Pre-exposure prophylaxis (PrEP) as a means of reducing the risk of HIV infection in high risk individuals is commonly discussed in relation to men who have sex with men (MSM). Other high-risk populations, such as prisoners, are frequently side-lined. We argue that in the global fight against HIV and AIDS, it is important that the potential of PrEP as a HIV harm reduction intervention in prisons is recognised. Existing interventions to reduce the spread of HIV in prisons, such as needle exchanges, focus on reducing harm from intravenous drug use only. PrEP would be effective against HIV infection through both intravenous drug use and condomless sex, both of which are significant factors in the increased risk of infection in prisons.
Firstly, we highlight how objections to needle exchanges are not applicable to PrEP provision: condoning drug use; the weaponisation of needles; and poor uptake. We also demonstrate that ethical objections to PrEP provision generally, such as risk compensation and poor adherence, do not stand when considering PrEP provision for incarcerated individuals. Finally, we argue that the ethical issues raised by the question of post-incarceration access are not strong enough to block this policy due to the significance of the increased risk of HIV infection prisoners are at. In doing so, we demonstrate the lack of substantive objections to the introduction of PrEP as an HIV harm reduction intervention in prisons and call for further consideration in both academic and policy circles of PrEP’s potential outside of the MSM community.