HIV/AIDS and HCV in Prisons
A Select Annotated Bibliography
HIV/AIDS and Hepatitis C in Prisons: Prevalence and Risk Behaviours
This section contains articles and reports that provide information about prevalence of HIV/AIDS and/or hepatitis C in prisons, as well as information about prevalence of risk behaviours in prisons. To make materials more accessible, the section is divided into the following subsections:
Many of the articles in the next section ("HIV and HCV Transmission in Prison"), while focusing on the risk of HIV and HCV transmission, also contain information about prevalence of HIV and/or HCV and of risk behaviours. Readers interested in prevalence data from a particular region or country should therefore consult that section as well. Finally, because there are so many studies on HIV prevalence and/or risk behaviours in prison, this section does not attempt to be comprehensive. For more information on HIV in prisons in developing and transitional countries, see in particular the review prepared by Dolan et al, 2004, infra.
Essential Resources
Dolan K et al. (2004).  Review of injection drug users and HIV infection in prisons in developing and transitional countries. UN Reference Group on HIV/AIDS Prevention and Care among IDUs in Developing and Transitional Countries.
Available via http://ndarc.med.unsw.edu.au/ndarc.nsf/website/Research.current.cp47publications.
Provides the results of a survey undertaken on behalf of the UN Reference Group on HIV/AIDS Prevention and Care among IDUs in Developing and Transitional Countries.
European Monitoring Centre on Drugs and Drug Addiction. (2002). 2002 Annual Report on the State of the Drugs Problem in the European Union and Norway. Luxembourg: Office for Official Publications of the European Community.
Macalino GE et al. (2004). Hepatitis C infection and incarcerated populations. International Journal of Drug Policy, 15: 103-114.
A review of prevalence and incidence of HCV in prisons worldwide.
Shewan D, Stöver H, Dolan K (2005). Injecting in prisons. In: Pates R, McBride A, Arnold K (eds). Injecting Illicit Drugs. London: Blackwell Publishing, 69-81.
Other Resources
Overviews
Abeni D, Perucci CA, Dolan K, Sangalli S (1998). Prison and HIV-1 infection among injecting drug users. In: Stimson G, Des Jarlais D, Ball A (eds). Drug Injecting and HIV infection. London: University College London, 168-182.
Centers for Disease Control and Prevention. Hepatitis C fact sheet. http://www.cdc.gov/hepatitis
Dolan K (1999). The epidemiology of hepatitis C infection in prison populations. National Drug and Alcohol Research Centre, UNSW.
Gore SM, Bird G (1999). HIV, hepatitis and drugs epidemiology in prisons. In: D Shewan, JB Davies (eds). Drug Use and Prisons: An International Perspective. Amsterdam: Harwood Academic.
A review of HIV/AIDS and hepatitis C in prisons.
Mahon N (1997). Methodological challenges in studies of prisoners' sexual activity and drug use. International Journal of Drug policy, 8 (1).
Points out that prisons and jails are far from ideal places to talk about sex and drug use. Indeed, undertaking a study of prisoners' high-risk behaviours invites many methodological, logistical and ethical challenges. These challenges stem primarily from three aspects of prisoners' lives: correctional facilities are by nature coercive environments; sex and drug use violate correctional regulations; and, sexual behavior involves identity issues that often spur shame and a fear of homophobic violence from other inmates. Not surprisingly, studies of prisoners' high-risk acts are relatively small in number. They are also concentrated in a few countries, particularly England, Australia, Canada, and, most recently, the United States. This article outlines and discusses the methodological challenges of performing research on prisoners' sexual and drug-related activities and the limitations that these hurdles may place on the gathered data. Points out that advocates must thoroughly understand the nature and limitations of research in order to effectively employ it to advocate for programs.
Pickering H, Stimson, GV (1993). Syringe sharing in prison. The Lancet, 342: 621-22.
Prison policies put inmates at risk (1995). British Medical Journal, 310: 278-283.
A series of brief articles on the situation of HIV/AIDS in prisons in England and Wales, Scotland, Australia, India, Denmark, the United States, France, The Netherlands, Germany, Thailand, and Israel. The articles include reference to national policies, epidemiology, and strategies for the prevention of HIV and hepatitis.
Reindollar RW (1999). Hepatitis C and the correctional population. American Journal of Medicine, 107(6B): 100S-103S.
Shewan, D, Davies JB (eds) (1999). Drug Use and Prisons: An International Perspective. Amsterdam: Harwood Academic.
Stevens D (1997). Prison regime and drugs. Howard Journal of Criminal Justice, 36: 14-27.
Examining the effects of the prison regime on drug trafficking, 172 offenders in one prison and 229 offenders in a similar custody level prison were surveyed. Data rejected the hypothesis that a restrictive regime with formal inmate-custodian relations has greater control over drug trafficking in prison than a less restrictive regime with informal inmate-custodian relations.
Swann R, James P (1998). The effect of the prison environment upon inmate drug taking behaviour. Howard Journal of Criminal Justice, 37: 252-265.
The aim of the present study was to examine, from a prisoner perspective, their use of drugs and the perceived effect of the prison environment upon their drug using behaviour. The results suggest that the prison environment is not a supportive environment for individuals who wish to abstain from drug use and indeed for most respondents, actually encouraged drug use.
Documents by region
Africa (http://www.who.int/about/regions/afro/en/index.html)
Adesanya A et al. (1997). Psychoactive substance abuse among inmates of a Nigerian prison population. Drug and Alcohol Dependence, 47: 39-44.
The main objective of this study was to assess the prevalence rate of psychoactive drug use and dependence among prisoners of a Nigerian prison population within the past month. In mid 1995 395 subjects (97.5% males, mean age 30.5 years) were interviewed. Cannabis was the only drug regularly used in the past month, by 26 (6.6%) subjects (all male). Use of intravenous drugs was not evident.
Banerjee A et al. (2000). Prevalence of HIV, sexually transmitted disease and tuberculosis amongst new prisoners in a district prison, Malawi. Tropical Doctor, 30(1): 49-50.
Jolofani D, DeGabriele J (1999). HIV/AIDS in Malawi Prisons. Penal Reform International.
A study of HIV transmission and the care of prisoners with HIV/AIDS in Zomba, Blantyre and Lilongwe Prisons. Produced in English, Russian, Czech, and Romanian. See at http://www.penalreform.org/english/frset_pub_en.htm for more information.
