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This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer-reviewed literature and potential sources of grey literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from 18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons., (© 2023 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

Purpose: The dual epidemic of non-communicable diseases (NCDs) and human immuno-deficiency virus (HIV) in Sub-Saharan Africa has increased substantially in recent years, with cardiovascular disease representing a significant contributor to the regional burden of disease. Very little is known about the cardiovascular health of people deprived of their liberty in the region. The purpose of this study was to collate extant literature on the topic., Design/methodology/approach: A scoping review mapped and described what is known about cardiovascular disease in prison populations in Sub-Saharan Africa. A systematic search of empirical literature with no date limitation was conducted in English. Sixteen studies representing six Sub-Saharan African countries (Cameroon, Nigeria, Guinea, Burkina Faso, Ghana and Ethiopia) were charted, categorised and thematically analysed., Findings: Seven key themes were identified: custodial deaths and autopsy; cardiorespiratory fitness and exercise; cardiovascular disease and elderly people in prison; cardiovascular disease and women in prison; dietary deficiencies; influence of sleep patterns on cardiovascular disease; and other associated risk factors. Most natural deaths at autopsy of custodial deaths were due to cardiovascular disease. Cardiorespiratory fitness was low in prisons, and poor sleep patterns and dietary deficiencies are likely contributors to the burden of cardiovascular disease in prisons. The needs of elderly and female prison populations are ill-considered., Originality/value: To the best of the authors' knowledge, this is the first known attempt to scope extant literature on cardiovascular disease in Sub-Saharan African prisons. A strategic focus on the cardiovascular health of people in prison is warranted. Routine monitoring and expansion of existing prison health-care services and integration of NCD services with infectious disease (HIV and tuberculosis) programmes in prisons are required., (© Emerald Publishing Limited.)

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., Competing Interests: Declaration of interests We declare no competing interests. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Out of the 11 million detained in prisons globally, the female prison population of 740,000 has increased by 50 % since 2000. 410,000 children are in detention. 19,000 live in prison with their mother., Objective: To conduct a socio legal assessment of global progress in adopting the Convention on the Rights of the Child since 2010, and alignment with United Nations (UN) normative standards of care in prisons., Participants and Setting: Children detained with their mothers at the global level., Methods: A comprehensive search of all published Concluding Observation reports of the UN Committees on the Rights of the Child (CRC), Elimination of Discrimination Against Women (CEDAW), Against Torture (CAT) and Human Rights (CCPR) since 2010 (n = 905). 316 CRC, 246 CEDAW, 173 CAT and 170 CCPR reports were scrutinised to examine the situation of children living with detained mothers against UN normative standards of care., Results: 51 reports (24 CRC, 13 CEDAW, 12 CAT, 2 CCPR) representing 43 countries (majority in Africa) contained direct violations of the best interests of the child. These include the treatment of children as prisoners, difficulties in securing identity documents, poor detention conditions, exposure to violence, lack of access to child-appropriate healthcare, and lack of transparent data. Countries differed in durations of time permitting children to stay in prison (6 months to 8 years, with Eritrea observing no limit)., Conclusions: Achieving a balance between protection of the child and punishment of the mother is inconsistent globally, and exacerbates the multiple vulnerabilities of the child., Competing Interests: Declaration of competing interest Authors have no conflict of interest to declare., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Importance and Objective: Women represent about 6% of the global prison population of 11 million. The female prison population has increased significantly in the past decade. Where attention is devoted to women's unique sexual and reproductive health needs in prison, this is largely focused on menstruation management and ante/postnatal care. There is no explicit guidance regarding imprisoned menopausal women's health care in the United Nations normative standards of detention (Mandela Rules, Bangkok Rules). A human rights assessment of menopausal women's access to age- and gender-sensitive nondiscriminatory health care in prison since 2010 was conducted., Methods: Arksey and O'Malley's scoping review methodology was adhered to. A systematic search was conducted using detailed MeSH terms on CINAHL, MEDLINE, PubMed, ProQuest Central, PsycInfo, Scopus, and the Web of Science. All published materials in the English language in the time frame of 2010-2022 were collated (n = 268). Fourteen duplicates were removed. Two hundred thirty-four were excluded after title and abstract screening, with five records remaining. Hand searching yielded an additional 11 records. Sixteen records were charted and analyzed thematically using a human rights lens. Themes were the following: environmental conditions and menopausal sequelae, gender-sensitive nondiscriminatory free health care, evidence-based age/gender-sensitive prison health policies, and medical insensitivity and incompetencies in menopausal care., Discussion and Conclusion: Menopausal women have the right to the underlying environmental determinants of health in prison and rights to nondiscrimination and equivalence of care, essential medicines, medical care and treatment, preventive health services, and participation in the generation of prison policies and support initiatives. The lack of visibility regarding their health needs in policies and healthcare provisions is reflected in the realities of life in prison, with glaring gaps in the practical medical and lifestyle supports of menopause. Further research is warranted to inform evidence-based prison reforms to improve the quality of life of older women in prison., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2022 by The North American Menopause Society.)

