1. Globally, there are more than 10.35 million people held in prisons on any given day. The total annual global prison population is significantly greater due to high turnover in the incarcerated population. One third of the imprisoned people are in pretrial detention centres. The global incarceration rate has risen by 6% over the past 15 years and now stands at 144 per 100 000. Health in prisons is complicated by the elevated risk for the transmission of infectious diseases, including HIV, and by limited access to health services.
2. The prison population is unevenly distributed across countries. The United States of America (USA) has the largest incarceration rate and the greatest number of incarcerated persons in the world, comprising approximately 20% of the global total.
3. HIV exists in prison settings in all regions of the world, although HIV prevalence within prison populations differs from region to region. HIV prevalence is especially high in subSaharan Africa (reflecting the high prevalence of HIV in the general population) and in eastern Europe and Asia (reflecting the large proportion of people who inject drugs who are incarcerated). A systematic review published in 2016,2 estimated that 389 000 (3.8%) people in prisons were living with HIV, 1.55 million were living with HCV (15.1%), 492 500 with chronic HBV infection (4.8%), and 286 000 with active tuberculosis (2.8%).
4. Since 2000, the total female prison population has increased by 50% compared to 18% among the male prison population. Women in prison represent 5–10% of the global prison population. However, HIV prevalence among women in prisons is typically higher than among men in prisons.
5. These data show that preventing and treating HIV infection in prisons is a worldwidechallenge. Places of incarceration are among the many settings where HIV infections can be prevented, and where people living with HIV can obtain a test to discover their HIV status and be provided with treatment and care. Like everyone else in society, the people held in these facilities have the right to health. The facilities have both a public health and human rights obligation to provide them with the necessary services and to help manage the HIV epidemic.4 People in incarceration therefore should be offered health services, as well as linkage to health services upon release and access to prevention services both inside and outside the facilities. Previous reports have shown that the health outcomes of prisoners and detainees, including key populations who are incarcerated, can improve significantly when treatment and comprehensive prevention programmes are available.