Odujinrin MT, Adebajo SB (2001). Social characteristics, HIV/AIDS knowledge, preventive practices and risk factor elicitation among prisoners in Lagos, Nigeria. West Afr J Med, 20(3): 191-198.
A cross-sectional study of prison inmates using an anonymous risk-factors identification questionnaire was undertaken in January 1997. The Kiri-kiri (maximum, medium and female) prisons were selected by balloting. 252 prisoners were selected by systematic random sampling method. 42.8% said they knew that homosexuality was the most prevalent sexual practice in the prison while 28.6% claimed there was no sexual practice and 13.1% feigned ignorance of any sexual practices in the prisons. Many (53.2%) claimed to have multiple sexual partners although 94.8% denied any sexual practice whilst still in prison. The study concluded that well designed information, education and communication programs on AIDS, provision of harm-reduction devices, and risk-reduction counselling are urgently recommended for the Nigerian prisoners to effectively combat the spread of HIV among the prison inmates.
Simooya O et al. (1995). Sexual behaviour and issues of HIV/AIDS prevention in an African prison. AIDS, 9(12): 1388-1399.
Simooya OO et al. (2001) "Behind walls": a study of HIV risk behaviours and seroprevalence in prisons in Zambia. AIDS, 15: 1741-1744.
Simooya O, Sanjobo N (2002). Study in Zambia showed that robust response is needed in prisons. British Medical Journal, 324(6 April): 850.
In this letter to the editor, Simooya and Sanjobo reported on a survey of HIV seroprevalence and risk behaviours in Zambian prisons. Prevalence of HIV was 27 percent compared to a national average of 19 percent. The authors said that "some inmates may be getting infected inside prison. Only 4% of inmates agreed in one to one interviews that they had sexual relations with other men, but indirect questioning suggested that the true figures were much larger. No condoms were available in any prison." 17 percent of prisoners had been tattooed in prison, and 63 percent reported sharing razor blades.
Vaz RG et al. (1995). Syphilis and HIV infection among prisoners in Maputo, Mozambique. Int J STD AIDS, 6(1): 42-46.
A cross-sectional study was carried out among 1284 male and 54 female prisoners to assess the prevalence of and risk factors for sexually transmitted diseases (STD) in 4 correctional institutions of Maputo. Among the men, 32% reported a history of contact with sex workers and 41% reported a history of STD. Only 9% reported having ever used condoms. Seventy (5.5%) men reported having had sexual intercourse while in prison. In all but one instance this involved sex with another man. There was no reported intravenous drug use. One hundred and four (7.8%) inmates had positive serological tests for syphilis and 8 (0.6%) had antibodies to HIV. The study concluded that there is a need for STD screening and treatment programs in prisons in Mozambique and for the introduction of educational interventions, including condom promotion.
(http://www.who.int/about/regions/amro/en/index.html)
Central and South America
Alvarado-Esquivel C et al. (2005). Hepatitis virus and HIV infections in inmates of a state correctional facility in Mexico. Epidemiol Infect, 133(4): 678-685.
The authors sought to determine the prevalence and associated characteristics of hepatitis A, B, C and D viruses and HIV infections in a prison in Durango, Mexico. Sera from 181 prisoners were analyzed. Prevalence of HCV and HIV was 10.0 and 0.6% respectively. HCV infection was associated with being born in Durango City, history of hepatitis, ear piercing, tattooing, drug use history, intravenous drug use and lack of condom use.
Catalan-Soares BC, Almeida RT, Carneiro-Proietti AB (2000). Prevalence of HIV-1/2, HTLV-I/II, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among prison inmates at Manhuacu, Minas Gerais State, Brazil. Rev Soc Bras Med Trop, 33(1): 27-30.
The purpose of this study was to determine the prevalence of HIV, HBV, HCV, etc among 63 male prisoners in Manhuacu, Minas Gerais, Brazil and to compare this with data from eligible blood donors. The positive results were as follows: 11/63 (17.5%) for HBV, 4/63 (6.3%) for HCV, and 2/63 (3.2%) for HIV.
Cravioto P et al. (2003). [Patterns of heroin consumption in a jail on the northern Mexican border: barriers to treatment access] [article in Spanish]. Salud Publica de Mexico, 45: 181-190.
The study assessed the prevalence of heroin use, patterns of initiation, intense use, and drug-dependency; also, to assess barriers to drug treatment access. It was conducted in the Ciudad Juarez, Chihuahua prison. Subjects were selected using simple random sampling from census of prison inmates. Barriers to drug treatment were identified and analyzed using a logistic regression model. The prevalence of heroin use for the last six months was 26.4%. A multivariate model showed that the significant barriers to drug treatment access were: low education, withdrawal, overdosing, presence of chronic diseases, and duration of heroin use. The study urged that treatment programs be established in prisons.
Lopes F et al (2001). [HIV, HPV, and syphilis prevalence in a women's penitentiary in the city of Sao Paulo] [article in Portuguese]. Cad Saude Publica, 17(6): 1473-1480.
All prisoners at the Women's Penitentiary in Sao Paulo, Brazil, were invited to participate in the study, which was divided into two stages: STD/AIDS preventive workshops including interviews; and laboratory tests. 262 women participated. HIV prevalence rate was 14,5%. The authors conclude that STD/HIV constitute a serious health problem in the prison system, requiring urgent preventive measures.
Magis-Rodriguez, C et al. (2000) Injecting drug use and HIV/AIDS in two jails of the North border of Mexico. Abstract for the XIII International AIDS Conference, Durban.
Massad E et al. (1999). Seroprevalence of HIV, HCV and syphilis in Brazilian prisoners: Preponderance of parenteral transmission. European Journal of Epidemiology, 15(5): 439-445.
Between November 1993 and April 1994, the authors interviewed and took blood samples of 631 prisoners randomly drawn from the largest prison of South America, which counted about 4700 prisoners at that time. The interview consisted of questions related to risk behaviour for HIV infection, and the subjects were asked to provide blood for serological tests for HIV, HCV and syphilis. Overall prevalence was: HIV: 16% (95% confidence interval (CI): 13-19%); HCV: 34% (95% CI: 30-38%), and syphilis: 18% (95% CI: 15-21%). Acknowledged use of ever injecting drugs was 22% and no other parenteral risk was reported. The results, as compared with other studies in the same prison, suggest that HIV prevalence has been stable in recent years, and that the major risk factor for HIV infection in this population is parenteral exposure by injecting drug use.