Purpose: The Sub-Saharan African (SSA) region remains at the epicentre of the HIV epidemic and disproportionately affecting women, girls and prisoners. Women in prison are a minority group and their special health needs relating to gender sensitivity, reproductive health, their children and HIV/AIDs are frequently neglected. Our study responded to this need, and aimed to investigate the issue., Design/methodology/approach: A qualitative study using focus group discussions and key informant interviews explored the perspectives of women in prison, correctional officers, correctional health professionals and non-governmental organisations around prison conditions and standards of health care while incarcerated in a large female prison in Zimbabwe. Narratives were transcribed and analysed using thematic analysis., Findings: The three key themes that emerged are as follows: "Sanitation and hygiene in the prison", "Nutrition for women and children" and "Prison-based health services and health care". Divergence or agreement across perspectives around adequate standards of sanitation, hygiene, quality and adequacy of food, special diets for those with health conditions, access to health care in prison and the continuum of care across incarceration and community are presented., Practical Implications: Understanding prison environmental cultures which shape correctional staff's understanding and responsiveness to women in prison, environmental health conditions and access to health care are vital to improve conditions and continuum of care in Zimbabwe., Originality/value: Policy and technical guidance continues to emphasise the need for research in SSA prisons to garner insight into the experiences of women and their children, with a particular emphasis on the prison environment for them, their health outcomes and health-care continuum. This unique study responded to this need., (© Emerald Publishing Limited.)

Purpose: Sub-Saharan African prisons have seen a substantial increase in women prisoners, including those incarcerated with children. There is very little strategic literature available on the health situation and needs of women prisoners and their circumstantial children in Malawi. The study aims to explore this issue., Design/methodology/approach: A qualitative exploratory study using in-depth key informant interviews with senior correctional stakeholders (commissioner of prison farms, senior correctional management staff, senior health officials and senior officers in charge) ( n  =   5) and focus group discussions (FGD) with women in prison of age between 18 and 45 years ( n  =   23) and two FGD with correctional staff ( n  =   21) was conducted in two prisons in Malawi, Chichiri and Zomba. Narratives were transcribed and analysed using thematic analysis., Findings: Three key themes emerged and are as follows: "hygiene and sanitary situation across multiple prison levels and subsequent health implications for women"; "nutritional provision and diets of women and children in prison"; and "women's access to prison-based and external health services". Divergence or agreement across perspectives around sanitation and disease prevention, adequacy of nutrition for pregnant or breast-feeding women, health status and access to prison-based health care are presented., Practical Implications: Garnering a contemporary understanding of women's situation and their health-care needs in Malawian prisons can inform policy and correctional health practice change, the adaptation of technical guidance and improve standards for women and their children incarcerated in Malawi., Originality/value: There is a strong need for continued research to garner insight into the experiences of women prisoners and their children, with a particular emphasis on health situation., (© Emerald Publishing Limited.)

