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The first prison system case in Zimbabwe was notified in July 2020 shortly after State declaration of disaster. A legal-realist assessment was conducted of the Zimbabwean correctional system response to COVID-19 during state disaster measures, with a focus on assessing right to health, infectious disease mitigation and the extent to which minimum state obligations complied with human and health rights standards.

The Zimbabwean correctional system operations during COVID-19 disaster measures are scrutinized using a range of international, African and domestic human rights instruments in relation to the right to health of prisoners. This study focused particularly on standards of care, environmental conditions of detention and right of access to health care.

Systemic poor standards of detention are observed, where prisoners experience power outages, water shortages and a lack of access to clean drinking water and water for ablution purposes, a severe lack of safe space and adequate ventilation, poor quality food and malnutrition and a lack of sufficient supply of food, medicines, clothing and bedding. Whilst access to health care of prisoners in Zimbabwe has greatly improved in recent times, the standard of care was severely stretched during COVID-19 due to lack of government resourcing and reliance on non-governmental organisation and faith-based organisations to support demand for personal protective equipment, disinfection products and medicines.

Prison conditions in Zimbabwe are conducive to chronic ill health and the spread of many transmissible diseases, not limited to COVID-19. The developed legal-realist account considers whether Zimbabwe had a culture of respect for the rule of law pertinent to human and health rights of those detained during COVID-19 disaster measures, and whether minimum standards of care were upheld.

The menstrual health and menstrual hygiene management (MHM) of incarcerated women remains relatively low on the agenda of public health interventions globally, widening the inequitable access of incarcerated women to safe and readily available menstrual health products (MHP). The COVID-19 pandemic has adversely impacted on the MHM gains made in various development sectors in the global North and South, through its amplification of vulnerability for already at-risk populations. This is especially significant to developing countries such as South Africa where the incarcerated female population are an often-forgotten minority.

This viewpoint highlights the ignominious silence of research and policy attention within the South African carceral context in addressing MHM. The ethical and political implications of such silences are unpacked by reviewing international and local literature that confront issues of inequality and equitable access to MHP and MHM resources within incarcerated contexts.

Structural inequalities in various contexts around the world have exacerbated COVID-19 and MHM. Within the prison context in South Africa, women face multiple layers of discrimination and punishment that draw attention to the historical discourses of correctional facilities as a site of surveillance and discipline.

This study acknowledges that while this viewpoint is essential in rising awareness about gaps in literature, it is not empirical in nature.

The authors believe that this viewpoint is essential in raising critical awareness on MHM in carceral facilities in South Africa. The authors hope to use this publication as the theoretical argument to pursue empirical research on MHM within carceral facilities in South Africa. The authors hope that this publication would provide the context for international and local funders, to assist in the empirical research, which aims to roll out sustainable MHP to incarcerated women in South Africa.

The authors believe that this viewpoint is the starting point in accelerating the roll out of sustainable MHP to incarcerated females in South Africa. These are females who are on the periphery of society that are in need of practical interventions. Publishing this viewpoint would provide the team with the credibility to apply for international and national funding to roll out sustainable solutions.

It is hoped that the gaps in literature and nodes for social and human rights activism highlighted within this viewpoint establish the need for further participatory research, human rights advocacy and informed civic engagement to ensure the voices of these women and their basic human rights are upheld.

Prisons in the sub-Saharan African region face unprecedented challenges during the COVID-19 pandemic. In Malawi, the first prison system case of COVID-19 was notified in July 2020. While prison settings were included in the second domestic COVID-19 response plan within the Law Enforcement cluster (National COVID-19 preparedness and response plan, July–December 2020), they were initially not included in the K157bn (US$210m) COVID-19 fund. The purpose of the study was to assess prison preparedness, prevention and control of COVID-19 in Malawi..

A multi-method situation assessment of the COVID-19 response and human rights assurance of prisoners and staff was conducted in a large prison complex in Malawi. Qualitative research underpinned by the Empirical Phenomenological Psychological (EPP) framework consisted of interviews with key informants such as prison health personnel, senior prison staff, penal and judicial policymakers, government and civil society organisations (n = 14) and focus group discussions with consenting male (n = 48) and female prisoners (n = 48) and prison wardens (n = 24). Prison site visits were supported by detailed observations based on the World Health Organisation Checklist for COVID-19 in prisons (n = 9). Data were collected and analysed thematically using the EPP stepwise approach and triangulated based on Bronfenbrenner’s model conceptualising COVID-19 as a multi-level event disrupting the prison eco-system.

The results are presented as MICRO-MESO level individual and community experiences of incarceration during COVID-19 spanning several themes: awareness raising and knowledge of COVID-19 in prisons; prison congestion and the impossibility of social distancing; lack of adequate ventilation, hygiene and sanitation and provisions and correct use of personal protective equipment; MESO-MACRO level interplay between the prison community of prisoners and staff and judicial policy impacts; medical system COVID-19 response, infrastructure and access to health care; COVID-19 detection and quarantine measures and prisoner access to the outside world.

