“Gholamhossein Mohseni Ejei, the head of the judiciary, recently mentioned in a meeting of the administrative council of Alborz province that the judiciary and specifically the prison organization suffer greatly from overcrowding in prisons. With the high density in prisons, it is no longer possible to carry out effective cultural activities to socialize prisoners. However, a topic that is often neglected by judicial and prison officials is the sanitary conditions of prisons in Iran. The transfer of prisoners from Tehran or prisons located in Alborz province to outside the city raises the question of to what extent are software issues in the health sector considered in these transfers?”

To discuss the rights of prisoners and the need for prison reform, it is important to emphasize that prisoners are sent to prison as punishment, not for punishment. This means that depriving someone of their freedom is the punishment, not the conditions of their confinement. However, keeping a person in state custody should not have negative effects on their health. Unfortunately, this is a problem in many prisons in Iran. Has there been any possibility for a practical discussion about a healthy environment in Iranian prisons, or has the time come to talk about the rights of prisoners and the health services that are supposed to be provided to them by the detaining authorities? The answer to this question is that prisoners have inalienable rights granted to them by international treaties and conventions. These rights undoubtedly include access to healthcare and protection against communicable diseases. The issue of how to access these rights in the often harmful environment of Iranian prisons and the prevalence of HIV – which unfortunately has a high rate of spread in Iranian prisons – is the

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Public health policies are meant to ensure the best possible conditions for all members of society to benefit from. Unfortunately, prisoners in Iran are often forgotten in this equation or deliberately deprived of this right. Prisoners are constantly entering and leaving prisons for various reasons. Some are released from prison after being recognized as innocent or completing their sentence. Others are taken out of prison during investigations and trials and then returned. In addition, some prisoners are often transferred from one prison to another for various reasons, such as punishment or serving their sentence in a prison that is appropriate for their crime. Therefore, prisoners are in contact with many individuals who enter and exit the prison on a daily basis. Law enforcement and intelligence officers, prison guards, prison staff, medical personnel, repairmen, visitors, and lawyers all come and go from the prison every day. Finally, prisoners are released from prison after serving their sentence or occasionally when there is amnesty. This constant movement and activity inside and outside the prison makes controlling any contagious diseases in

Considering the budget allocation problems in Iran and the high cost of keeping prisoners, the financial circulation of prisoners is an important issue in ensuring their health. In most countries, the annual financial circulation of the prison population is four to six times the number of prisoners held at any given time. However, in Iran, due to lack of financial transparency, the financial circulation of prisoners is not clear. Therefore, due to lack of transparency and not taking into account the prison population, addressing public health issues such as HIV or any other infectious disease in Iranian prisons seems impossible.

In many prisons in Iran, violence and coercion among prisoners can directly or indirectly lead to serious health risks. Physical assaults and even murder can occur in prisons, many of which have been reported by human rights sources. Incidents of abuse between prisoners and correctional officers, and even more so between prisoners themselves, are common. Many cases of violence among prisoners – especially sexual assault – have been reported in Iranian prisons.

Violence in prison has many reasons. Conflicts may be due to ethnic or relational reasons related to competition between gangs. The cramped living conditions and overcrowding in Iranian prisons also lead to animosity between inmates. The monotonous environment of prison and lack of mental and physical stimulation result in built-up frustration and tension. This environment paves the way for risky activities such as drug use, sexual activities between men, self-harm, and other forms of gang violence. Some engage in these activities to escape the monotony of prison life. However, others are forced to participate in forced games in order to gain power or financial gain. This high-risk lifestyle can lead to the spread of diseases among inmates and, if left unchecked, pose a serious threat to public health.

Uncontrolled violence in Iranian prisons makes unprotected contact with human blood possible. Unprotected sexual acts involving the exchange of bodily fluids pose a real danger. Forced sexual relationships among prisoners are not necessarily cases of sexual assault; on the contrary, the violent prison environment may force many prisoners, especially those who are financially disadvantaged, to engage in sexual acts they would otherwise avoid. Intravenous drug use and sharing of needles and syringes create many problems. If some prisoners force others to use injectable drugs and contaminated shared tools, coercion may be involved. Medical and custodial staff must be aware of the risks of such contacts and take measures to prevent contamination. If HIV or other communicable diseases are to be controlled in Iranian prisons, education on these issues is the first and even most essential step.

Prisoners have the right to be protected from dangerous environments in Iranian prisons, and they expect authorities to protect them from physical and sexual violence. This right goes beyond the right to request solitary confinement. Prison authorities in Iran should be able to ensure a safe environment for all prisoners without resorting to such extreme measures. Unfortunately, violence in prisons is a reality in the country. The internal hierarchy of prisoners is approved, encouraged, or even ignored by prison authorities. This system severely punishes lower-class prisoners and in extreme cases, turns some of them into sexual objects and victims of abuse. The prevalent system in Iranian prisons is evolving and becoming more complex with the emergence of drug gangs and their leaders who challenge the established hierarchy.

