This World Hepatitis Day (28th July), Waverley Care is highlighting the vital role support, education and compassion play in Scotland’s efforts to eliminate hepatitis C – especially within the prison system.
We spoke with Wendy Cooper, Development Manager, who leads Waverley Care’s Prison Link Project, supporting people in prison or connected to the justice system who are living with a blood borne virus (BBV), helping them stay safe, healthy, and supported inside and beyond prison.
With hepatitis C remaining more prevalent among prison settings than in the general population, it is stigma, fear and lack of access to information and support that continues to stand in the way of testing, diagnosis and treatment.
In this interview, Wendy shares powerful insights from her work at Waverley Care, from breaking down barriers to treatment, to helping people navigate life with a blood-borne virus upon release. Her message for hepatitis C is clear: with the right support, people can and do move forward, clear the virus and live well.
The Reality of Blood Borne Viruses in Prisons:
Hepatitis C remains significantly more common in prisons, more so than in the general population, particularly among women. With limited access to harm reduction services, stigma, and a lack of health education, this contributes to increased risks.
Whether an individual is coming into the prison environment already having a diagnosis, or contracting hepatitis C during their prison stay, Wendy says: “We need up to date data to know exactly what the current BBV prevalence is and if people are acquiring BBV after coming into prison or if people tend to have a known BBV before coming into prison.”
The distinction is crucial because it helps shape how we respond. If people are contracting blood borne viruses while in prison, then greater focus must be placed on harm reduction and prevention measures within these settings.
To effectively address and prevent risk factors which exist inside prisons, we must first understand them. Wendy explains that in prison, there are multiple BBV transmission risks:
People might be using makeshift tattoo equipment, sharing snorting instruments, or having condom-less sex — whether consensual or not. Even steroid use, which is quite common, can carry serious risks if people aren’t informed about safe use.
Wendy notes that while hepatitis C is less likely to be transmitted through sex, the risk increases depending on the type of sexual activity, especially if there are cuts, tears, or menstrual bleeding.
While access to injecting equipment in prison is heavily restricted, the use of synthetic drugs is rising, and often more dangerous. These substances are harder to manage and can worsen a person’s overall health, compounding the barriers to treatment and recovery.
Support from the inside out:
We know that leaving prison can be a time of huge uncertainty. Waverley Care’s Prison Link Project strives to make that process as smooth as possible, focusing on the moment of transition and aiming to ensure people feel supported, not just whilst they are inside, but as they take their next steps back into the community.
At the heart of this work is the principle of continuity care. From living well inside to liberation and beyond, we walk alongside people as they prepare for release – making sure they’re connected with the right support at the right time.
“People leaving prison tend to go back to what they know, what’s familiar, and gravitate back to people they feel comfortable with even if this comes with potential risks” explains Wendy. Having community links in place before the person walks out of the gate can make a huge difference. Whether it’s access to harm reduction, peer support, continued support around BBV diagnosis & treatment, or just knowing somewhere is there to check in can lead to real positive change. That support is shaped by each person’s needs. Wendy shares:
We’ve supported people to link in with immigration specialist lawyers to help them navigate complex legal processes, and we’ve worked alongside prison equality and inclusion managers to ensure people’s rights are respected. We’ve helped individuals who were struggling with treatment adherence to manage it more effectively — reconnecting them with clinical care after treatment was declined or paused for various reasons.
After release, this support continues. Wendy explains: “We’ve linked people with community services for opiate replacement therapy, safer substance use practices, and other psychosocial supports. This has helped reduce overdose risk, improve injecting practices, and increase treatment retention and re-engagement.”
And we actively see this type of support has a positive and long-lasting impact, Wendy explains: “People have independently taken the necessary steps to go on and improve their overall health & wellbeing and are living well with their BBV & have now cleared the Hepatitis C virus. Is it so wonderful to see people take back control of their lives and manage the complexities of life whilst living with a BBV much better than before.”
With Waverley Care, this support can take many forms, with some people moving directly into residential rehab facilities, while others link into community recovery services or specialist legal support. Our Prison Link project also aligns closely with NHS teams and equality staff inside prisons to ensure people’s rights and healthcare needs are recognised and respected.
More importantly, people are moving forward with dignity and support, meeting them where they are in their journey.