This unique situation assessment of the Malawian prison system response to mitigate COVID-19 illustrates the dynamics at the micro-level whereby prisoners rely on the state and have restricted agency in protecting themselves from disease. This is due to severe structural inadequacies based on low resource allocation to prisons leading to a compromised ability to prevent and treat disease; an infirm and congested infrastructure and bottlenecks in the judicial system fuelling a continued influx of remand detainees leading to high overcapacity. Multi-pronged interventions involving key stakeholders, with prison management and line Ministry as coordinators are warranted to optimise COVID-19 interventions and future disease outbreaks in the Malawian prison system.

The dual epidemic of non-communicable diseases (NCDs) and human immuno-deficiency virus (HIV) in Sub-Saharan Africa has increased substantially in recent years, with cardiovascular disease representing a significant contributor to the regional burden of disease. Very little is known about the cardiovascular health of people deprived of their liberty in the region. The purpose of this study was to collate extant literature on the topic.

A scoping review mapped and described what is known about cardiovascular disease in prison populations in Sub-Saharan Africa. A systematic search of empirical literature with no date limitation was conducted in English. Sixteen studies representing six Sub-Saharan African countries (Cameroon, Nigeria, Guinea, Burkina Faso, Ghana and Ethiopia) were charted, categorised and thematically analysed.

Seven key themes were identified: custodial deaths and autopsy; cardiorespiratory fitness and exercise; cardiovascular disease and elderly people in prison; cardiovascular disease and women in prison; dietary deficiencies; influence of sleep patterns on cardiovascular disease; and other associated risk factors. Most natural deaths at autopsy of custodial deaths were due to cardiovascular disease. Cardiorespiratory fitness was low in prisons, and poor sleep patterns and dietary deficiencies are likely contributors to the burden of cardiovascular disease in prisons. The needs of elderly and female prison populations are ill-considered.

To the best of the authors’ knowledge, this is the first known attempt to scope extant literature on cardiovascular disease in Sub-Saharan African prisons. A strategic focus on the cardiovascular health of people in prison is warranted. Routine monitoring and expansion of existing prison health-care services and integration of NCD services with infectious disease (HIV and tuberculosis) programmes in prisons are required.

Prisons in Africa face unprecedented challenges during Coronavirus disease 2019 (COVID-19). In July 2020, the first prison system case of COVID-19 was notified in Zimbabwe. Subsequently, the Zimbabwe Prisons and Correctional Services released their COVID-19 operational plan. The purpose of the study was to assess preparedness, prevention and control of COVID-19 in selected prisons in Zimbabwe.

A multi-method situation assessment of COVID-19 preparedness was conducted across three Zimbabwean prisons. The World Health Organization checklist to evaluate preparedness, prevention and control of COVID-19 in prisons was administered to frontline health managers. Information garnered was further explored during site observation and in multi-stakeholder key informant interviews with policymakers, prison health directorate, frontline health-care professionals, officers in charge and non-governmental organizations (n = 26); focus group discussions with correctional officers (n = 18); and male/female prisoners (n = 36). Data was triangulated and analyzed using content thematic analysis.

Outdated infrastructure, severe congestion, interrupted water supply and inadequate hygiene and sanitation were conducive to ill-health and spread of disease. Health professionals had been well-trained regarding COVID-19 disease control measures. COVID-19 awareness among prisoners was generally adequate. There was no routine COVID-19 testing in place, beyond thermo scanning. Access to health care was good, but standards were hindered by inadequate medicines and personnel protective equipment supply. Isolation measures were compromised by accommodation capacity issues. Flow of prison entries constituted a transmission risk. Social distancing was impossible during meals and at night.

This unique situation assessment of Zimbabwean prisons’ preparedness and approach to tackling COVID-19 acknowledges state and prison efforts to protect prisoners and staff, despite infrastructural constraints and inadequate resourcing from government.

The first case of COVID-19 in the Malawi prison system was reported in July 2020. Human rights organisations raised concerns about the possibility of significant COVID-19 outbreaks and deaths in the prison system, because of the poor infrastructure, lack of healthcare and adequate COVID-19 mitigation measures, existing co-morbidities (tuberculosis, HIV and hepatitis C), malnutrition and poor health of many prisoners.

The authors conducted a legal-realist assessment of the Malawian prison system response to COVID-19 during state disaster measures, with a specific focus on the right to health and standards of healthcare as mandated in international, African and domestic law.

The Malawi prison system was relatively successful in preventing serious COVID-19 outbreaks in its prisons, despite the lack of resources and the ad hoc reactive approach adopted. Whilst the Malawi national COVID plan was aligned to international and regional protocols, the combination of infrastructural deficits (clinical staff and medical provisions) and poor conditions of detention (congestion, lack of ventilation, hygiene and sanitation) were conducive to poor health and the spread of communicable disease. The state of disaster declared by the Malawi Government and visitation restrictions at prisons worsened prison conditions for those working and living there.