Miranda AE et al. (2000). Sexually transmitted diseases among female prisoners in Brazil: prevalence and risk factors. Sex Transm Dis, 27(9): 491-495.
The study aimed at determining the prevalence of and risk factors for STDs among female inmates in a Brazilian prison. All female prisoners at the Espirito Santo State Prison were offered enrollment in this cross-sectional study. An interview exploring demographics, criminal charges, and risk behavior was conducted. Of 122 eligible women, 121 (99%) agreed to participate. Prevalence rates were: HIV 9.9%, HCV 19%, syphilis 16%. Previous or current drug use (54%), injection drug use (11%), and blood transfusion (16%) were associated with at least one STD. Condom use was infrequent. The study concluded that the prevalence of STDs and of behaviours leading to transmission are high among female prisoners in Vitoria, Brazil, and demonstrate the importance of prevention activities targeting this population.
Olivero JM, Roberts JB (1995). AIDS in Mexican prisons. AIDS Soc, 6(4): 4.
This article reports that Americas Watch, which toured Mexican prisons, reported in 1991 that all prisoners with HIV infection in the Mexico City area were housed in a single AIDS ward in Santa Marta Prison. In 1991, the 16-bed facility had 15 patients; in 1993, this number had increased by 5. In Mexico City, with 3 prisons holding over 2000 male adults each, there were only 20 known infected prisoners in the AIDS ward at Santa Marta. In 1991, authorities at Matamoros, in the state of Tamaulipas, insisted that none of their inmates had ever been diagnosed as infected with HIV. The prison physician at Reynosa indicated that only 2 inmates since 1985 had ever been diagnosed as infected. In 1992, the prison in Saltillo, in the state of Coahuila, reported that here had yet to be a single positive test for HIV. The prison at Reynosa held 1500 people and only 2 inmates were diagnosed as having AIDS between 1985 and 1991. Prisons at Matamoros and Saltillo held similar numbers but had no experience of infected inmates. A survey of 2 prisons in the state of Tamaulipas indicates that around 12% of the population may use IV drugs, and 9% indicate sharing needles. It is possible for prisoners to die of diseases like pneumonia, associated with AIDS, without the connection to AIDS being diagnosed. Each state, and possibly each prison in Mexico, has its own particular AIDS policies. Santa Marta was the single facility in Mexico City used to house AIDS-infected prisoners, who were segregated. Finally, the prison at Saltillo required all women entering the facility to have a medical examination, including a test for HIV. High-level prison personnel have demonstrated ignorance and fear of AIDS and intolerance of infected prisoners. The article concludes that Mexico must reassess the need to provide adequate medical care to offenders who are sick and dying behind bars.
Peixinho ZF et al. (1990). Seroepidemiological studies of HIV-1 infection in large Brazilian Cities. Nat Immun Cell Growth Regul, 9: 133-136.
A study carried out in 1987. It found an HIV seroprevalence of 12.5% among prisoners.
Strazza L et al. (2004). The vulnerability of Brazilian female prisoners to HIV infection. Brazilian Journal of Medical and Biological Research, 37(5): 771-776.
Canada
Beal J et al. (1998). Up close and personal: recruiting and interviewing federally incarcerated inmates. Can J Infect Dis, 9(Supplement A): 26A (abstract 177P).
Calzavara L et al. (1995). To estimate rates of HIV infection among inmates in Ontario, Canada. AIDS 1995; 9(6): 631-637.
The objective was to estimate the prevalence of HIV-1 infection among adult and young offenders admitted to remand facilities in the province of Ontario, Canada, by using a design that reduces volunteer bias. A study was conducted with urine specimens routinely collected from male and female entrants to all Ontario jails, detention and youth centres between February and August 1993. Information on sex, age, and history of injecting drug use was also collected. Data were obtained on 10,530 adult men, 1518 adult women, 1480 young male offenders, and 92 young female offenders. Urine specimens were available for 88% of new entrants. Overall rates of HIV-1 infection were 1% for adult men, 1.2% for adult woman, and 0% for young offenders. 13% of adult man, 20% of adult women, 3% of young male offenders, and 2% of young female offenders reported a history of drug use. Rates of infection were highest among self-reported IDUs. Rates of infection were 3.6% for adult men and 4.2% for adult women who injected compared with 0.6 and 0.5%, respectively, for non-injecting drug users.
Calzavara, L et al. (1995). Reducing volunteer bias: using left-over specimens to estimate rates of HIV infection among inmates in Ontario, Canada. AIDS, 9: 631-637.
Calzavara, L et al. (1995). The prevalence of HIV-1 infection among inmates in Ontario, Canada. Canadian Journal of Public Health, 86(5): 335-339.
Calzavara L et al. (1997). Understanding HIV-Related Risk Behaviour in Prisons: The Inmates' Perspective. Toronto: HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto.
Contains the results of a small exploratory pilot study undertaken in 1994 to gain an understanding of the potential for HIV transmission among inmates in federal institutions in Canada. The study showed that "inmates engage in high-risk behaviour and that many do not use the harm reduction tools available to them. The structure of prison life and prison culture are barriers to their use."
Calzavara L et al. (2003). Prior opiate injection and incarceration history predict injection drug use among inmates. Addiction, 98: 1257-1265.
This cross-sectional survey aimed to describe injection drug use among inmates, and to identify correlates of drug injection while incarcerated. In six provincial correctional centres in Ontario, Canada, face-to-face interviews were conducted with a random sample of 439 adult males and 158 females. Inmates were asked about drug use in their lifetime, outside the year prior to their current incarceration, and while incarcerated in the past year. Among the 32% with a prior history of drug injection, independent correlates of injection while incarcerated in the past year were identified using multiple logistic regression. Among all inmates while incarcerated in the past year, 45% used drugs and 19% used non-cannabis drugs. Among those with a prior history of injecting, 11% injected while incarcerated in the past year. Rates of injection with used needles were the same pre-incarceration as they were while incarcerated (32%). Independent correlates of drug injection while incarcerated were injection of heroin (OR = 6.4) or other opiates (OR = 7.9) and not injected with used needles (OR = 0.20) outside in the year prior to incarceration, and ever being incarcerated in a federal prison (OR = 5.3). The study concluded that the possibility of transmission of HIV, HCV or other blood-borne diseases exists in Ontario correctional centres.
