The authors declare that they have no competing interests.
LM designed the study, supervised the design of the questionnaire and data collection, and wrote and revised the manuscript. CL conducted the data analysis in and contributed to the results section. SVM, JS, WV contributed to the questionnaire, collected data in Belgium and revised the final version of the manuscript. KH and TK contributed to the questionnaire, collected data in Denmark and revised the final version of the manuscript. NW and AM contributed to the questionnaire, collected data in Austria and revised the final version of the manuscript. MJR and OM contributed to the questionnaire and revised the final version of the manuscript. MPC supervised the data analysis and revised the final version of the manuscript. CB and HS contributed to the design of the study and revised the final version of the manuscript. All authors read and approved the final manuscript.
Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations.
Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison.
A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08).
Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community.