The global burden of injecting drug use, HIV, hepatitis and TB in prisons: findings from INHSU 2025 – European AIDS Treatment Group

Global Review Links Prison Health Crisis to Sustainable Development Goals

Introduction

A comprehensive global review, presented at the 2025 International Conference on Health and Hepatitis Care in Substance Users (INHSU 2025), has highlighted the critical health disparities faced by incarcerated populations worldwide. The study, titled The global epidemiology of injecting drug use, HIV, viral hepatitis and tuberculosis among people who are incarcerated, consolidates data from nearly 72,000 documents. It underscores that the high burden of infectious disease in carceral settings presents a major barrier to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being).

Key Findings: Disproportionate Disease Burden

The review reveals extraordinarily high rates of infectious diseases and injecting drug use among the world’s estimated 11.3 million incarcerated individuals, posing a significant challenge to global public health.

• Injecting Drug Use (IDU): An estimated 11.1% of incarcerated people have injected drugs, a rate 52.9 times higher than in the general population.
• HIV: 3.2% of the incarcerated population is living with HIV, a prevalence 12.2 times higher than the general population.
• Hepatitis C (HCV): 11% have a current HCV infection, a rate 16.4 times higher.
• Hepatitis B (HBV): 4.5% have a current HBV infection, a rate 2.3 times higher.
• Tuberculosis (TB): 2.0% have active TB, a staggering 48.1 times higher than the general population.

Implications for Sustainable Development Goals

The findings demonstrate that neglecting the health of incarcerated individuals directly undermines progress on several key SDGs. Without urgent and targeted action, global targets will not be met.

• SDG 3: Good Health and Well-being: The elevated prevalence of HIV, TB, and viral hepatitis in prisons directly threatens Target 3.3, which aims to end the epidemics of these diseases by 2030. The lack of adequate screening, prevention, and treatment in these settings is a major obstacle to achieving universal health coverage (Target 3.8).
• SDG 10: Reduced Inequalities: The vast health disparities between incarcerated individuals and the general population represent a profound inequality. Addressing this crisis is essential for fulfilling the commitment to “leave no one behind” and reducing health inequities.
• SDG 16: Peace, Justice and Strong Institutions: The report highlights the need for systemic reform to ensure that carceral institutions provide equivalent healthcare standards to the general community, promoting justice and upholding the human rights of all individuals.

Recommendations for Policy and Action

To address this public health crisis and accelerate progress towards the SDGs, governments and international organizations must prioritize the following actions:

1. Integrate routine screening, prevention, and treatment for HIV, HCV, HBV, and TB into standard prison healthcare, directly supporting SDG 3.3.
2. Provide comprehensive services to prevent drug-related harm and treat drug dependence, including Opioid Agonist Treatment (OAT) and Needle and Syringe Programs (NSPs).
3. Establish stronger linkage-to-care programs to ensure continuity of treatment for individuals post-release, crucial for long-term public health outcomes.
4. Pursue reform of criminal legal systems to reduce unnecessary incarceration, particularly for people who use drugs, aligning with SDG 16 and SDG 10.
5. Fully integrate prison health services with national health systems to guarantee equivalent and universal healthcare for all, in line with the principles of SDG 3.8.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article addresses several Sustainable Development Goals (SDGs) due to its focus on health disparities, infectious diseases, and vulnerable populations within the criminal justice system. The primary SDGs connected to the issues are:

• SDG 3: Good Health and Well-being: This is the most central SDG addressed. The article’s entire focus is on the high burden of infectious diseases (HIV, viral hepatitis, TB) and injecting drug use among incarcerated populations. It directly discusses the failure to meet global disease elimination targets without addressing health in prisons, which aligns with the goal of ensuring healthy lives for all.
• SDG 10: Reduced Inequalities: The article highlights the significant health disparities between incarcerated individuals and the general population, referring to them as a “critical but often neglected group.” By focusing on the disproportionately high rates of disease in this marginalized group, the article directly addresses the need to reduce inequalities in health outcomes.
• SDG 16: Peace, Justice and Strong Institutions: The article calls for the “reform of the criminal legal system to reduce unnecessary incarceration, particularly for people who use drugs” and the “integration of prison health with national health systems.” This connects to the goal of promoting just, peaceful, and inclusive societies by advocating for more effective, accountable, and equitable institutions, including prisons and the justice system.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, several specific targets under the identified SDGs can be identified:

1. Under SDG 3 (Good Health and Well-being):
   • Target 3.3: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.” The article explicitly states that “global efforts to eliminate HIV, viral hepatitis, and TB will continue to fall short” without addressing the high disease burden in prisons. It calls for actions that directly contribute to ending these epidemics.
   • Target 3.5: “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.” The article highlights the extraordinarily high prevalence of injecting drug use (IDU) in prisons and recommends implementing “services to prevent drug-related harm and treat drug dependence, including OAT and NSPs.”
   • Target 3.8: “Achieve universal health coverage… and access to quality essential health-care services…” The call to “ensure equivalent healthcare for all” and for the “integration of prison health with national health systems” directly supports the principle of universal health coverage, ensuring that incarcerated individuals have access to the same quality of care as the general population.
2. Under SDG 10 (Reduced Inequalities):
   • Target 10.2: “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… other status.” Incarcerated individuals represent a group defined by “other status.” Addressing their specific health needs and ensuring continuity of care post-release are crucial steps toward their social inclusion and well-being.
   • Target 10.3: “Ensure equal opportunity and reduce inequalities of outcome…” The article’s core finding is the massive inequality of health outcomes, with disease prevalence being up to 50 times higher in prisons. The recommendations aim to reduce this gap and ensure incarcerated people have an equal opportunity to be healthy.
3. Under SDG 16 (Peace, Justice and Strong Institutions):
   • Target 16.3: “Promote the rule of law at the national and international levels and ensure equal access to justice for all.” The recommendation to “reform of the criminal legal system to reduce unnecessary incarceration, particularly for people who use drugs” directly relates to promoting a more just and equitable application of the law.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several explicit quantitative indicators and implies others that can be used to measure progress.

• Explicit Indicators Mentioned: The review provides baseline global prevalence rates that serve as direct indicators. Progress can be measured by tracking the reduction of these rates over time.
  • Prevalence of injecting drug use among incarcerated people (Global estimate: 11.1%).
  • Prevalence of people living with HIV among the incarcerated population (Global estimate: 3.2%).
  • Prevalence of current Hepatitis C (HCV) infection among the incarcerated population (Global estimate: 11%).
  • Prevalence of current Hepatitis B (HBV) infection among the incarcerated population (Global estimate: 4.5%).
  • Prevalence of active Tuberculosis (TB) among the incarcerated population (Global estimate: 2.0%).
• Implied Indicators: The article’s recommendations imply the need to track the implementation and coverage of key health services within carceral settings.
  • The coverage rate of routine screening for HIV, HCV, HBV, and TB in prisons.
  • The coverage rate of prevention services, such as needle and syringe programs (NSPs), for incarcerated people.
  • The coverage rate of treatment for drug dependence, such as opioid agonist therapy (OAT), among the prison population.
  • The rate of linkage-to-care and continuity of treatment for individuals post-release.
  • The number of countries that have integrated prison health services into their national health systems.

4. Table of SDGs, Targets, and Indicators

Source: eatg.org