Calzavara LM et al. (2005). Prevalence and predictors of HIV and hepatitis C in Ontario jails and detention centres. Final report. HIV Social, Behavioural, and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto.
The objectives of the study were: to determine the prevalence of HIV infection in adults and young offenders admitted to Ontario jails and detention centres; to determine the prevalence of HCV infection in adults and young offenders admitted to Ontario jails and detention centres; and to identify any differences in rates of HIV and HCV that may exist in different demographic groups, by history of incarceration, and by known history of risk factors for infection.
Adult and young offenders admitted, between February 2003 and June 2004, to 13 remand facilities across the province of Ontario were eligible for participation. 1,942 offenders participated in the study, for a participation rate of 89.4%. 1,877 provided both a saliva specimen and survey information. The study over-sampled females and young offenders in order to ensure sufficient power to detect differences in prevalence rates between and within these groups.
Among adults, the HIV prevalence was 1.6% (95% C.I. 1.0-2.3) and among young offenders it was 0% (95% C.I. 0.0-1.0). 21% of those who tested HIV-positive reported that they were unaware of their status or were HIV-negative. Among adults, the HCV prevalence was 19.1% (95% C.I. 17.1-21.0) and among young offenders it was 0.4% (95% C.I. 0.01-2.1). Over 35% of those who tested HCV-positive were unaware of their status or reported being HCV-negative.
Based on the number of adults admitted and the prevalence found in this study, it is estimated that 9,197 (range 7,942 to 10,447) HCV-positive and 828 HIV-positive (range 440-1,269) adults were admitted to the Ontario correctional system in 2003-2004.
Risk factors significantly associated with HIV infection among adult inmates were: being older, having a previous federal incarceration, ever being diagnosed with a sexually transmitted disease, ever being tattooed while incarcerated, history of injection drug use, injecting with a used needle, and having unprotected sex.
Risk factors significantly associated with HCV infection among adult inmates were: being 40 to 49 years of age, being female, born in Canada, self-identified as White, having a previous federal incarceration, ever having been diagnosed with a sexually transmitted disease, having had a blood transfusion before 1991, ever being pierced, being pierced while incarcerated, ever being tattooed, being tattooed while incarcerated, ever sharing a toothbrush or razor, sharing a toothbrush or razor while incarcerated, ever injecting drugs, injecting drugs while incarcerated, injecting with a used needle and ever having had sex with a same-sex partner.
Since the previous study undertaken by the same author in 1993, HIV prevalence increased from 1.0% in 1993 to 1.6% in 2003/04. Based on the participants' self-reported behaviours, the potential for further transmission of HIV and HCV is high.
Correctional Service Canada (1996). 1995 National Inmate Survey: Final Report. Ottawa: CSC (Correctional Research and Development), No SR-02.
The results of a CSC survey of 4285 inmates, confirming that a high proportion of prisoners engage in high-risk behaviours.
Correctional Service Canada. (1996b) 1995 National Inmate Survey: Main Appendix. Ottawa: The Service, Correctional Research and Development.
Correctional Service of Canada (2003). Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01. Report of the CSC Infectious Diseases Surveillance System, pages 5 and 7.
www.csc-scc.gc.ca/text/pblct/infectiousdiseases/index_e.shtml
De P, N Connor, F Bouchard, D Sutherland (2004). HIV and hepatitis C virus testing and seropositivity rates in Canadian federal penitentiaries: A critical opportunity for care and prevention. The Canadian Journal of Infectious Diseases & Medical Microbiology, 15(4): 221-225.
See at www.pulsus.com/Infdis/15_04/de_ed.htm.
This study investigated rates of testing and seropositivity for HIV and HCV among prisoners in all 53 Canadian federal penitentiaries. It found that of 7,670 new admissions during 2002, 30 percent were tested for HIV and HCV. 0.7 percent tested positive for HIV and 10 percent tested positive for HCV. Overall seroprevalence rates at year-end for 2002 were 2 percent for HIV and 26 percent for HCV and were substantially higher among women.
Dufour A et al. (1995). HIV prevalence among inmates of a provincial prison in Quebec City. The Canadian Journal of Infectious Diseases, 6(suppl B): 31B.
Dufour A et al. (1996). Prevalence and risk behaviours for HIV infection among inmates of a provincial prison in Quebec City. AIDS, 10: 1009-1015.
The study assessed HIV prevalence and related risk factors among prisoners at the Quebec Detention Centre (QDC). Prisoners incarcerated at the QDC in September 1994 were asked to participate in an anonymous survey concerning HIV infection. The overall participation rate was 95% (618 out of 651). HIV prevalence was 2% (11 out of 499) in men. Twelve male prisoners admitted injecting drugs during imprisonment, of whom 11 shared needles and three were HIV-positive. Nine of the 119 women were HIVpositive (8%).
Ford PM et al. (1994). Seroprevalence of HIV-1 in a male medium security penitentiary - Ontario. Canada Communicable Disease Report, 20(6): 45-47.
Ford, PM et al. (1995). Seroprevalence of Hepatitis C in a Canadian Federal Penitentiary for Women. Canada Communicable Disease Report, 21(14): 132-134.
Ford PM et al. (1995). Voluntary anonymous linked study of the prevalence of HIV infection and Hepatitis C among inmates in a Canadian federal penitentiary for women. Canadian Medical Association Journal, 153(11):1605-1609.
Ford PM et al. (1999). HIV and hep C seroprevalence and associated risk behaviours in a Canadian prison. Canadian HIV/AIDS Policy & Law Newsletter, 4(2/3): 52-54.
Available at www.aidslaw.ca/Maincontent/otherdocs/
Newsletter/spring99/prisons.htm#1.
Ford PM et al. (1999). Risk behaviour in a Canadian federal penitentiary-association with Hepatitis C and HIV seroprevalence. Can J Infect Dis, 10: 65B (abstract 385P).
Ford PM et al. (2000). HIV, hepatitis C and risk behaviour in a Canadian medium-security federal penitentiary. Quarterly Journal of Medicine, 93: 113-119.
In a voluntary anonymous HIV and hepatitis C serology screen in a Canadian male medium security federal penitentiary, 68% of 520 prisoners volunteered a blood sample and 99% of those giving a blood sample completed a risk behaviour questionnaire which was linked numerically to the blood sample. Compared to previous screenings for HIV (4 years earlier), and hepatitis C (3 years earlier) in the same institution, HIV seroprevalence had risen from 1% to 2% and hepatitis C seroprevalence from 28% to 33%. The overwhelming risk association for hepatitis was with drug use outside prison, although there was a small group of men who had only ever injected drugs inside prison, over half of whom had been infected with hepatitis C. The proportion of prisoners who had injected drugs in prison rose from 12% in 1995 to 24% in 1998. The proportion of individuals sharing injection equipment at some time in prison was 19%.
