1. Tattooing in Scottish Prisons A healthcare needs assessment Dona Milne, Specialist in Public Health

2. Needs assessment objectives: To describe the current population in Scottish prisons and the disease burden related to blood borne viruses To identify current tattooing practices and associated risks/potential risks To elicit stakeholders views: prisoners, staff and management To consider evidence of effective interventions to reduce risks related to tattooing in prison To recommend potential interventions to reduce risks associated with tattooing

3. Methods – epidemiological/comparative BBV Surveillance reports SPS Prisoner Survey Prevalence studies Clinical case reports Published and grey literature search on effective interventions (limited)

4. Methods - corporate Four prisons identified: interviews were conducted with a Hall Manager, Health Centre Manager, and one each of hepatitis C specialist staff and prison officers a one to one interview was completed with a tattooist and a focus group of prisoners who had obtained a tattoo whilst in prison A short survey of prison doctors (25 approx) was completed to identify the frequency of clinical complaints related to tattooing Literature review on effective interventions

5. SPS Annual Prisoner Surveys reported tattooing activity amongst prisoners: 55% prisoners reported having a tattoo with 19% reporting receipt of a tattoo in prison (2007) 54% prisoners reported having a tattoo with 18% reporting receipt of a tattoo in prison (2008)

6. PrisonType of Establishment Tattooing rate Edinburgh Closed, local, remand and short-stay 22% Inverness Closed, local, remand and short-stay 25% Perth Closed, local, remand, short and long-stay 21% Shotts Closed, national long stay 28%

7. Tattooing activity Reasons for getting a tattoo Tattooing equipment Sharing and cleaning equipment Perceived risks from tattooing

9. Staff views on tattooing activity Prison doctors Prison Officers Health care staff And responses to interventions…..

10. Intervention PrisonersPrison officersPrison medical staff Total Numbers of each survey group 178732 Confiscate gun components 459 Increase punishment/better security 112 Educational materials such as leaflets and posters 97723 Addictions services provide cleaning materials and equipment 82515 Provide training on health and safety 112 Discussion groups/induction 718 Local education project 213 Increase staff knowledge 22 Provide a prison tattoo service 125623

11. Conclusions Prevent tattooing in prisons Educate prisoners on the risk of tattooing in prison Provide access to cleaning materials and tattoo equipment A multi-faceted approach But what can be done in the prison environment?

12. Recommendations review existing health promotion materials on tattooing in prisons with Scottish prisoners to ensure the relevance of the final materials information on risks from tattooing in prisons should be featured in staff training and prison induction sessions prisoner survey amended to seek information on when prisoners got a tattoo within prison, to better assess current tattooing activity within prisons

13. Sterilisation materials or facilities should be made available to prisoners providing tattoos, either through health care or addictions staff The Scottish Prison Service health care standard on blood borne virus prevention, care and treatment should be updated to reflect the inclusion of the above approaches within prison health care services SPS should consider a tattoo room pilot in a long stay establishment

14. Work by C plus and prisoners in Edinburgh

16. Prison Public Health Don’t forget the community links…. Lothian tattooing incident 2010 Unlicensed tattooist Young women under 16 Common link – tattoo parties