Russia, like many countries of the Former Soviet Union including new EU members such as the Baltic states, have high rates of TB which is often resistant to the main drugs used in therapy.

As a rapid epidemic of HIV infection (and other blood-borne viruses) is also being seen in many of these states, Francis Drobniewski (King's College Hospital Dulwich, London, UK) and his British and Russian colleagues examined the role of prisons in bringing these two diseases together performing one of the largest (and the largest in Eastern Europe) population-based studies of TB patients.

The authors analysed the prevalence of HIV amongst 1345 prisoners with TB in one region of Russia and identified risk factors for HIV infection and drug resistant TB.

HIV and hepatitis B and/or C co-infection occurred in 12.2% and in 24.1% of prisoners respectively, and rates were significantly higher than in civilians. Almost half of prisoners were drug-users, most intravenously, frequently sharing needles. Over two-thirds of prisoners had had previous TB drug therapy linking with the significantly higher drug resistant TB rates seen.

Prison health affects civil society and the study has implications and lessons for other countries with high rates of incarceration, such as the USA and UK, and high rates of prisoner drug use (for example, in the UK it is estimated that 24% of prisoners are injecting drug users).

Prisons are major drivers of the TB and HIV epidemics and should be one of the main sites for HIV harm reduction activities.