Breaking the Stigma
For those experiencing life in prison, it can be stigma that is the biggest barrier to getting tested and receiving treatment for hepatitis C. The fear of judgment, discrimination, or even bullying amongst peers can mean that many keep their diagnosis to themselves and suffer in silence instead of asking for help.
“People in prison are generally frightened someone may find out about their diagnosis and treat them differently. People often worry they may be ridiculed, discriminated against or become a target for bullying,” says Wendy. They worry they’ll be treated differently by their cellmate, other prisoners, or even staff. That kind of fear can stop someone from taking the first step.
Even after building the confidence to get tested, receiving medication can be stressful. In some prisons, treatment is handed out in labelled packaging or, in some instances, given out in a public setting, which can lead to unwanted questions and attention from others.
We work alongside people to help them manage their treatment in a way that is both safe and private. This could be talking through storing medication discreetly or deciding how to respond if someone asks about it; the support we offer is always shaped by the person’s needs.
Sometimes, it’s not about a referral or a service...it’s about listening — helping someone understand what their diagnosis means, how long treatment lasts, or just giving them space to talk it through
That judgement-free space can be the first step toward someone choosing to get tested, start treatment, or re-engage with care. Because when stigma is removed, people are more likely to reach out and take control of their health.
The success of Waverley Care’s Prison Link Project is rooted in strong partnerships with NHS prison-based blood borne virus nurses, NHS Prison Health Improvement teams, The Scottish Prison Service, equality officers, legal teams and community-based services. These partnerships are essential in helping people navigate complex systems and take positive steps forward.
“Partnership work is important as it maximises resources and increases staff capacity and enables an approach that best suits people’s needs” Wendy stresses. “If we’re serious about eliminating hepatitis C in Scotland, then we need joined-up care before, during, and after prison.”
Encouragingly, micro-elimination efforts are already making an impact. High-intensity test and treat programmes in Scottish prisons have seen up to 90% of people come forward for hepatitis C testing, a massive step forward and a win for all.
Looking ahead
Scotland’s target to eliminate hepatitis C transmission by 2024 may not have been met, but we remain hopeful.
My hope is that no one leaves prison without the support they need — whether that’s treatment, harm reduction, or just someone to talk to. We can’t afford to lose people during that transition. That’s when support matters most.
As we mark World Hepatitis Day, it’s clear that reaching elimination is about more than just making treatment accessible and more about creating a system and a culture that meets people where they are, treats them with compassion, reduces stigma and believes in their potential to change.
Wendy’s message to anyone in prison who’s unsure about getting tested is this: fear around blood-borne viruses is often tied to concerns about testing, treatment, and the stigma that can come with them—concerns usually rooted in misinformation.
But the reality is that testing for hepatitis C is quick and straightforward, requiring just a small finger-prick blood test. Treatment is simple, accessible, and typically lasts only 8 to 12 weeks. Knowing your diagnosis and starting treatment early can help avoid health complications later in life and give you the best chance to live a healthy life.
You are not on your own, and support is available to help you navigate the process of starting treatment or receiving a positive test result.
As we look to the future of hepatitis C elimination in Scotland, it’s vital that funding continues and grows for peer-led support within prisons. Peer support not only reduces stigma but builds trust, encourages testing, and helps people feel seen and understood.
People with lived experience are uniquely placed to connect with others in ways that professional services sometimes can’t. This is especially true in prison settings, where individuals face complex emotional and social challenges.
Redefining Support: One-to-One Approaches in the Justice System
One-to-one support gives people a safe, welcoming and non-judgemental space to talk through any worries they have and to find solutions that work or them to overcome some of the barriers that deter people from managing treatment, wanting to start treatment or even to have a BBV test completed.
Without continued investment in this work, we risk losing the vital human connection that turns awareness into action and diagnosis into recovery. If we’re serious about eliminating hepatitis C for good, we must ensure that support remains at the heart of the response — inside and outside prison walls.
One-to-one support is very much needed as people are dealing with so much when living in prison – getting used to the prison routine, dealing with personal issues they have no or limited control over, lack of privacy, boredom & isolation, dealing with stigma or others’ negative attitudes and biases whilst trying to keep a BBV diagnosis secret.
Contact Us
Use our service finder to locate your nearest testing site. To contact Wendy about post-liberation support, email us.