Frequently Asked Questions

Why is the provision of viral hepatitis services in prisons important? 

Ensuring access to prevention and treatment services for viral hepatitis in prisons is vital to address the disproportionate burden of viral hepatitis among people living in prison and to prevent further transmission.  

Managing and treating hepatitis B and C within the prison environment improves the health outcomes of people living in prison and can also contribute to overall population health. Furthermore, scaling up hepatitis services in prisons can help prevent the spread of viral hepatitis in the community (Stone J, 2017). 

Why are the rates of viral hepatitis high in prison? 

The rates of viral hepatitis are notably higher in prison settings primarily because prisons are populated by individuals who have/have had increased risks for exposure to HBV and HCV. This group often includes individuals with a history of injecting drug use, a major mode of viral hepatitis transmission.  

The prison environment can further exacerbate the risk due to factors such as inadequate access to harm reduction measures, sub-optimal healthcare resources, and a higher prevalence of comorbid conditions, including mental health disorders.  

Overcrowded living conditions and the potential for high-risk practices, such as sharing injection equipment, contribute to increased transmission. Additionally, migrant populations are over-represented in prisons across Europe and more likely to be incarcerated.  

Reasons for this high representation are related to the fact that they are often coming from more socially disadvantaged backgrounds, and the criminal justice system is often more punitive towards migrants. A quantitative study published in 2024 on different attitudes of European countries’ policies toward migrant integration, show that migrant populations are almost twice more exposed to detention than in other groups and have a different propensity to be held in prison with respect to other citizens (Ballerini V, 2025).  

Finally, people coming from high endemicity countries may be at risk of having been previously infected. 

What are the main causes of ​​​​hepatitis B and C transmission of in prison? 

HBV is most commonly spread through contact with infected body fluids such as blood, saliva, vaginal fluids and semen. It is most commonly transmitted through unprotected sexual exposure with an infected individual, injecting drug use with contaminated needles or syringes, or from an infected mother to her baby (see Factsheet: Introduction to Hepatitis B). Nosocomial transmission in healthcare settings can also occur if suboptimal infection control practices are conducted.  

HCV is also a blood-borne virus and in Europe is most commonly transmitted through injecting drug use through the sharing of contaminated needles, syringes or drug injecting paraphernalia when the blood of an infected person enters another person’s bloodstream. 

Less commonly transmission of infection may occur through unprotected sexual exposure with an infected individual or from unsafe medical procedures where appropriate precautions have not been taken to limit transmission (see Factsheet: Introduction to Hepatitis C).  

Transmission in prisons is considered to be mostly due to the sharing of contaminated needles or other equipment used for injecting drugs, however suboptimal infection control practices, unsafe tattooing and piercing practices and exposure through unprotected sex are also risk factors.  

The close living conditions and shared facilities in prisons may also increase the likelihood of coming into contact with infected blood.  

To prevent transmission, it is crucial to focus on targeted strategies like educating about the risks associated with viral hepatitis (among people in prison as well as prison staff), safer injection practices, and harm reduction interventions such as NSPs and OAT along with strict infection control practices, safe sex interventions including condoms and lubricants, and vaccination against HBV (see Factsheet: Harm reduction interventions to prevent bloodborne virus infections).  

Why treat if there are high rates of hepatitis C reinfection? 

Treating individuals for hepatitis C in prison is crucial despite the challenges associated with high rates of reinfection (which can be prevented with good access to harm reduction measures for injecting drug use and other infection control measures) reported in some settings.  

Addressing hepatitis C, and hepatitis B, within the prison population not only improves the health and well-being of people living in prison who are infected with hepatitis, but also contributes to broader public health outcomes when individuals released from prison move back into the community.  

By providing comprehensive treatment and support within the prison setting, there is an opportunity to have a positive impact on community health and mitigate the risk of viral hepatitis transmission outside of prison settings. This approach aligns with a comprehensive public health strategy that recognises the interconnectedness of prison and community health, emphasising the importance of continuity of care for individuals transitioning from prison to the broader society.