Epidemiology and control of human immunodeficiency and hepatitis C virus in Spanish prisons over the last 30 years: Towards the achievement of sustainable development goals.

Abstract

Objectives: Our aims were to describe the public health interventions for the prevention and control of HIV and HCV infections in penitentiary institutions in Spain from 1989 until 2023 and to describe the epidemiological trends of HIV and HCV among inmates from 1993 until 2023. Study design: Ecological and retrospective observational study. Methods: All prevention programs and control measures for HIV and HCV infections implemented in Spanish prisons were reviewed. Aggregate data were extracted from central registries, reports, official documents (grey literature) and epidemiological bulletins issued by the Public Health division of the General Subdirectorate of Prison Health. Results: Various control measures, such as harm reduction programs, including syringe exchange and methadone maintenance programs, have been implemented in Spanish prisons since 1989. These measures have been modified and adapted in response to changes in the prison population. The prevalence of HIV and HCV infection among inmates in Spanish prisons has decreased markedly over the study period: from 23.5 % in 1993 to 3.2 % in 2023 for HIV, and from 48.6 % in 1998 to 9.6 % in 2023 for HCV. In the past three years, fewer than 1 % of inmates had a detectable HCV viral load. No HIV or HCV seroconversions have been reported in Spanish prisons since 2015 and 2020, respectively. Conclusions: This ecological study found a correlation between interventions designed and implemented in Spanish prisons for the prevention, diagnosis and treatment of HIV and HCV, and a reduction in the prevalence of these infections among the prison population.