HIV, tuberculosis and viral hepatitis – notably hepatitis C virus (HCV) – are of major concern for people detained in prisons and other closed settings. Available data demonstrate that 1 in 4 detainees are HCV-positive, and the estimated global HIV prevalence in prisoners is 3% (UNODC, 2020).

Access to recommended prevention, testing and treatment for these conditions is often not available in prisons. When it is, services are generally inequitable to those available in the community.

WHO, with the United Nations Office on Drugs and Crime (UNODC) and other partners, supports the implementation of comprehensive HIV and HCV services for people who live in prisons and other closed settings.

Worldwide, 30 million people a year will spend time in prison. And across all 5 continents, prison populations are growing. On any given day in 2018, more than 11 million people worldwide, including at least 410 000 children, were held in prisons – a total growth of 24% since 2000. While women prisoners are still a small minority in most countries, their numbers have grown by 50% over the same time period. Member States resort to imprisonment at very different degrees. While the average imprisonment rate at the global level stands below 150 prisoners per 100 000 of the national population, it reaches a rate of 300–650 prisoners per 100 000 of the national population in more than 25 Member States (1).

Female prisoners make up 5–10% of the global prison population. They are more likely to use drugs, and their populations often have higher prevalence rates for HIV (double or more) when compared to male prisoners. Globally, the number of incarcerated women is growing, increasing by an average of 16% in the last 6 years. Women in prison are vulnerable to gender-based sexual violence. They may engage in risky behaviours and practices, such as unsafe tattooing and injecting drug use, and they are more susceptible to self-harm.

People who use drugs are over-represented in many prison populations due to criminalization of drug use and drug possession. Furthermore, some people start using drugs in prison, or start using additional drugs or engaging in riskier injecting practices while incarcerated. Syringe sharing among people who inject drugs is common in prisons. This is exacerbated by a lack of needle/syringe programmes in prison settings worldwide. Other risk factors include unsafe sex due to a lack of availability of condoms in prisons, sexual violence, other high-risk sexual behaviours, and tattooing and piercing.