ACBB. The issue is always one of money and the cost of these measures. There is often a higher rate of STBBIs among prisoners than the general population. Their care is very much an opportunity for public health: many prisoners go in and out of prison on a regular basis. They risk transmitting these STBBIs during their time outside. The measures taken in prison therefore have a direct impact on the overall health of the population. Yet, it is a constant battle to have infected prisoners and asymptomatic carriers receive care.
At the same time, we, as health personnel, can always make room for improvement. We can still improve the screening process and the way we provide care to those who need treatment. We try, for example, to provide care as quickly as possible. But it is not always that easy.
Sometimes it is difficult to come up with a treatment plan when we do not know the length of the prisoner’s stay or how we can provide follow-up. The difficulty is always how to ensure continuity of care once the prisoner is transferred or released from prison.
Even if our goal is to at least guarantee continuity of care for people, it is still not always achievable. It is a goal that can be improved, but which depends very much on the type of population concerned. The challenges are different for people integrated in society who have a roof over their head, and those who are homeless without a residence permit. However, there are community resources available that guarantee continuity of care for prisoners leaving prison. It is also our role to provide information about the released prisoners to those providing care and to see that they can obtain their treatment until they are admitted to a halfway house. For example, if prisoners are released on a Friday night or a Saturday morning, they can receive up to three days of treatment. This allows them to survive until Monday and to receive the next part of their medication at the halfway house. The goal is to prevent people from suffering from withdrawal and to avoid any risky behaviours that may lead to overdose.
More generally, there are still many challenges around risk reduction. We continue, for example, to explore ways of making tattooing practices less risky. The idea is to also see what prisoners’ expectations are. Perhaps tattooing is not as prevalent as it was a few years ago, and the focus is now elsewhere. Our work also consists of identifying needs and to see how we can meet them.
We must also remember that what is available in prison is a reflection of what is accepted and implemented in the community. In the Geneva canton, there are, among other things, injection sites and heroin prescription treatment programmes for people with substance use disorder. Their existence makes it easier to develop these types of programmes in prisons. However, there are obstacles like logistics, funding and the issue of acceptance. Risk reduction is not usually a prison administration priority, so our work to change this must continue.