Guyon L et al. (1999). At-risk behaviours with regard to HIV and addiction among women in prison. Women Health, 29(3): 49-66.
Hankins C et al. (1989). HIV-1 infection in a medium security prison for women - Quebec. Canada Diseases Weekly Report, 15(33): 168-170.
The first HIV seroprevalence study in a Canadian prison.
Hankins C et al. (1991). HIV-1 infection among incarcerated men - Quebec. Canada Communicable Disease Report, 17(43): 233-235.
Hankins C et al. (1994). HIV infection among women in prison: An assessment of risk factors using a nonnominal methodology. American Journal of Public Health, 84(10): 1637-1640.
The relative contributions of needle use practice and sexual behaviours to HIV antibody seropositivity among 394 women incarcerated in Quebec were determined by risk factor assessment and serology with a nonnominal methodology. HIV positivity was found in 6.9% of all participants and in 13% of women with a history of injecting drug use. HIV seropositivity among women with a history of injecting drug use was predicted by sexual or needle contact with a seropositive person, self-reported genital herpes, and having had a regular sexual partner who injected drugs. However, it was not predicted by prostitution. The study concluded that non-nominal testing is an ethical alternative to mandatory and anonymous unlinked testing among correctional populations.
Hankins C et al. (1995). Prior risk factors for HIV infection and current risk behaviours among incarcerated men and women in medium security correctional institutions - Montreal. Can J Infect Dis, 6(Supplement B): 31B (abstract 311).
Health Canada (2004). Inventory of HIV Incidence and Prevalence Studies in Canada. Ottawa: Centre for Infectious Disease Prevention and Control.
http://www.phac-aspc.gc.ca/publicat/hips-ipvc04/
At 104-105, contains a table with key information from HIV prevalence studies among prisoners undertaken in Canada.
Jürgens R (2004). Canada: Study provides further evidence of risk of hepatitis C and HIV transmission in prisons. HIV/AIDS Policy & Law Review, 9(3): 45-46.
Available in English and French at
www.aidslaw.ca/Maincontent/otherdocs/
Newsletter/vol9no32004/prisons.htm#p3
Landry S et al. (2004). Étude de prévalence du VIH et du VHC chez les personnes incarcérées au Québec et pistes pour l'intervention. Canadian Journal of Infectious Diseases, 15 (Suppl A): 50A (abstract 306).
A study of prevalence of HIV and HCV among prisoners in provincial prisons in Québec.
Lior LY et al. (1998). Behind bars: an epidemiologic investigation of HIV, HBV and HCV inside a federal penitentiary. Can J Infect Dis, 9(Supplement A): 45A (abstract 262P).
Pearson M et al. (1995). Voluntary screening for hepatitis C in a Canadian federal penitentiary for men. Canada Communicable Disease Report, 21(14): F4-F5.
Plourde C, Brochu S (2002). Drugs in prison: a break in the pathway. Substance Use Misuse 2002; 37: 47-63.
The research presented here explores patterns of inmate drug use during imprisonment. Selected at random, 317 respondents in 10 Canadian penitentiaries were interviewed in 1999 to complete self-reported questionnaires. The data indicate various types of important changes, notably with regard to substances used, frequency of use, and motivations for use.
Prefontaine RG, Chaudhary RK (1990). Seroepidemiologic Study of Hepatitis B and C Viruses in Federal Correctional Institutions in British Columbia. Canadian Disease Weekly Report, 16: 265-266.
Prefontaine RG et al. (1994). Analysis of Risk Factors Associated with Hepatitis B and C Infections in Correctional Institutions in British Columbia. Canadian Journal of Infectious Diseases, 5: 153-156.
Rothon DA et al. (1994). Prevalence of HIV infection in provincial prisons in British Columbia. Canadian Medical Association Journal, 151(6): 781-787.
The objective was to ascertain the prevalence of HIV infection among people entering provincial adult prisons in British Columbia and to study associations between HIV infection and specific demographic and behavioural characteristics. A prospective, unlinked, voluntary survey involving HIV antibody testing of saliva specimens was undertaken between 1 October and
31 December 1992. 2482 (91.3%) of 2719 eligible inmates volunteered for testing. Prisoners who reported a history of injection drug use were more likely than the others to refuse HIV antibody testing (12.9% v. 6.8%; p < 0.001). 28 prisoners were confirmed to be HIV positive, for an overall prevalence rate in the study population of 1.1% (95% confidence interval 0.8% to 1.6%). The prevalence rates were higher among women than among men (3.3% v. 1.0%; p = 0.023, Fisher's exact test). Logistic regression analysis revealed the higher prevalence rate among the women to be explained by more of the women than of the men reporting a history of injection drug use. Of the 30 people who stated that they were HIV positive and who were tested, 19 (63.3%) had a negative result; conversely, 17 who reported that they were HIV negative or had not been tested had a positive result.
Rothon D et al. (1997). Determinants of HIV-related high risk behaviours among young offenders: a window of opportunity. Can J Public Health, 88(1): 14-17.
Small W et al. (2005). Incarceration, addiction and harm reduction: inmates' experience injecting drugs in prison. Substance Use & Misuse, 40: 831-843.
The goal of the research was to qualitatively examine HIV risk associated with injecting inside British Columbia prisons. It concludes that "the harms normally associated with drug addiction, and injection drug use are exacerbated in prison. Interpersonal relationships and the possession of exchangeable resources determine access to scarce syringes. The scarcity of syringes has resulted in patterns of sharing amongst large numbers of persons. Continual reuse of scarce syringes poses serious health hazards and bleach distribution is an inadequate solution."
Svenson LW et al (1995). Past and current drug use among Canadian correctional officers. Psychol Rep, 76(3 Pt 1): 977-978.
Current and past drug use was assessed in a sample of 77 Canadian correctional officers working in two medium-security penitentiaries. 58% of correctional officers indicated past illicit drug use. This compares with 20% of Canadians who indicate illicit drug use. Correctional officers were more likely than the general population to have used marijuana and cocaine.
