HIV and hepatitis prevention in prisons
This thesis comprises three studies that explore the attitudes and beliefs of prison staff and prisoners towards HIV and hepatitis B and C prevention policy in prisons. Analysis of the factors that influence the way prisoners and prison staff view prevention strategies highlighted some important issues from the perspective of the people most closely involved with implementation of prevention policy. The exploration of these issues was complex due to the security, legal, cultural and ethical issues that had to be considered. A case study approach incorporating qualitative and quantitative methods was used to try to embrace the complexity of the research aim. A qualitative foundation for staff and prisoner interviews was used for two reasons; firstly, so that the views of the researcher were not imposed and secondly because there were few prior research studies to base the current study on. In addition, as prisons differ in security category and in the types of prisoners held, it was presumed that developing the research to give a wider representation of the issues would be valuable; this overview was achieved by questionnaire. Data were collected from ten prisons, there were fortyone in-depth staff interviews from three types of prisons; data from 182 questionnaires from 7 prisons and 18 in-depth interviews with prisoners from the three prisons where staff were interviewed. The results show that the predominant concern of staff is that the prevention policies discussed in the study are to do with sex and drug misuse; activities considered illegal within the prison environment. Staff believed that some of the prevention measures concerned with reducing the risk associated with injecting drug use conflict with their discipline and security role and also conflict with the drug strategy policies that focus on eradicating drug use in prisons. Opiate detoxification programmes, abstinence based therapeutic programmes and drug-free areas were viewed most positively by staff and were portrayed as most closely aligned to their security and discipline role and the role of prisons in society. Most staff believed that providing condoms in prisons would also act against their discipline and security role. This is principally because of the potential to conceal or smuggle drugs using condoms and also because the stigma of same sex relationships in prisons may lead to aggression and bullying from other prisoners. Prisoners described a hidden culture of same sex relationships in prisons and generally did not completely welcome policies concerned with improved access to condoms. However, some of the prisoners highlighted a moral imperative to distribute condoms in prisons. Prisoners stated that they would view suspiciously any change in prevention policy concerned with injecting drug use, which ran counter to the current policies of intolerance to illicit drug use in prisons.