Marco Barracchia,1 Richard Bódi,1 Göksun Işıl,1 Maurice Jägers,1 Marlijn Kremer,1 Ömer Faruk Sönmez,1 Jessica Neicun2,3
Abstract
Background: People who inject drugs (PWID) in prisons and other closed settings are disproportionately affected by bloodborne viruses (BBV) such as Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV), mainly acquired through needle sharing and compounded by limited access to healthcare services. Romania, despite having high prevalence rates of HIV and HCV among its prison populations, has experienced a decline in harm reduction measures due to underfunding, stigma, and political neglect.
Methods: This policy brief examines evidence-informed interventions, including needle and syringe programmes (NSP), opioid substitution therapy (OST), HIV-HCV testing and treatment and naloxone provision, all of which have demonstrated significant efficacy in reducing HIV-HCV transmission and overdose deaths in prison settings. Priority levels for interventions were determined based on effectiveness, cost-effectiveness, and feasibility within the Romanian prison context, drawing from existing frameworks from EUDA, WHO and the Global Fund and best-practice models from Australia and Spain.
Results and conclusion: Despite the proven benefits, Romania’s prison system lacks sufficient implementation of these measures, posing substantial public health risks. We argue for the urgent integration of harm reduction policies specifically targeting people who inject drugs in prisons and other closed settings through healthcare strategies, combined with structural reforms and stigma reduction measures. These interventions are essential not only for protecting the health of people in prisons but also for mitigating HIV-HCV transmission risks in the broader community, supporting the need for sustainable, evidence-informed approaches to prison healthcare reform.
Keywords: Harm reduction, Drug use, Prisons, HIV/HCV prevention