Wood E et al. (2004). Incarceration is independently associated with syringe lending and borrowing among a cohort of injection drug users. The Canadian Journal of Infectious Diseases, 15 (supplement A).
United States of America
Altice FL et al. (1998). Predictors of HIV infection among newly sentenced male prisoners. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 18(5): 444-53.
An HIV serosurvey of 975 newly sentenced male prisoners. HIV prevalence was 6.1%; multivariate regression analysis indicated injection drug use (OR = 18.9), black race (OR = 5.5), Hispanic ethnicity (OR = 3.4), psychiatric illness (OR = 3.1) and a history of having had a sexually transmitted disease (OR = 2.2) were independent predictors of HIV infection. The majority (71%) of HIV-seropositive persons self-reported their HIV status. This finding may suggest that HIV-infected individuals will self-report their status if HIV care is comprehensive and consistent. The large number of HIV-infected individuals within prisons makes prisons important sites for the introduction of comprehensive HIV-related care. The high prevalence of HIV-seronegative inmates with self-reported high-risk behaviors also suggests the importance of prisons as sites for the introduction of appropriate risk-reduction interventions.
Altice FL et al. (2005). Correlates of HIV infection among incarcerated women: implications for improving detection of HIV infection. Journal of Urban Health - Bulletin of the New York Academy of Medicine, 82(2): 312-326.
In order to determine the HIV seroprevalence and to identify the correlates of HIV infection among female prisoners, an anonymous, but linked HIV serosurvey was conducted at Connecticut's sole correctional facility for women (census = 1,100). Of the 3,315 subjects with complete information, 250 (7.5%) were HIV-positive. Of these, 157 (63%) self-reported being HIV-positive. Using multiple logistic regression analysis, having sex with a known HIV-positive person [adjusted odds ratio (AOR)=9.1] and injection drug use (AOR=6.1) were the most highly correlated risk factors for HIV.
Baillargeon J et al. (2003). Hepatitis C seroprevalence among newly incarcerated inmates in the Texas Correctional System. Public Health, 117(1): 43-48.
The seroprevalence of HCV infection was examined among a sample of incoming prisoners in the Texas Department of Criminal Justice (TDCJ) prison system. Rates were compared across demographic factors and three types of prison facilities: substance abuse felony punishment units (SAFPs), state jails and prisons. The study sample consisted of 3712 incoming inmates incarcerated for any duration, dating from 1 November 1998 to 31 May 1999. Among males, prisoners entering SAFPs and state jails had comparable HCV infection rates (29.7 and 27.0%, respectively) to those entering prisons (27.3%). Among females, inmates entering prisons had a higher rate of infection (48.6%) than those entering state jails (35.1%) or SAFPs (38.3%).
Baillargeon J et al. (2005). The infectious disease profile of Texas prison inmates. Prev Med, 38(5): 607-612.
The study examined the prevalence of major infectious diseases in Texas. The study population consisted of 336,668 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated for any duration between 1 January 1999 and 31 December 2001. The study showed that the prison population had prevalence rates that were substantially higher for latent TB, HIV/AIDS, and hepatitis C than those reported for the general population and some incarcerated populations. The rate of active TB among TDCJ inmates, however, was comparable to that of the general population and other incarcerated populations.
Clarke JG et al. (2001). Active and former injection drug users report of HIV risk behaviors during periods of incarceration. Subst Abus, 22(4): 209-216.
Found that 31% of injection drug users with a history of imprisonment had used illicit drugs in prison, and nearly half of these persons had injected drugs while incarcerated. Male gender and number of times incarcerated were associated with drug use in prison. The authors concluded that interventions for drug-using prisoners that are available in some European prisons, such as needle exchange programs and methadone maintenance, need attention in the US.
Dean-Gaitor HD, Fleming PL (1999). Epidemiology of AIDS in incarcerated persons in the United States, 1994-1996. AIDS, 13: 2429-2435.
In this 1994-1996 survey, 70% of prisoners with AIDS reported parenteral drug use as their mode of exposure.
Gellert GA et al (1993). HIV infection in the women's jail, Orange County, California, 1985 through 1991. American Journal of Public Health, 83 (10): 1454-1456.
The incidence and prevalence of HIV infection among women seeking confidential testing in the Orange County Women's Jail were assessed from 1985 to 1991. A total of 4616 voluntary tests were completed on 3051 women, and 865 women were tested repeatedly. Eighty-two women tested positively, a ratio of 1.8 positives per 100 tests or 2.7% of all persons tested. Cumulative HIV prevalence increased from 2.5% to 2.7% between 1985 and 1991, increased by age, and showed racial differences. Of women with multiple tests, 29 seroconverted. Incidence declined from 5.7 to 1.4 cases per 100 person-years of observation between 1985 and 1991. The overall rate of seroconversion was 1.6 per 100 person-years of observation.
Glass G et al. (1988). Seroprevalence of HIV antibody among individuals entering the Iowa prison system. American Journal of Public Health, 78(4): 447-449.
Hammett TM (1986). Acquired immunodeficiency syndrome in correctional facilities: a report of the National Institute of Justice and the American Correctional Association. Morbidity and Mortality Weekly Report, 35(12): 195-199.
The first comprehensive study of HIV in US prison systems.
Hammett TM, MP Harmon, W Rhodes (2002). The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997. American Journal of Public Health, 92: 1789-1794.
This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. Data from surveys, surveillance, and other reports were synthesized to develop these estimates. During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. The study concluded that correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.
Hanrahan JP et al. (1982). Opportunistic infections in prisoners [letter]. New England Journal of Medicine, 307: 498.
The first report of AIDS in a correctional facility.
Hensley C (2001). Consensual homosexual activity in male prisons. Corrections Compendium, American Correctional Association, 26(1): 1-4.
Mahon N (1996). New York inmates' HIV risk behaviors: the implications for prevention policy and programs. American Journal of Public Health, 86: 1211-1215.
A study exploring inmate perceptions of high-risk behaviour in New York state prisons and New York City jails. It found that "a range of consensual and nonconsensual sexual activity occurs among inmates and between inmates and staff.... Prisoners also shoot drugs intravenously with used syringes and pieces of pens and light bulbs." Concludes that "the absence of harm-reduction devices behind bars may create a greater risk of HIV transmission there than in the community" and that "[o]fficials should consider distributing risk-reduction devices to prisoners through anonymous methods."
