Abstract
Sir: Given the lack of robust surveillance for infectious diseases in prisons, the paper by Gabriel et al. 1 in the January edition of International Journal of STD & AIDS provided a useful insight into the situation at HMP Holloway. It also reinforced the social characteristics of prisoners in England and Wales and the link between drug use and sexually transmitted infections (STI). The authors alluded to the population of Young Offender Institutions (YOI) being at high risk for STIs and suggested primary prevention and drug eradication programmes. The authors implied that little has been done around these issues in prisons, but this is not correct; the problems are well known and have been acknowledged by the Department of Health (DH). Since April 2006, responsibility for commissioning healthcare services within prisons has been devolved to National Health Service (NHS) Primary Care Trusts. Offender Health (DH) has developed prison health performance indicators to aid the development of prison health services with equivalence to other NHS services. 2 Many of the areas suggested by the authors are addressed by these indicators around Health Promotion Action Groups, sexual health and chlamydia screening. Indeed some prisons, such as HMP Littlehey, have local initiatives based on these key issues. 3 Gabriel et al. undertook their study between 2003 and 2005. In April 2003, Islington PCT, which is responsible for the provision of healthcare services within Holloway, started to participate in the National Chlamydia Screening Programme (NCSP) which screens people under 25 year olds for Chlamydia trachomatis. More than 68 prison estates (48% of all prison estates) take part in the NCSP, 20,829 screens being done in this setting in 2007, which is 8% of all screens (n = 259,081) done in England. In the same edition of the International Journal of STD & AIDS, Kawsar and Richards 4 suggest that the NCSP should have had an impact on sexual health at the population level within two years of implementation. Coverage rates have to increase substantially if the NCSP is to have a measurable impact within high-risk populations such as YOIs and attendees at genitourinary medicine clinics.