Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis, Jack Stone et al., Lancet Infect Dis (2018)

Stone et al. reviewed over 40 studies from Europe, North America, Latin America, and East and Southeast Asia to determine the relationship between incarceration and HIV and/or HCV risk among people who inject drugs (PWID). The relationship between these data points is clearly laid out: PWID have a high rate of interaction with the criminal justice system (58% of PWID have a history of incarceration), PWID experience high risk of acquiring HIV and HCV, and the risk of relapse as well as disconnection from care are common outcomes of release from incarceration. The findings of the authors’ meta-analysis are staggering: respectively, recent incarceration is associated with an 81% and 62% increased risk of acquiring HIV and HCV.

The data gleaned from this study show clearly that there is a link between incarceration and health for PWID. The effects of incarceration on the health status of PWID can influence the ways in which connection to care and treatment programs are designed. Furthermore, it makes the need for policy and programs which address structural issues all the more necessary for PWID. PWID interact with the criminal justice system at a higher rate than most populations – they are considered hyper-criminalized. Programs which seek to address the health needs of PWID without naming mass incarceration or without fighting to reduce the criminalization of drug use are missing a critical piece of the puzzle.