Maruschak L (2004). HIV in Prisons and Jails, 2002. Washington, DC: US Dept of Justice, Bureau of Justice Statistics Bulletin.
Available via http://www.ojp.usdoj.gov/bjs/abstract/hivpj02.htm.
Summarizes the situation with regard to HIV/AIDS in prisons in the US. Updated yearly. Provides the number of HIV-positive and active AIDS cases among State and Federal prisoners at yearend 2002. Reports the number of AIDS-related deaths in prisons, a profile of those inmates who died, the number of female and male prisoners with AIDS, and a comparison of AIDS rates for the general and prisoner populations. Based on the 2002 Survey of Inmates in Local Jails, the report provides estimates of HIV infection among jail inmates by age, gender, race, Hispanic origin, education, marital status, and by current offense and selected risk factors such as prior drug use. Also included is information on AIDS-related deaths among jail inmates.
Seal DW et al. (2004). A qualitative study of substance use and sexual behavior among 18-29-year-old men while incarcerated in the United States. Health Educ Behav, 31(6): 775-789.
The study describes men's perceptions of and experience with substance use and sexual behavior during incarceration. Grounded theory content analyses were performed on qualitative interviews conducted with 80 men, aged 18-29, in four US states. Participants believed that drugs were easily available in prison. Half reported using substances, primarily marijuana or alcohol, while incarcerated. Key themes included the role of correctional personnel in the flow of substances in prison and the economic significance of substance trafficking. With regard to sexual behavior, most men acknowledged that it occurred but were hesitant to talk in-depth about it. There was a strong belief in "don't look, don't tell" and sex in prison was often associated with homosexual behavior or identity. Sex during incarceration was reported by 12 men, mostly with female partners. Participants were pessimistic about HIV/STD/hepatitis prevention efforts inside correctional facilities. These findings highlight the need for risk reduction programs for incarcerated men.
Stephens TT et al. (2003). History of prior TB infection and HIV/AIDS risk behaviours among a sample of male inmates in the USA. Int J STD AIDS, 14(8): 514-518.
This study looked at prisoners' self-reported data on prior treatment for TB and HIV/AIDS risk among a sample of prisoners in a medium security prison. Findings suggest that prisoners who reported being treated for TB were more likely to have had sex with a man while in prison and to report that, while in prison, they had a main sex partner. They were also 1.15 times more likely to have had sex with a person from the transgender community while in prison and 2.53 times more likely to report having been forced to have sex while in prison than those without a past history of being treated for TB.
Swartz JA, Lurigo AJ, Aron Weiner D (2004). Correlates of HIV-risk behaviors among prison inmates: implications for tailored AIDS prevention programming. The Prison Journal, 84(4): 486-504.
This study used extensive interviews to assess Illinois prison inmates' sexual and drug-use practices, their knowledge about HIV risk-reduction techniques, and their beliefs regarding their own HIV-risk status and their ability to avoid HIV infection.
Truman B et al. (1988). HIV seroprevalence and risk factors among prison inmates entering New York State Prisons. Presented at the IVth International Conference on AIDS. Abstract no 4207.
20% of prisoners in New York City tested HIV-positive.
Vlahov D et al. (1989). Temporal trends of Human Immunodeficiency Virus Type 1 (HIV-1) Infection among inmates entering a statewide prison system, 1985-1987. JAIDS, 2(3): 283-290.
Vlahov D et al. (1991). Prevalence of antibody to HIV-1 among entrants to US correctional facilities. Journal of the American Medical Association, 265: 1129-32.
Vlahov D et al. (1993). Prevalence and incidence of hepatitis C virus infection among male prison inmates in Maryland. European Journal of Epidemiology, 9(5): 566-569.
Weinbaum CM, Sabin KM, Santibanez SS (2005). Hepatitis B, hepatitis C, and HIV in correctional populations: a review of epidemiology and prevention. AIDS, 19(Suppl 3): S41-46.
The 2 million persons incarcerated in US prisons and jails are disproportionately affected by HBV, HCV and HIV, with prevalences of infection two to ten times higher than in the general population. Infections are largely due to sex- and drug-related risk behaviors practised outside the correctional setting, although transmission of these infections has also been documented inside jails and prisons. The article argues that public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV and HIV testing and counseling, medical management of infected persons, and substance abuse treatment in incarcerated populations.
Wormser GP et al. (1983). Acquired immunodeficiency syndrome in male prisoners. Annals of Internal Medicine, 98: 297-303.
Together with Hanrahan (1982, supra), the first report of AIDS in prisons.
Afshar P (2003). Iranian prisons organisation and harm reduction initiatives. Connections, 13: 6-7.
Available via http://www.endipp.net/index.php?option=com_remository&Itemid;=39&func;=fileinfo&filecatid;=16&parent;=category.
Reports that according to a recent study, 30.7% of all prisoners use drugs, and 2.3% were HIV positive. As a result, Iran has introduced a range of harm reduction interventions in its prison system.
Baqi S et al. (1998). HIV antibody seroprevalence and associated risk factors in sex workers, drug users, and prisoners in Sindh, Pakistan. J Acquir Immune Defic Syndr Hum Retrovirol, 18(1): 73-9.
A voluntary serosurvey of HIV-1 and HIV-2 and risk behaviors of 3525 prisoners in Sindh was conducted between July 1994 and December 1994. Of 3441 male prisoners, 1 was HIV-1 infected, and of 84 female prisoners, 1 was HIV-1 infected. No prisoner was positive for HIV-2 antibody. The study concluded that the prevalence of HIV in prisoners in Sindh was low and that intervention programs implemented at this stage can make an impact in HIV prevention.
The infected male prisoner reported multiple encounters with sex workers in Bombay in 1990; the only identifiable risk factor in the HIV-positive female prisoner was several injections at the prison dispensary with reused syringes.
Nassirimanesh B (2002). Proceedings of the Fourth National Harm Reduction Conference, Seattle, USA; abstract.
A study in a local prison in Fars Province of Iran revealed prevalence rates of 30% and 78% for HIV and HCV infections among incarcerated drug users, respectively.
Rowhani-Rahbar A, Tabatabee-Yazdi A, Panahi M (2004). Prevalence of common blood-borne infections among imprisoned injection drug users in Mashhad, North-East Iran. Archives of Iranian Medicine, 7(3): 190-194.