Background: Treatment and special protection of the rights of incarcerated young people in prisons are mandated under the Sustainable Development Goals (SDG), as well as under United Nations (UN) human rights instruments., Methods: A scoping review mapped what is currently known about prison conditions and health situation of detained and incarcerated young people in sub- Saharan African (SSA) prisons. A systematic search collected and reviewed all available and relevant published and grey literature. Following application of exclusion measures, 54 records remained, which represented 37 of the 49 SSA countries. These records were charted and thematically analysed., Results: The ages of children and adolescents held in SSA prisons ranged from 12 to 18 years. Three main themes were generated during the charting exercise; the prison environment for young people; availability and accessibility of basic necessities and navigating the prison system for health care and outside continuum of care., Conclusions: The review highlights the grave and continuing deplorable situation of young people held in SSA prisons. The violation of international human rights norms is observed in the systemic abuse and detention of young people with adults. Basic needs are not met in relation to sanitation, ventilation, safe spaces, protection from physical and sexual violence, clothing, food and access to HIV and medical care.

IntroductionData on chronic hepatitis C (HCV) infection prevalence in European prisons are incomplete and impact the public health opportunity that incarceration provides.AimsWe aimed to estimate the seroprevalence of untreated chronic HCV infection and to identify associated risk factors in an Irish male prison.MethodsWe conducted a cross-sectional study involving a researcher-administered questionnaire, review of medical records and HCV serology.ResultsOf 422 prisoners (78.0% of the study population) who participated in the study, 298 (70.6%) completed the questionnaire and 403 (95.5%) were tested for HCV antibodies. Of those tested, 92 (22.8%) were HCV antibody-positive, and of those, 53 (57.6%) were HCV RNA-positive, 23 (25.0%) had spontaneous clearance, 16 (17.4%) had a sustained viral response, 10 (11.0%) were co-infected with HIV and six (6.0%) with HBV. The untreated chronic HCV seroprevalence estimate was 13.1% and the seroprevalence of HCV among prisoners with a history of injecting drug use (IDU) was 79.7%. Risk factors significantly associated with past HCV infection were IDU (p < 0.0001), having received a prison tattoo (p < 0.0001) or a non-sterile community tattoo (p < 0.0001), sharing needles and other drug-taking paraphernalia (p < 0.0001). Small numbers of prisoners had a history of sharing razors (n=10; 3.4%) and toothbrushes (n=3; 1.0%) while incarcerated. On multivariable analysis, history of receiving a non-sterile community tattoo was the only significant risk factor associated with HCV acquisition (after IDU was removed from the model) (p = 0.005, β = 0.468).ConclusionThe level of untreated chronic HCV infection in Irish prisons is high, with IDU the main associated risk.

Background: In recent times, sub-Saharan African (SSA) prisons have seen a substantial increase in women prisoners, including those incarcerated with children., Methods: A scoping review mapped what is currently known about the health situation and unique rights violations of children incarcerated with their mothers in SSA prisons. A systematic search collected and reviewed all available and relevant published and grey literature (2000-2018). Following application of exclusion measures, 64 records remained, which represented 27 of the 49 SSA countries. These records were charted and thematically analysed., Results: Four main themes were generated as follows: 1) the prison physical environment; 2) food availability, adequacy and quality; 3) provision of basic necessities and 4) availability and accessibility of health services for incarcerated children., Conclusions: The review highlights the grave situation of children incarcerated with their mothers in SSA prisons, underpinned by the lack of basic necessities, inadequate hygiene, sanitation and safe drinking water, exposure to diseases in overcrowded cells, inadequate nutrition, lack of provision of clothing and bedding, and difficulties accessing paediatric care. Reported paediatric morbidity and mortality associated with such prison conditions is deeply concerning and contrary to international mandates for the rights of the child, right to health and standards of care.

