Marie Claire Van Hout
Ulla-Britt Klankwarth
Simon Fleißner
Heino Stöver
Children living in prison with a primary caregiver: a global mapping of age restrictions and duration of stay

Women represent a growing proportion of the global prison population of 11·5 million people. No reliable estimates exist of the number of pregnant women or number of children born in or living in prison with a primary caregiver. Permitting a child to stay in prison with a primary caregiver for any duration has advantages and disadvantages for both the caregiver and the child. Global consensus on the age at which child confinement inhibits healthy development has not been reached. Human rights violations worldwide illustrate the failures of prison systems to consider the needs of children and ensure humane standards for children living in detention. In this Health Policy, we map the global variation in age restrictions and durations of stay in prison with a primary caregiver. We show a broad range of approaches and provisions for the placement of children in prison. Policy makers are advised to adopt provisions of Article 30 of the African Charter on the Rights and Welfare of the Child, as it is the only set of explicit guidelines regarding individualised qualitative judicial decision-making processes, consideration of relevant safeguarding factors, practical application of permissions to stay in prison regarding standards of paediatric care, and provisions of safety-net supports on prison exit. Training of staff and routine monitoring of paediatric standards of detention by national prison inspectorates and UN Human Rights Treaty Bodies are crucial. Future research agendas must focus on optimal child safeguarding and development during transfer and confinement, and on requisite prison-exit supports in various cultural contexts and settings.

See more...
Жетибаев Ерзат Жетибайулы
Еликулова Маржан Жомартовна

Проблема предупреждения преступности и исправления осужденных было основной проблемой во все времена. Данная проблема и ее решение всегда оказывается в тупиковом положении и даже оценочное положение осужденных в социальной среде, после проведения долгого времени в исправительных учреждениях, сформировал определенное стереотипную картину «человека третьего сорта», это фундаментальная проблема нашего общества. Осужденные после пребывания в исправительных учреждениях переживают много проблем связанное с трудоустройством, социальным самоопределением и организацией жизни вообще. Корнем всех проблем являет нравственно идеологические порядки в исправительных учреждениях.

See more...
Daniela Jamin
Wouter Vanderplasschen
Orphée Sys
Marie Jauffret‑Roustide
Laurent Michel
Philippe Trouiller
Andreia Neisa
Mariana Homen
Vânia Mendes
Heino Stöver
Harm reduction Prison Overdose Drug use Risk behaviour Release Recovery
“My first 48 hours out”: drug users’ perspectives on challenges and strategies upon release from prison

Background: Prisoners report much higher prevalence rates of drug use and more harmful consumption patterns than the general population. People who use drugs have above-average experiences with the criminal justice system in general, and the prison system and subsequent release situations in particular. Release from prison is associated with increased mortality rates among drug users due to the risk of overdose. The EU-funded project ‘My first 48 hours out’ aimed to address the gaps in continuity of care for long-term drug users in prison and upon release, with a special focus on drug user’s perspectives on needs and challenges upon release.

Methods: A multi-country (Belgium, France, Germany and Portugal) qualitative study was set up to explore drug users’ perceptions of drug use and risk behaviour upon prison release, experiences of incarceration and release, and strategies to avoid risks when being released. In total, 104 prisoners and recently released persons with a history of drug use participated in semi-structured interviews and focus groups discussions on these topics.

Results: Respondents pointed out that there are numerous challenges for people who use drugs when released from prison. Lack of stable housing and employment support were frequently mentioned, as well as complex administrative
procedures regarding access to services, health insurance and welfare benefits. Besides structural challenges, individual issues may challenge social reintegration like ‘old habits’, mental health problems and disrupted social networks. As a result, (ex-)prisoners adopt individual strategies to cope with the risks and challenges at release.

Conclusion: Measures to prepare prisoners for release often do not focus on the individual and specific challenges of persons who use drugs. Psychosocial and medical support need to be improved and adjusted to drug users’ needs
inside and outside prison. To improve the quality and continuity of care around release, the perspectives and coping strategies of people who use drugs should be used to better address their needs and barriers to treatment.

See more...
Anna Pękala-Wojciechowska
Andrzej Kacprzak
et al.
Mental and Physical Health Problems as Conditions of Ex-Prisoner Re-Entry

The article focuses on a less-discussed issue of social marginalization of people leaving penitentiaries, which is the prevalence of multifaceted health problems experienced by people in this category. It includes poor health status, resulting from, among others, poor housing conditions, harmful or risky lifestyle, and lack of access to medical services. Data from the District Inspectorate of the Prison Service in Lodz, Poland on the health conditions of inmates was accessed. These data were supplemented by qualitative research conducted in 21 juvenile detention centers and 8 prisons across the country, conducting direct observations and In-Depth Interviews (IDI). A total of 198 IDIs were conducted with incarcerated (72) and released (30) juvenile offenders, and incarcerated (68) and released (28) adult offenders. These were complemented by IDIs with experts (50) and Focus Group Interviews (FGIs; 8) with male and female inmates in 4 Polish prisons. The study revealed that mental and physical health is a serious obstacle to social reintegration of ex-prisoners. It is rarely addressed by state institutions. There are strong associations between neglect of health issues in the prison population and increasing social exclusion after leaving prison. As Poland has a restrictive penal policy, former prisoners remain a group with social stigma and little support.

See more...
Nasrul Ismail
Audrey Lazaris
Éamonn O'Moore
et al.
Leaving no one behind in prison: Improving the health of people in prison as a key contributor to meeting the Sustainable Development Goals 2030

Worldwide, approximately 11 million people are currently being held in prison, a sizeable population which has been growing steadily since the turn of the 21st century. The prison population is more likely to suffer from physical and mental ailments both during and prior to their imprisonment, underpinned by poverty, social exclusion and chaotic lifestyles. Recognition of people in prison is noticeably absent from the Sustainable Development Goals (SDGs), which seek to predicate positive health outcomes for all populations, particularly the ‘left behind’.

