Barriers to health in the community may mean that women have lacked access to health care before detention. In some contexts, the initial health screen might therefore be their first contact with health services. Due to the increased risk of physical, sexual and psychological violence in the community there should be specific screening for this upon admission and access to confidential psychological and medical support. Women may also be more at risk of drug and alcohol misuse and so, as well as assessment for rehabilitation, they should also be offered screening and any required prevention, treatment and care for HIV, Hepatitis B and other sexually transmitted infections (STI’s). 

Although the initial health screening on admission should determine the reproductive health history of the woman detainee, including current or recent pregnancies, childbirth and any related reproductive health issues, it must be stressed that the individual retains her right to confidentiality of her sexual health history. This includes a specific prohibition of virginity testing. Virginity testing is discriminatory, humiliating and causes pain and suffering as well as being an intrusion of privacy. It may be considered a form of cruel, inhuman or degrading treatment or torture, and also rape.

There should be free sanitary towels and hygiene facilities provided for women, and advise on health and nutrition for pregnant women, breastfeeding mothers and for babies, children. Children accompanying their detained mother must also have access to an initial medical screening, and ongoing health care to ensure their physical, mental and social development. This should preferably be by a paediatrician.

Prison health services must provide preventive health measures that are specific for women including cervical smears (Papanicolaou or Pap test) for cervical cancer, breast and other gynaecological cancers. To protect the dignity and privacy of women during consultations and treatment there should be sufficient numbers of female health care staff appointed to prisons housing women. In situations where only male health staff are available there should at least be a female chaperone present during consultations and examinations.

Children in prison, including children accompanying imprisoned parents, have the same right to health as children in the community. The best interests of the child must be taken into account in decision making involving the health of the child, and in decisions involving the primary caregiver in the case of children of imprisoned parents. Special care should be taken to ensure that girls are not discriminated against in all health care related issues.

Any children admitted to a prison, including children who accompany a detained parent, should undergo health screening on arrival, preferably by a child health specialist. As well as assessing existing mental and physical health problems and treatments, the children should be assessed for substance misuse, previous torture, ill-treatment and sexual violence. Particular attention must also be made to their physical, psychological and social development.

The prison environment for children should resemble as closely as possible that for children in the community. The children must have access to the same health promotion and prevention programs as children in the community, in particular to all the immunisations recommended by the public health service. To ensure their proper development they will also require good, balanced nutrition in sufficient quantity and regular exercise. The prison health staff should be able to recommend special diets to children, especially if they note problems with growth.

In detention centers for juveniles and in prisons where there are a significant number of child detainees  a paediatrician should routinely visit the place, or otherwise the children should be referred to the nearest community health facility. The paediatrician should not just see sick children, but should routinely see all the children to monitor their physical, psychological and emotional development, screen for diseases, and provide immunisations. The children should also have access to other specialised health care, such as psychiatrists, ophthalmologists etc.

Children in detention are particularly at risk of physical, sexual and psychological abuse from both staff and co-detainees. Health staff must be especially vigilant for signs of abuse, as well as the risk of self-harm or suicide, since the child may very well not make any direct complaint or express any fears. If the health staff note any health issues that may be further compromised by continued detention, with the consent of the child the health staff should discuss these with the director and other related independent bodies and seek appropriate action.

Children with mental health problems should imperatively be diverted from the criminal justice system at every opportunity. Children requiring specialised care for mental health problems whilst in detention should be referred to an appropriate mental health facility in the community. 

The health staff, in conjunction with the prison administration, must pay particular attention to the health and social well-being of the child during the pre-release period. It is essential that there is continuity of care and that the child is referred to the relevant health and social services in the community upon release.

The right to health applies equally to detainees with mental or physical disabilities without discrimination. Detainees with disabilities retain exactly the same rights to autonomy, informed consent, confidentiality and privacy in their health care. As far as the prison environment allows, detainees with disabilities must be allowed to have the maximum independence, as well as inclusion and participation in daily prison life and activities. Those necessary adjustments or modifications to the prison environment must be made to allow detainees with disabilities the enjoyment of the same rights as other detainees. The prison service must ensure that accessibility to health services takes into consideration persons with disabilities.

Detainees with disabilities must be provided with the specific health care that they may need in relation to the disability, including rehabilitation programs, but also to protect them from further disability or other health problems. The training of prison staff, including the health care staff, must include the rights and specific needs of those with disabilities.

