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Research has shown that a key issue for prisoners using healthcare services during their sentence is that of patient confidentiality. Maintaining prisoners’ medical confidentiality has been shown to be difficult in the prison setting as many treatments, especially those considered to be out of the ordinary, are more likely to result in a breach of medical confidence. This can include treating infectious diseases, such as HIV/AIDS, Hepatitis or tuberculosis, which can often include long term and regular contact with healthcare staff, and which, in some cases, may require referrals to specialists outside the prison setting. In addition, institutional factors unique to prisons may impact on healthcare staffs’ ability to maintain prisoners’ confidentiality, such as security or health and safety concerns. Drawing on research carried out by the author on healthcare and people with problematic drug use in prisons in a range of European countries, this paper considers the factors that impact on maintaining prisoners’ medical confidentiality and some of the attempts to address this issue.