A LASTING PUBLIC-HEALTH RESPONSE TO AN OUTBREAK OF HIV-INFECTION IN ASCOTTISH PRISON

Between April and June 1993, 8 cases of acute clinical hepatitis B inf ection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day per iod commencing at the end of June. A team of 18 counsellors and phlebo tomists was brought together rapidly as part of a unique organizationa l exercise in the field of public health. Fourteen cases of HIV infect ion were identified of which 13 were almost certainly infected in Glen ochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean; injecting equipment, a methadone detoxification programme, i ncreased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measu res had been sustained and several could be found in many other prison s throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HN during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decrea sed over the last 3 years, these activities are still being reported a nd it is highly likely that transmissions of bloodborne infections, in paticular hepatitis C, continue to occur. The surveillance and preven tion of infections associated with injecting drug use in the prison se tting remain a high public health priority.