of substance dependency in prisoners

alongside a lack of accessible treatment and harm reduction programmes. The global

prison population has grown by 20 per cent in the last decade, outpacing population

growth, with a substantial proportion of this population serving time for drug-related

offences (Harm Reduction International, 2018). The need for effective and acceptable

interventions targeted at thosewith a drug dependency is evident.

The World Health Organization (WHO) recommends PrEP for population groups at

substantial risk of HIV infection (World Health Organization, 2016), and prisoners

undoubtedly fulfil this criterion. Information that delineates whichcohorts would benefit from

PrEP consistently includes intravenous drug users. In 2017, the WHO highlighted the

Jordan Parsons is based at

the Bristol Medical School,

University of Bristol, Bristol,

UK. Chelsea Cox is based

at the Faculty of Law,

University of Ottawa,

Ottawa, Canada.

Received 20 September 2019

Revised 10 October 2019

Accepted 25 October 2019

DOI 10.1108/IJPH-09-2019-0053 VOL. 16 NO. 2 2020, pp. 199-206, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 199