Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
Section of Infectious Diseases, Yale University School of Medicine and School of Public Health, New Haven, Connecticut, USA.
Curr Opin HIV AIDS. 2019 Sep;14(5):415-422. doi: 10.1097/COH.0000000000000572.
People with HIV and HCV are concentrated within criminal justice settings globally, primarily related to criminalization of drug use. This review examines updated prevention and treatment strategies for HIV and HCV within prison with a focus on people who inject drugs and the challenges associated with the provision of these services within prisons and other closed settings and transition to the community.
The prevalence of HIV and HCV are several-fold higher in the criminal justice system than within the broader community particularly in regions with high prevalence of injecting drug use, such as Asia, Eastern Europe and North America and where drug use is criminalized. Strategies to optimize management for these infections include routine screening linked to treatment within these settings and medication-assisted treatments for opioid dependence and access to syringe services programs. We build upon the 2016 WHO Consolidated Guidelines through the lens of the key populations of prisoners. Linkage to treatment postrelease, has been universally dismal, but is improved when linked to medication-assisted therapies like methadone, buprenorphine and overdose management. In many prisons, particularly in low-income and middle-income settings, provision of even basic healthcare including mental healthcare and basic HIV prevention tools remain suboptimal.
In order to address HIV and HCV prevention and treatment within criminal justice settings, substantial improvement in the delivery of basic healthcare is needed in many prisons worldwide together with effective screening, treatment and linkage of treatment and prevention services to medication-assisted therapies within prison and linkage to care after release.
全球范围内，感染 HIV 和 HCV 的人群主要与吸毒行为的刑事定罪有关，集中在刑事司法系统中。本综述探讨了监狱内 HIV 和 HCV 的最新预防和治疗策略，重点关注注射吸毒者以及在监狱和其他封闭环境中提供这些服务以及向社区过渡所面临的挑战。
与更广泛的社区相比，刑事司法系统中 HIV 和 HCV 的流行率要高出数倍，特别是在亚洲、东欧和北美等高流行率地区，吸毒行为被定为刑事犯罪。优化这些感染管理的策略包括与这些环境中的治疗相关的常规筛查，以及针对阿片类药物依赖的药物辅助治疗和获得注射器服务计划。我们通过囚犯关键人群的视角来建立 2016 年世界卫生组织综合指南。释放后的治疗联系普遍不佳，但如果与美沙酮、丁丙诺啡和过量管理等药物辅助疗法联系起来，情况会有所改善。在许多监狱中，特别是在低收入和中等收入国家，提供基本的医疗保健，包括精神保健和基本的 HIV 预防工具，仍然不尽如人意。
为了解决刑事司法系统中 HIV 和 HCV 的预防和治疗问题，需要在全球范围内改善许多监狱提供基本医疗保健的状况，同时在监狱内有效进行筛查、治疗以及将治疗和预防服务与药物辅助治疗联系起来，并在释放后提供治疗联系。