The initial medical screening should include an individualised and gender sensitive assessment of any disabilities and any necessary adaptations required in the prison regime and habitat. Self-harm and suicide need careful assessment and care, treatment or referral as needed. Women in particular, especially those admitted to prison for the first time, are particularly at risk of self-harm or suicide.

When accessing healthcare some minorities, indigenous people and some foreign detainees may require interpretation if they do not speak the national language. Interpretation is essential for ensuring that the detainee can properly communicate their health problem, and also receive a clear explanation of any diagnosis and treatment. The provision of an interpreter should be free of cost to the detainee. Ideally there should be independent interpreters available who work only for the health service. Such interpreters may be available at community hospitals or in the social services. It is important that interpreters are not members of the prison security staff since this would interfere with medical confidentiality and trust in the health service. Similarly co-detainees should not be used. However, in the event that there is no other alternative a co-detainee that is chosen by the person with the health complaint could be used, but the health staff must insist that they do not share the information with others.

To assist in the protection of the mental health of foreign nationals they should be permitted regular access to their family and children through family visits, letters and telephone calls and other means of communication such as email where feasible.

Prison health staff must be aware of, and make provisions for the specific health care needs of LGBTI detainees. LGBTI detainees are particularly vulnerable to physical, psychological and sexual violence, including bullying and intimidation. However, due to the acknowledged negative health effects of solitary confinement, this does not mean that LGBTI detainees should be isolated from the general prison population for their protection.

LGBTI detainees may also face discrimination in access to health care in the prison and in referrals to community health facilities. In some States there may be specialised health programmes for transgender individuals, including gender reassignment, and transgender detainees should have the possibility to access these, especially if they were already enrolled on these healthcare programs before detention. Since such programs are rare, access may be facilitated by transferring the detainee to a prison located close to the program. There should also be access to specialised psychological support within the prisons. Health care personnel should use the information about detainees’ sexual orientation with caution and ensure confidentiality of personal data.

In many contexts, the prison population has an increasing proportion of elderly detainees. Some of these elderly detainees may present additional challenges to the prison health care service such as multiple chronic illnesses, like heart disease, diabetes, chronic lung disease etc. that require regular monitoring and management, including referrals for specialist consultations.  There may also be reduced mobility related to joint or bone disorders or to neurological diseases such as Parkinson’s disease. The elderly detainees may also present with cognitive health problems such as dementia related to Alzheimer’s or other causes. The elderly may well also present with terminal illnesses that will not only require specialist health care management but which may also trigger requests for release on medical or humanitarian grounds.

Factors such as poor conditions of detention, especially a lack of hygiene, poor nutrition, lack of ventilation, lack of access to good health care and overcrowding can encourage the spread of diseases in prison, in particular HIV, Hepatitis B and Tuberculosis.

The prison authorities must include initiatives on HIV (as well as Hepatitis) prevention, treatment and care in closed settings promoted by the World Health Organisation and the United Nations Office on Drugs and Crime. This includes the introduction of specialised treatment programs for injecting drug users and specific harm reduction measures. The prevention of mother to child transmission of HIV must be available for pregnant and breastfeeding women detainees. The prison health staff should recommend voluntary HIV testing and counselling (VCT) to all detainees during medical examinations, in particular if someone has signs or symptoms indicating possible HIV infection, or if they have Tuberculosis, as well as to any pregnant female detainees who arrive at the place of detention.

Overcrowding and poor conditions of hygiene and nutrition contribute to the spread of tuberculosis in places of detention. Health care staff should receive specific training on the control of tuberculosis in prisons in co-ordination with the national tuberculosis program and conduct routine screening and where necessary active case finding. In some parts of the world tuberculosis has become multi-drug resistant and access to treatment for such cases is often limited and expensive. Due to the increased risk of contracting the disease, detainees who are known to be HIV positive should be routinely screened for TB.

There must be screening of all new admissions for signs and symptoms of mental or physical violence, including sexual violence and torture. Screening should not only be for individuals who allege they were ill-treated, but for any case which the physician has reason to believe that they might have been a victim of such violence. Physicians in particular who work in places of detention must be trained on how to examine and document victims of torture and other ill-treatment according to the principals of the Istanbul Protocol.