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With the HIV Health Equity and Justice Partnership, we called for people living with HIV in prisons to not be left behind. Pank Sethi, member of the partnership and our Community Advisory Group, shares personal reflections on why this work matters to him:
Work on HIV and prisons matters deeply to me because it sits at the intersection of two systems that too often fail the people within them.
Prisons are not separate from our communities—they are part of them. The health inequalities that exist outside prison walls are often intensified inside them, and HIV is a clear example of this. When people in prison are denied consistent access to testing, prevention, treatment, and dignity, it is not just a prison issue—it is a public health, a human rights, and a moral issue.
For many people in prison, HIV risk is shaped by structural factors: poverty, lack of access to healthcare, substance use, stigma, and marginalisation. These are not new realities, but they are often overlooked in policy conversations. Addressing this is important to me because it is about ensuring that no one is left behind. It is about recognising that people in prison deserve the same standard of care as anyone else, and that their health outcomes affect the wider society to which most will return.
What Needs to Change
While there has been progress, significant gaps remain. One of the most urgent changes needed is the normalisation and expansion of opt-out HIV testing across all prisons. Testing should be routine, accessible, and stigma-free. Too often, people are either not offered tests or feel unable to accept them due to fear or lack of privacy. Early diagnosis is key—not only for individual health outcomes but also for preventing onward transmission.
Equally important is ensuring continuity of care. People entering prison may already be on HIV treatment, but disruptions occur due to delays in accessing medication or poor communication between services. Upon release, many people face gaps in care that can lead to treatment interruption. A seamless pathway between prison healthcare and community services is essential. No one should fall through the cracks simply because they moved between systems.
Prevention must also be taken seriously. This includes access to condoms, harm reduction services such as needle and syringe programmes, and education about HIV. While standard in many community settings, they are still inconsistently available in prisons. This inconsistency reflects a broader reluctance to acknowledge the realities of life inside prison, but ignoring those realities only increases risk.
Stigma remains one of the biggest barriers. People living with HIV in prison can face isolation, discrimination, and breaches of confidentiality. Staff training is critical—not just on clinical issues, but on understanding HIV in a modern context and challenging outdated attitudes. People living with HIV should feel safe, respected, and supported.
Personal and Professional Reflections
As a person living with HIV who has lived experience of being in prison, and as a founding member of the HIV and Health in Justice Partnership, I have seen firsthand how transformative the right information and support can be. I remember one session where a group of individuals spoke openly—many for the first time—about their fears around HIV. Some believed myths that we have long debunked in wider society. Others had never been offered a test.
What struck me most was not just the lack of information, but the hunger for it. People wanted to understand, to protect themselves, and to look after their health. When given the space to ask questions without judgement, the conversation shifted from fear to empowerment.
I also recall speaking with someone living with HIV who described the anxiety of keeping their status private in a system where confidentiality can feel fragile. The fear of stigma was constant, and it affected their willingness to engage with healthcare services. This highlights how policy gaps translate into lived experience.
These moments reinforce why this work matters. Behind every statistic is a person navigating complex challenges, often without the support they need.
Hopes for National AIDS Trust Work
As a member of National AIDS Trust’s Community Advisory Group, I am proud of the organisation’s leadership in advocating for evidence-based, rights-focused approaches to HIV. Looking ahead, I hope National AIDS Trust continues to push for systemic change in the prison system.
One key area is accountability. Policies around testing, treatment, and prevention must not only exist—they must be implemented consistently across all prisons. National AIDS Trust is well placed to monitor progress, highlight gaps, and hold decision-makers to account.
I would also like to see continued emphasis on lived experience. People who have been in prison, particularly those living with HIV, must be at the centre of policy development. Their insights are invaluable and ensure that solutions are grounded in reality.
Partnership working is another priority. Addressing HIV in prisons requires collaboration between health services, prison authorities, community organisations, and policymakers. The HIV and Health in Justice Partnership, of which National AIDS Trust is another of the founding members, can play a crucial role in bringing these stakeholders together and ensuring that HIV remains a priority within broader health and justice agendas.
Finally, I hope National AIDS Trust continues to challenge stigma at every level. This includes public awareness, professional training, and advocacy. Changing attitudes is not always easy, but it is essential for creating environments where people feel safe to access care.
A Message for 2026
If there is one message I would want people to take away about HIV and prisons in 2026, it is this: equity cannot stop at the prison gate.
We have the tools to end new HIV transmissions. We have effective treatment, prevention methods, and a clear understanding of what works. The challenge is not a lack of knowledge—it is a lack of consistent implementation and political will.
People in prison are part of our communities. Their health is our collective responsibility. Ensuring access to HIV services in prisons is not about special treatment—it is about equal treatment.
We must also move beyond outdated narratives. HIV is no longer a death sentence, but stigma persists. In prison settings, that stigma can be even more pronounced. Challenging it requires education, empathy, and leadership.
Looking Ahead
As we move forward, it is important to recognise that progress is possible. There are examples of good practice—prisons where testing is routine, where treatment is uninterrupted, and where education is prioritised. The task now is to make this the norm, not the exception.
We must also consider the broader context. Issues such as overcrowding, mental health, and substance use all intersect with HIV risk and care. A holistic approach is needed—one that addresses the social determinants of health as well as the clinical aspects.
Ultimately, this work is about dignity. It is about recognising the humanity of people in prison and ensuring that they are treated with respect and care. It is about building a system that supports health, rather than undermines it.
For me, this is why the work matters, why it must continue and why I won’t stop until every person in the UK is included, regardless of what setting they reside in.
Read the cross-sector report Prisons and HIV: a call to action to support the goals of the HIV Action Plan for England
Discover more about our work on prisons with the HIV Health Equity and Justice Partnership.