Suffering from any type of illness in Iranian prisons is not part of the punishment for prisoners. This fact becomes even more significant when the disease is potentially fatal (such as HIV). Many international documents emphasize the right to the highest standard of physical and mental health for prisoners, and this right is also recognized in Iran’s domestic laws. However, for various reasons, it is not implemented or is implemented based on personal preferences. The right to the highest health standards should be applied without discrimination and political considerations regarding prison hygiene conditions and healthcare for prisoners. This right includes access to healthcare and a healthy environment, along with other prisoner rights such as non-discrimination, privacy protection, and confidentiality.

Given that prisoners are unable to take care of their personal affairs in detention, it is the responsibility of the government to provide them with healthy health and environmental services. Human rights documents require governments to provide prisoners with equivalent health care to that available to the foreign population. On the one hand, in many of these documents, the term “equivalent” is used instead of “equality”, as prisons are closed institutions with a role of confinement that does not always allow for equal care outside. On the other hand, since prisoners are likely to be in a bad mental and physical state when entering prison, and these unfavorable conditions worsen their health, the need for health care and treatment in prison is often greater than in an external community. However, providing basic health care to prisoners in Iran, where the health system is not stable and strong, is very difficult.

Given the specific topic of HIV and other infectious diseases, various areas are addressed by these documents. Officials are responsible for maintaining the personal health of prisoners and promoting the public health of both the prison population and the outside community. Protecting public health within the prison system is connected to improving and safeguarding the health of prisoners and reducing the impact of illness and death on both prisoners and the larger society. This includes all prison staff, family members of prisoners, and other visitors.

Identifying risk factors and high-risk behaviors is essential for understanding how infections spread in regards to infectious diseases. This information is used to develop prevention programs. This is also typically done for other diseases such as tuberculosis and syphilis. In the past, mandatory actions such as isolation and quarantine were often taken to control epidemics and public health threats. However, it should be noted that these specific actions may limit individual behaviors for the greater good. In recent years, these mandatory actions have been questioned mainly due to the presence of various civil groups advocating for the rights of individuals living with HIV. The debate was that protecting public health should go hand in hand with respecting human rights. If individuals living with HIV face discrimination or their right to medical confidentiality is not respected, they will be less likely to volunteer for testing. Additionally, they will be less likely to seek advice on prevention methods. In Iranian prisons, due to a lack of education on HIV transmission compared to outside environments, there is often a negative attitude

Medical confidentiality and education are one of the solutions for controlling this issue. In every doctor-patient relationship, confidentiality is the cornerstone of medical care. Doctors who work with prisoners have a special duty to ensure that the doctor-patient relationship is maintained and that doctors are not simply seen as part of the prison administration. Doctors are responsible for ensuring the confidentiality of medical records of prisoners, which may contain sensitive information. In systems where prison doctors cannot guarantee privacy, they should not document anything that may put their patients in conflict or danger with prison management.

It is very important to consider HIV in this matter. Imagine a prisoner who is not convinced that their personal information, as much as their HIV status, is being protected confidentially in their medical file. In this case, there will be no trust in the doctor-patient relationship. Without trust, doctors will lose any influence they may have in protecting prisoners who seek their help. Unfortunately, Iranian prisons are notorious for not respecting medical secrets. Inappropriate disclosure of HIV status can completely alienate prisoners from medical services and make prevention and education even more difficult. Information about an HIV-positive prisoner should only be disclosed to non-medical authorities by doctors in a limited, accountable, and absolutely necessary manner. The right of a prisoner to medical confidentiality must be respected and not violated in the name of control and security – as often happens.

Emphasizing on education and training of peers, gaining public trust, and fostering cooperation in managing HIV epidemics makes it possible. In Iranian prisons, there is still a lot of work to be done in terms of education and hygiene in this regard. There is a dire need for education and convincing the medical staff and their superiors in the prison administration, as well as the prisoners themselves. It is necessary to mention in managing HIV that any restrictions on prisoners’ rights should only be used as a last resort, with a specific purpose.

In addition, the fundamental rights of prisoners should never be restricted and limitations should not apply to the majority of prisoners unrelated to the committed action. Any action that restricts the rights of prisoners should be under external supervision and periodically reviewed to assess its effectiveness. However, in some cases, pretrial detention may be justified to protect HIV prisoners.

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In Iranian prisons, the human environment is often a dangerous one that is either voluntarily created by prisoners in positions of power or forcibly imposed on weaker prisoners. Prisoners have the right to live in a place where their personal safety is guaranteed. Having a complete understanding of how HIV is transmitted in a specific prison is crucial for prison management. If sexual coercion or violence is the main issue, better supervision and active interventions to protect the targeted prisoners must be implemented. If the main problem is drug injection and sharing of injection equipment, active education may not be enough as those who bring drugs into the prison may try to coerce other prisoners into buying and injecting drugs, undermining drug treatment programs and harm reduction efforts for addicted prisoners. HIV-positive prisoners should not be deprived of access to recreation, education, or normal outside access. From a purely medical standpoint, there is no justification for isolation as long as the prisoner is healthy. Solitary confinement for HIV-positive prisoners should be prohibited. Any restrictions should be exceptional, such as

Reducing the overall population of prisons improves the physical and working conditions of prisons and helps ensure the safety of all individuals in detention. It goes without saying that financial resources should also be allocated to prison systems. One effective way to control the increase in prison population is to provide alternative punishments for criminals instead of imprisonment.