[Reducing the risks in prison surroundings. Between policies and realities, the challenge persists]

Numerous health problems Prison population demographics have dramatically increased during the last thirty years and there is no element that foresees a forthcoming inflection of this tendency. Many studies carried out both in France and elsewhere have assessed the extent of the health problems both on admission to prison and during detention. Difficulties in reducing the risks While available data fully justify the need of a true risk reduction policy, there is an obvious lack of pragmatism and courage in many of the field workers and professionals. Confusion between global prevention, general measures of hygiene and education, and true risk reduction programmes makes the risk reduction policy unclear. The strategy to be adopted All efforts should be dedicated today to make the measures of risk reduction widely available, in particular drug maintenance treatments and condoms, to train prison staff, and to evaluate on a regular basis the clinical practices and their effects. Only a voluntarist and clear health and drug policy, together with a motivated prison staff, including health professional and administration staff, are the keys to success for an efficient risk reduction strategy. It is crucial to implement and to test innovative programs, and to regularly assess all the facets of the risk reduction policy in prisons.