New cross-sector report urges the government to meet the challenges of HIV care in prisons

A new report from the HIV Health Equity and Justice Partnership urges the government to meet the challenges of HIV care in prisons and ensure that people living with HIV in prisons are not left behind.  

The partnership - a collaboration between Sophia Forum, Ci2 Bureau, Terrence Higgins Trust and National AIDS Trust - are calling for the HIV Action Plan for England to be complemented with a set of concrete actions and have today written a joint letter to the Secretary of State for Health and Social Care, Wes Streeting MP, and Minister for Prisons, Lord Timpson, calling for: 

• A dedicated set of concrete actions that meet the challenges of HIV care in prisons 
• Urgent action to address the knowledge gap around HIV and prisons; including that we do not know how many people living with HIV are currently in prison in England 
• A joint response to the ongoing systemic issues that lead people to experience poor levels of care including gaps in treatment, inconsistency in HIV testing, and continued high levels of stigma 
• Shared accountability and leadership between Department of Health and Social Care, HM Prison and Probation Service, NHS and local authorities and the third sector to deliver these changes that are vitally needed 

The report - Prisons and HIV: a call to action to support the goals of the HIV Action Plan for England – highlights the systemic problems within prisons which are detrimental to the health and wellbeing of people living with HIV and mean that crucial opportunities in HIV testing, prevention, and treatment continue to be missed.   

It makes a strong case that the healthcare needs of people in prison who are living with HIV are not currently sufficiently met, nor are their experiences recognised, responded to or prioritised. According to the Partnership, "unless these issues are understood properly, and responded to fully, people in prison will continue to experience poor health outcomes, stigmatising experiences and unmet mental health needs".

The report calls for urgent action on issues including:  

1. Poor quality data, including lack of estimates of numbers of people living with HIV in prison 
2. Unlawful discrimination and data breaches 
3. Lack of consistent access to HIV medication and care for people while in prison 
4. Lack of awareness of HIV transmission, U=U, and treatment - amongst people in prison, healthcare staff and other staff
5. Lack of knowledge and access to HIV prevention methods including PEP, PrEP, and condoms amongst people in prison, healthcare staff and other staff 
6. High levels of HIV stigma 

Research carried out by the Terrence Higgins Trust, Sophia Forum, and Ci2 Bureau involving approx. 3,000 people in prison and 250 staff show pervasive misconceptions and HIV-related stigma:  

• Over half (57%) of participants believed HIV could be transmitted via sharing a toothbrush, compared to just 17% of the general public 
• Only 20% felt people living with HIV are treated fairly in prison. 
• 38% were unsure about – and 35% were opposed to – sharing a cell with someone who is living with HIV 

Whilst the Partnership acknowledges how England is making progress towards achieving the Government target of ending new HIV transmissions by 2030, a comprehensive approach that fully responds to the challenges related to HIV in prisons has been lacking. 

Sophie Strachan, CEO of Sophia Forum, said: “As a woman diagnosed in prison 23 years ago, it is unacceptable that gaps in consistent access to HIV treatment and care still persist for people living with HIV in our prisons today. Many continue to live in fear of their status being disclosed due to high levels of stigma.

"This is a clear sign that much work remains at a systemic and structural level. If we are to achieve true health equity and health justice in the UK’s HIV response - and hope to achieve our 2030 goals - people in prison must be included and offered the same opportunities in treatment and care as those in the community. This can only be achieved with direct partnering with community organisations and multi sector partners.” 

Pank Sethi, Director of Ci2 Bureau, said: “If we are truly committed to ending new HIV transmissions by 2030, we must recognise the humanity of people in prison and our shared responsibility for their health and dignity. Inclusion cannot be an afterthought to the HIV Action Plan - it must be a deliberate and urgent action in its own right.

"People detained by the state ARE the responsibility of the state.  From both a moral and public health perspective, leaving people in prison behind will cost lives and keep zero out of reach. We urge politicians and decision makers to lead with compassion and evidence and ensure that no one is excluded.”

Richard Angell, Chief Executive of Terrence Higgins Trust, said: “Across our work, we hear from people in prison who are still facing deeply entrenched HIV stigma and unacceptable barriers to the care they need. No one, regardless of their crime, should fear discrimination, breaches of confidentiality, or going without life‑saving treatment simply because they are in prison. The evidence in this report is clear: awareness of HIV is far too low, stigma is far too high, and the system is failing to deliver even the basics of modern HIV care.

"If the Government is serious about ending new HIV transmissions by 2030, then prisons cannot be overlooked. We need urgent, coordinated action to ensure consistent access to medication, proper HIV education for people in prison and staff, and robust support for everyone living with HIV in prison. Anything less means leaving people behind - and that is something we cannot and will not accept.” 

Robbie Currie, Chief Executive of National AIDS Trust, said: “It is essential that the healthcare needs of everyone living with HIV are met, wherever they are. Prisons are a unique setting where there are high levels of stigma and missed opportunities for testing and prevention that have to be responded to, and where prevalence of HIV is higher than in the general population.  

"The recent HIV Action Plan for England has a number of positive commitments for reaching the goal of ending new HIV transmissions by 2030, but specific, targeted, and urgent interventions to respond to the challenges of HIV in prisons are needed.”