Although most of the people in prison are men, female prisoners must not be forgotten. HIV prevalence among women in prison is high, and female prisoners need a range of HIV prevention and treatment services.

Many women in prison are there for drug-related crimes, and many use drugs while inside. This means they need access to harm reduction, just as male prisoners do. Although female prisoners are less at risk of HIV and STIs through sexual transmission than male prisoners, they may experience sexual violence and exploitation while incarcerated, and can also be exposed through the use of sex toys and oral sex. This means they need access to condoms, and PrEP and PEP if available. They also need support to report sexual violence.
 

Trans women are often incarcerated in male prisons. This makes them very vulnerable to violence, including sexual assault. Providing HIV prevention services, including HIV testing, alongside counselling and support for gender-based violence, is important.

Training well-respected prisoners as peer educators can be a good way to reach other prisoners with HIV, sexual health and harm reduction information and services. Prisoners are more likely to trust their peers than health workers, so they are more likely to engage with services.

Training prisoners with HIV as ‘treatment buddies’ to support others to take ART can also be effective. This can also be done with opioid agonist therapy if it is available. 

As sex in prison is stigmatised and often against prison rules, providing condoms and lubricants in anonymous and easy to access ways is a good idea. This includes having dispensing points throughout the prison and distributing condoms to all cells.

People who are newly released from prison may increase their drug or alcohol use. They may also engage in high risk sex, like having sex with multiple partners or without using condoms. 

Providing access to non-judgemental counselling and support, condoms and lubricant, HIV and STI testing, plus PrEP and harm reduction if available is vital. People may also need help with finding somewhere to live or employment. Any support in these areas can help people put things in place that will reduce their HIV risk. 

People with HIV who come out of prison need support to continue taking ART. They may also need help with HIV care, including treatment monitoring and adherence support.