Marcela Jofré is a criminal lawyer and a human rights analyst with the Human Rights and Justice Team at Harm Reduction International (HRI), working across projects. She holds a Master in Criminal law and a MSc in Human Rights and Politics from the London School of Economics and Political Science.

This presentation will illustrate the findings from the 2024 Global State of Harm Reduction’s prison chapter, including the main barriers to accessing harm reduction in prison. It will provide an independent analysis of these issues and discuss strategies to improve access to quality and voluntary services for all detained individuals.

Background: As of 2024, over 11.5 million people are imprisoned globally, with drug policies significantly contributing to incarceration rates. In 2022, 51% of prosecutions (1.4 million) and 54% of convictions (900,000) for drug-related offences were for drug use or possession. Criminalising drug use leads to an overrepresentation of drug users in prisons, with one-third to half of all entrants having a history of drug use. Drug use prevalence is higher in prisons than in the community, averaging 32% globally (ranging from 3.4% to 90% by region) compared to 5.6% in the community. Although the likelihood of injecting drugs decreases with incarceration, some continue or begin injecting in prison.

Prisons are high-risk environments for disease transmission due to poor conditions and unsafe drug use, yet access to harm reduction services remains limited.

Methodology: data on harm reduction services' availability and accessibility was gathered through two global surveys: 215 responses from the GSHR survey and 18 from a prison thematic survey. This information was verified and supplemented with an in-depth desk review.

Results and conclusions: Despite new data showing an expansion in harm reduction services, people in prison remain severely underserved. OAT is available in at least one prison in 61 countries (2 more than in 2022), 11 countries provide NSPs (2 more than 2022), and naloxone is available on release. However, the availability of interventions varies between regions, and barriers to accessing services remain a common issue, including stigmatisation, criminalisation and lack of confidentiality.