The fundamental right to equivalence of health care in prison settings encompasses the provision of medication to address mental health conditions. Considering the increased risk for self-harm among individuals dealing with depression, the limited effectiveness of conservative antidepressants is a major challenge in psychiatry. The high prevalence of suicidal tendencies within prison populations underscores the imperative for state-of-the-art pharmacological treatment to uphold adequate health care standards. Notably, the denial of access to effective medication could be deemed a violation of human rights of people living in prison according to international treaties, domestic law, and United Nations normative standards of detention. This article presents the authors' perspective on the accessibility of ketamine treatment in prison settings, discussing psychiatric and legal considerations as well as current challenges in this context. Implementing novel psychopharmacological interventions may alleviate the distress experienced by individuals struggling with depressive symptoms and suicidality. At the same time, unprecedented treatment alternatives bring along potential issues, including limited understanding of long-term effects and the risk of abuse. Given the scarce data-availability, a pressing need exists for further research on the benefits and risks of ketamine treatment within prison populations. [ABSTRACT FROM AUTHOR]

On any given day, almost 11 million people globally are deprived of their liberty. In 2020, the global female population was estimated to be 741,000, an increase of 105,000 since 2010. In order to investigate progress in the adoption of the Bangkok Rules since 2010, we conducted a legal realist assessment based on a global scoping exercise of empirical research and United Nations (UN) reporting, using detailed MESH terms across university and UN databases. We found evidences in 91 documents which directly relate to violations of the Bangkok Rules in 55 countries. By developing a realist account, we document the precarious situation of incarcerated women and continued evidence of systemic failures to protect them from custodial violence and other gender-sensitive human rights breaches worldwide. Despite prison violence constituting a complex and multifaceted phenomenon, very little research (from the United States, Canada, Brazil, Mexico, and Australia) has been conducted on custodial violence against women since 2010. Although standards of detention itself is a focus of UN universal periodic review, special procedures (violence against women) and concluding observations by the UN committees, very few explicitly mentioned women, and the implications of violence against them while incarcerated. We highlight three central aspects that hinder the full implementation of the Bangkok Rules; the past decade of a continued invisible nature of women as prisoners in the system; the continued legitimization, normalization, and trivialization of violence under the pretext of security within their daily lives; and the unawareness and disregard of international (Bangkok and others) rules. [ABSTRACT FROM AUTHOR]

Purpose: Prisons in the sub-Saharan African region face unprecedented challenges during the COVID-19 pandemic. In Malawi, the first prison system case of COVID-19 was notified in July 2020. While prison settings were included in the second domestic COVID-19 response plan within the Law Enforcement cluster (National COVID-19 preparedness and response plan, July–December 2020), they were initially not included in the K157bn (US$210m) COVID-19 fund. The purpose of the study was to assess prison preparedness, prevention and control of COVID-19 in Malawi.. Design/methodology/approach: A multi-method situation assessment of the COVID-19 response and human rights assurance of prisoners and staff was conducted in a large prison complex in Malawi. Qualitative research underpinned by the Empirical Phenomenological Psychological (EPP) framework consisted of interviews with key informants such as prison health personnel, senior prison staff, penal and judicial policymakers, government and civil society organisations (n = 14) and focus group discussions with consenting male (n = 48) and female prisoners (n = 48) and prison wardens (n = 24). Prison site visits were supported by detailed observations based on the World Health Organisation Checklist for COVID-19 in prisons (n = 9). Data were collected and analysed thematically using the EPP stepwise approach and triangulated based on Bronfenbrenner's model conceptualising COVID-19 as a multi-level event disrupting the prison eco-system. Findings: The results are presented as MICRO-MESO level individual and community experiences of incarceration during COVID-19 spanning several themes: awareness raising and knowledge of COVID-19 in prisons; prison congestion and the impossibility of social distancing; lack of adequate ventilation, hygiene and sanitation and provisions and correct use of personal protective equipment; MESO-MACRO level interplay between the prison community of prisoners and staff and judicial policy impacts; medical system COVID-19 response, infrastructure and access to health care; COVID-19 detection and quarantine measures and prisoner access to the outside world. Originality/value: This unique situation assessment of the Malawian prison system response to mitigate COVID-19 illustrates the dynamics at the micro-level whereby prisoners rely on the state and have restricted agency in protecting themselves from disease. This is due to severe structural inadequacies based on low resource allocation to prisons leading to a compromised ability to prevent and treat disease; an infirm and congested infrastructure and bottlenecks in the judicial system fuelling a continued influx of remand detainees leading to high overcapacity. Multi-pronged interventions involving key stakeholders, with prison management and line Ministry as coordinators are warranted to optimise COVID-19 interventions and future disease outbreaks in the Malawian prison system. [ABSTRACT FROM AUTHOR]

Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons. Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed. Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison. Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment. [ABSTRACT FROM AUTHOR]

High levels of undiagnosed and untreated HCV infection exist in prison populations globally. Prisons are a key location to identify, treat and prevent HCV infection among people who inject drugs (PWID). Understanding prisoners’ lived experiences of the HCV continuum of care informs how HCV care can be effectively delivered to this marginalised and high-risk population. This study aimed to explore Irish prisoners’ experience of prison and community-based HCV care. We conducted one-to-one interviews with 25 male prisoners with chronic HCV infection. Data collection and analysis was informed by grounded theory. The mean age of participants and first incarceration was 39.5 and 18.3 years respectively. The mean number of incarcerations was eight. The following themes were identified: medical and social factors influencing engagement (fear of treatment and lack of knowledge, HCV relevance and competing priorities), adverse impact of HCV on health and wellness, positive experience of prison life and health care and the transformative clinical and non-clinical changes associated with HCV treatment and cure. Findings suggest that prison release was associated with multiple stressors including homelessness and drug dependence which quickly eroded the health benefits gained during incarceration. The study generated a substantive theory of the need to increase the importance of HCV care among the routine competing priorities associated with the lives of PWID. HCV infected prisoners often lead complex lives and understanding their journeys through the HCV continuum can inform the development of meaningful HCV care pathways. Many challenges exist to optimising HCV treatment uptake in this group and incarceration is an opportunity to successfully engage HCV infected prisoners who underutilise and are underserved by community-based medical services. Support and linkage to care on release is essential to optimising HCV management. [ABSTRACT FROM AUTHOR]

Criminalisation of drug use and compulsory detention has largely characterised the Southeast Asia region's response to people who use drugs. Whilst access to and provision of healthcare for people living in prison are mandated by international human rights standards, many opioid dependent people living in prison continue to lack access to opioid substitution treatment (OST) during incarceration, and face uncertainties of continuity of care beyond the prison gate. A scoping review using Arksey and O'Malley's framework mapped what is currently known about the continuity of OST post-release in Southeast Asia, with a focus on the three countries (Indonesia, Malaysia, Vietnam) that provide OST in at least one prison. A multi-lingual systematic search (English, Malay, Indonesian, Vietnamese) on Medline, CINAHL, Scopus, Web of Science, PsycINFO and the Cochrane Library collected and reviewed extant relevant published empirical and grey literature including government reports between 2011 and 2021. Of the 365 records found, 18 were eligible for inclusion following removal of duplicates and application of exclusion criteria. These records were charted and thematically analysed. Three main themes were generated: Facilitators of post release continuity of care, Barriers to post release continuity of care and Therapeutic considerations supporting post release continuity of care. When individual and structural gaps exist, disruptions to continuity of OST care post release are observed. Adequate methadone dosage of >80mg/day appears significantly associated with retention in post-release OST. The review highlights the facilitators, barriers and therapeutic considerations of continuity of care of OST between prison and community for people living in prisons from Indonesia, Malaysia and Vietnam. Improving community services with family support are key to supporting continued OST adherence post release along with reducing societal stigma towards people who use drugs and those entering or leaving prison. Further efforts are warranted to ensure parity, quality and continuity of OST care post release. [ABSTRACT FROM AUTHOR]