In sub-Saharan Africa, there is limited capacity of prisons to adequately respond to COVID-19. This is the first legal-realist assessment of the Malawian prison system approach to tackling COVID-19, and it contributes to a growing evidence of human rights-based investigations into COVID-19 responses in African prisons (Ethiopia, South Africa and Zimbabwe).

The study aimed to identify and define core components of Throughcare. The global prison population has reached its highest level to date (11.5 million), with comparative data on recidivism unavailable. Despite the global shift away from punitive and towards rehabilitative approaches, reintegration programming (Throughcare) is limited, ill-resourced or non-existent in many countries.

This study conducted a global e-Delphi consensus study of professionals working in prison and correctional services to define critical components of effective rehabilitation and reintegration programming. Consensus was defined a priori as 70% or more participants scoring an outcome from 7 to 9 and fewer than 15% scoring it 1 to 3.

Following a call for expression of interest circulated to the International Corrections and Prisons Association member list (n = 7282), 175 members agreed to partake in the e-Delphi rounds. In Round One, 130 individuals completed an online survey where 35 statements were scored by importance, each with opportunity to provide written feedback. A total of 33 statements exceeded the set threshold of consensus. Written feedback supported refinement and further development of statements in Round Two. A total of 108 individuals completed Round Two. A total of 39 out of the 40 statements exceeded the set threshold of consensus.

Consensus statements are useful to provide a shared understanding for inter-agency Throughcare partnerships, to inform national prison policies and to expand prison and support staff capacity building and programmes all over the world.

To the best of the authors’ knowledge, to date, this is the first known attempt to elicit consensus from a broad range of professionals working in the field of prison and correctional services on core components of effective rehabilitation and reintegration programming.

Although we have achieved a greater understanding of cryptomarket specifics, evidence on the consumer side of cryptomarkets is still needed – not only regarding the role of cryptomarkets on individual drug-using careers but also on the motives for buying illicit drugs from cryptomarkets. Moreover, research has indicated that national differences exist regarding different variables relating to cryptomarket use and prevalence, as well as to why users are drawn to these markets. In this chapter, the author presents the results of a Belgian case study focusing on drug cryptomarket buyers. Using an online quantitative survey (N = 99) and semi-structured interviews (N = 10), we gain exploratory insight into the motives of Belgian buyers sourcing illicit drugs from cryptomarkets and how they believe these cryptomarkets affect their drug-using careers. Results indicate that most of the respondents had bought drugs offline before buying them from cryptomarkets and that the frequency of their drug use did not change once cryptomarkets were accessed. Almost 60% of our respondents, however, consumed different drugs or a wider range of drugs following their cryptomarket use. Furthermore, most of the respondents purchased from cryptomarkets for their personal consumption, and some of them also shared their supply with friends, that is, social supply. The alternative drug offer was the principal reason why they were using cryptomarkets, followed by curiosity and the price and the quality of the drugs. Although the respondents in this study were well aware of different risks related to market vendors, market administrators, and law enforcement, these risks were considered to be minimal and part of the cryptomarket environment. The results of this case study are informative and highlight areas requiring further research.

The COVID-19 pandemic likely impacted cannabis distribution, access and usage worldwide. This study aims to describe self-reported changes in cannabis use and related outcomes following COVID-19-related restrictions among an international sample of people who use drugs.

Using data from the Global Drug Survey COVID-19 Special Edition, the authors identified 20,417 respondents from 13 countries who reported whether the number of THC-containing cannabis usage days changed compared with February 2020 (before COVID-19 restrictions). Using descriptive statistics and a multinomial multivariable logistic regression, the authors investigated the impact of changes in cannabis use on respondents’ mental health, physical health, relationships, finances, work/study performance and cannabis-related pleasure/enjoyment.

Similar proportions of respondents reported that their cannabis use had stayed the same (38.2%) or increased (38.3%) compared with February 2020, while 21.9% of respondents reported a decrease. The most common reason for increased use was having more time (68.4%), while decreased use was associated with having less contact with people they use cannabis with (58.4%). The likelihood of reporting worse mental and physical health, finances, and work/study performance following COVID-19 restrictions was highest among those who reported increased cannabis use.

These findings provide a unique understanding of the short-term international impact of initial COVID-19 restrictions on cannabis use, and highlight the need for policy to address the ongoing and improved provision of evidence-based mental health and other support for people who frequently use cannabis.

To the best of the authors’ knowledge, this is the world’s largest international study exploring the impacts of these changes in cannabis use following initial COVID-19 restrictions on individuals’ mental health, physical health, relationships, finances, work/study performance and cannabis-related pleasure. This study is also unique in comparing these changes across multiple continents.