Underpinned by the ethos of ‘leaving no one behind’, this paper represents the first interdisciplinary analysis as to how improving the health of people in prison can contribute to the fulfilment of the SDGs. Furthermore, our normative conceptual framework illustrates that meeting 15 of the 17 SDGs will also help to meet existing international prison health standards. Acknowledging that the scope of prison health transcends incarceration, brokering the involvement of cross-sector stakeholders and co-producing solutions with both the prison workforce and people in prison are all critical factors in ensuring a systemic buy-in to the SDGs.

Future research is proposed to develop relevant indicators and to encourage the sharing of best practices which can promote the real-world impact on policy and practice. In order to reach the ‘furthest behind first’, it is crucial that prison health is at the forefront of the SDGs.

See more...
Treatment and care for people with drug use disorders in contact with the criminal justice system

Alternatives to Conviction or Punishment.

This initiative is developed, inter alia, considering resolution 58/5 of the Commission on Narcotic Drugs (CND) entitled “Supporting the collaboration of public health and justice authorities in pursuing alternative measures to conviction or punishment for appropriate drug related offences of a minor nature”. The Commission on Narcotic Drugs invited UNODC - in consultation with States and, as appropriate, other relevant international and regional organizations - to “provide guidelines or tools on the collaboration of justice and health authorities on alternative measures to conviction or punishment for appropriate drug-related offences of a minor nature”.

In response to this, UNODC and the World Health Organization (WHO), launched the initiative “Treatment and Care of People with Drug Use Disorders in Contact with the Criminal Justice System: Alternatives to Conviction or Punishment” at the 59th session of the Commission on Narcotic Drugs in 2016. This initiative aims to enhance the knowledge, understanding, scope and potential for alternative measures to conviction or punishment. In line with the international drug control conventions2 and other relevant international instruments, including human rights treaties and UN standards and norms in crime prevention and criminal justice,3 it explores options to divert people with drug use disorders who are in contact with the criminal justice system to treatment.

See more...
Roberto Abadie
Shira Goldenberg
Melissa Welch-Lazoritz
Celia B. Fisher
Establishing trust in HIV/HCV research among people who inject drugs (PWID): Insights from empirical research

Background: The establishment of trust between researchers and participants is critical to advance HIV and HCV prevention particularly among people who inject drugs (PWID) and other marginalized populations, yet empirical research on how to establish and maintain trust in the course of community health research is lacking. This paper documents ideas about trust between research participants and researchers amongst a sub-sample of PWID who were enrolled in a large, multi-year community health study of social networks and HIV/HCV risk that was recently conducted in rural Puerto Rico. 

Methods: Qualitative research was nested within a multi-year Social Network and HIV/HCV Risk study involving N = 360 PWID > 18 years of age living in four small, rural Puerto Rican communities. Semi-structured interviews were conducted between March 2017 and April 2017 with a subset of 40 active PWID who had been enrolled in the parent study. Interview questions invited participants to draw upon their recent experience as research participants to better understand how PWID perceive and understand participant-researcher trust within the context of HIV/HCV-related epidemiological research. 

Results: Fear of police, stigma and concerns regarding confidentiality and anonymity were identified as structural factors that could compromise participation in HIV/HCV-related research for PWID. While monetary compensation was an important motivation, participants also valued the opportunity to learn about their HIV/HCV status. During their participation in the study, gaining knowledge of safe injection practices was perceived as a valuable benefit. Participant narratives suggested that PWID may adopt an incremental and ongoing approach in their assessment of the trustworthiness of researchers, continuously assessing the extent to which they trust the research staff throughout the course of the research. Trust was initially generated through peer Respondent Driven Sampling recruitment. Research staff who maintained a presence in the community for the entire duration of the prospective study reinforced trust between participants and the research team.  

Conclusion: Although PWID face numerous structural barriers to research-related trust in HIV/HCV research, we found that using a peer-based recruitment method like RDS, and employing a research staff who are knowledgeable about the targeted population, culturally sensitive to their needs, and who maintain a long-term presence in the community may help mitigate many of these barriers. The reputation of the research is built incrementally as participants join the study. This contributes to a “street reputation” that grows as current or former participants vouch for the study. Establishing trust was identified as only the first step towards building a collaborative relationship with participants, and our findings suggest that steps to address criminalization and stigmatization also are necessary to support research trust. 

See more...
Kate Dolan
Effat Khoei
Cinzia Brentari
Alex Stevens
Prisons and Drugs: A global review of incarceration, drug use and drug services

Prisons play an important role in drug policy. They are used to punish people who break drug laws and they also hold a large number of people who have experience of drug use and drug problems. They therefore have an important part to play in attempts to reduce the harm caused by drugs. Imprisonment itself can be seen as one type of harm, as it causes problems for prisoners and their families and creates a large fi nancial burden for taxpayers. These harms and costs are diffi cult to calculate, but there is little evidence that large scale imprisonment of drug offenders has had the desired results in deterring drug use or reducing drug problems (Bewley- Taylor, Trace, & Stevens, 2005).

In this paper, we examine the international prevalence of drug users, drug use and related problems in prisons and we report on the problems that are related to the issue of drugs in prison. We go on to examine the international guidelines and effective responses that have been developed in this area in the last decade. The paper is a review of the literature, based on a search of bibliographic databases including Medline, PubMed, ISI as well as EMBASE and contacts with researchers and practitioners in the fi eld up to January 2007.

We hope that this paper provides an accessible guide to policymakers and service designers who are considering the appropriate responses, or evaluating and refi ning existing responses, to drug use in prisons in their own country.

See more...