The global harm reduction response – an assessment of the current situation, interventions and evaluation of specific programs

October 2017

Ms Rebecca Bosworth
Professor Michael Farrell
Professor Kate Dolan

Other collaborators:
Professor Frederick Altice, Yale University School of Medicine & School of Public Health Section of Infectious Diseases, AIDS Program & Division of Epidemiology of Microbial Diseases
Professor Stuart Kinner, Melbourne School of Population & Global Health, The University of Melbourne, Murdoch Children’s Research Institute & University of Melbourne

Project description: 

Project summary: This project attempts to understand the global epidemiology of infectious disease among prisoners in all countries. It will also assess the level of availability and coverage of interventions from the United Nations Comprehensive Package of HIV prevention, treatment and care services in prisons and other closed settings, in every country.

Rationale: The health of prison populations is extremely complex, with large proportions of prisoners living with multiple life-threatening diseases such as HIV, hepatitis, tuberculosis and sexually transmitted infections. HIV key populations (people who inject drugs (PWID), men who have sex with men (MSM), transgender people (TG) and sex workers (SW)) bear a high burden of these diseases. Risk behaviours such as sharing contaminated syringes, sex and unsafe tattooing practices within prison fuel the transmission of infectious diseases. The concentration of marginalized populations, combined with the risk behaviours pose a major public health threat, particularly as though prisoners often have limited access to essential health care, including preventative measures. The provision of health care is an ethical obligation, particularly as prisoners are solely dependent on prison authorities or health staff to provide care.


  1. To assess the prevalence, incidence, co-infection and mortality rates of HIV, hepatitis B, hepatitis C, and tuberculosis in prisons worldwide to understand the global epidemiology.
  2. To assess the current implementation and coverage of the 15 interventions recommended in the comprehensive package for prison populations in every country.

For full details please visit the NDARC website.