The purpose of the study was to estimate the prevalence of blood-borne infections in incarcerated IDUs in Mashhad. The study population comprised a convenience sample of 101 incarcerated IDUs. The seroprevalence of HCV, HBV, and HIV was 60%, 3%, and 7% respectively. The study concluded that there is an urgent need for effective harm reduction programs in Iran, particularly among incarcerated IDUs.
Europe (http://www.who.int/about/regions/euro/en/index.html)
Western and Southern Europe
Allwright S et al. (1990). Hepatitis B, Hepatitis C and HIV in Irish Prisoners: Prevalence and Risk. Dublin: The Stationary Office.
This study of 1200 incarcerated men and women found an overall HIV infection rate of two percent and an HCV infection rate of 37 percent. The same study found that nearly half the incarcerated women tested were infected with HCV.
Babudieri et al. (2003) [HIV and related infections in Italian penal institutions: epidemiological and health organization note] [article in Italian]. Ann Ist Super Sanita, 39(2): 251-7.
HIV and other infections represent an important health problem in Italian jails. In particular, HIV prevalence is high, due to the characteristics of the prison population, which is constituted by a large proportion of injecting drug users and foreigners. In addition, data from other countries suggest that risky behaviour are not uncommon during imprisonment, and transmission of HIV and other infection in this setting may also occur. Data from surveys conducted by the Penitentiary Authority in Italian jails show a decline of HIV seroprevalence from 9.7% in 1990 to 2.6% in 2001. However, these data are largely incomplete and do not account for possible biases due to self-selection of prisoners toward HIV serological testing or to variations in the access to screening activities. More accurate data, possibly obtained through anonymous unlinked surveys, are needed in order to better plan health services and preventive measures.
Bird A et al. (1992). Anonymous HIV surveillance in Soughton Prison, Edinburgh. AIDS, 6: 725-33.
Bird A et al. (1993). Study of infection with HIV and related risk factors in young offenders' institution. British Medical Journal, 307: 228-231.
Bird A et al. (1995). Anonymous HIV Surveillance with Risk Factor Elicitation at Scotland's Largest Prison, Barlinnie. AIDS, 9: 801-808.
The objective was to determine prevalence of HIV infection and risk behaviours among male prisoners of Her Majesty's Prison Barlinnie, Glasgow, Scotland on 8-9 September 1994.
A cross-sectional study was used: voluntary, anonymous HIV surveillance (using saliva samples) of all inmates and linked self-completion risk-factor questionnaire. Of 1073 prisoners available to participate, 985 (92%) completed a risk factor questionnaire and 982 salivettes were received for testing, of which 978 were tested for HIV antibodies. Nine saliva samples [eight IDUs, one recognized other risk] out of 978 were HIV-antibody-positive. Overall HIV prevalence was estimated at 1%. Half the IDU prisoners reported having injected while incarcerated and 6% had started to inject while incarcerated. Logistic regression showed that IDU who had injected inside and those whose injection career began prior to 1989 were more likely to have acute hepatitis.
Bird SM (2000). Prevalence of drug injecting among prison inmates. Commun Dis Public Health, 3(4): 308-309.
Blasotti A, Blotta MH, Gomes MC (1987). Serological survey of the prevalence of anti-HIV antibodies in prisoners of the public prison of Sorocaba. Rev Paul Med, 105(2): 117-8. [article in Portuguese]
Boys A et al. (2002). Drug use and initiation in prison: results from a national prison survey in England and Wales. Addiction, 97(12): 1551-1560.
More than 60% of the heroin users and cannabis users reported that they had used these drugs in prison compared with less than a quarter of the life-time cocaine users. More than a quarter of the heroin users reported that they had initiated use of this drug in prison. The extent of an individual's experience of prison was related more consistently to heroin and/or cocaine use in and out of prison than other personal background, social history or psychiatric variables assessed. The authors concludes: "The findings indicate that prisons are a high-risk environment for heroin and other drug initiation and use. Although related to drug use, psychiatric variables were not generally associated with initiation in prison, which was dominated by prison exposure. There is a need to explore ways of reducing heroin initiation in prison as part of a broader risk-prevention strategy."
Carvell A, Hart G (1990). Risk behaviours for HIV infection among drug users in prison. British Medical Journal, 300: 1383-1384.
A group of IDUs in London were studied to determine the degree of illicit drug use in prison and the prevalence of risk behaviours for HIV infection. It showed that most of the prisoners continued to take drugs while in custody and just over half not only injected drugs,
but shared equipment. Some of the male prisoners compounded their risk of HIV infection by engaging in sexual activity with multiple partners.
Curtis SP, Edwards A (1995). HIV in UK prisons: a review of seroprevalence, transmission, and patterns of risk. Int J STD AIDS, 6: 387-391.
In this study, data about risk behaviour and seroprevalence is reviewed and compared with experiences in other countries. The study concludes that injecting drug use in prison appears to be common. The majority of those who inject often share equipment which can have been used many times. Although sexual activity may be a smaller risk factor it does occur between men in prison. In addition, prisoners appear to have high rates of partner change between sentences. The true prevalence of HIV in UK prisons is difficult to assess but the available data suggest it is between 0.1 and 4.5%. A window of opportunity still exists to prevent further outbreaks of HIV in UK penal institutions and to maintain these low prevalence rates.
Dillon L (2001). Drug Use among Prisoners: An Exploratory Study. Dublin: The Health Research Board.
Available via http://www.hrb.ie/display_content.php?page_id=71&stream=1&div_id=2
Among the aims of the study were to explore the nature of drug use among prisoners, and to explore the impact of incarceration on prisoners' drug use. In-depth interviews were carried out with 29 prisoners in Mountjoy Prison in Dublin. 24 respondents had a history of drug use prior to imprisonment; seventeen were continuing to use illicit drugs in prison; 4 reported that they had their first-ever experience of heroin and injecting drug use while incarcerated. Once imprisoned, those who continued to engage in illicit drug use greatly reduced the quantity of drugs they used, and the frequency with which they used them, when compared to their drug use in the community. Injection drug use was common, and respondents said that injecting drug use in the prison was synonymous with the sharing of injecting equipment.
Dolan K, Donoghoe M, Stimson G (1990). Drug injecting and syringe sharing in custody and in the community: An exploratory survey of HIV risk behaviour. Howard Journal of Criminal Justice, 29(3): 177-186.
183 IDUs were interviewed in 12 cities in England, Scotland and Wales. Custodial experience was common (79% in custody at some time), recent (58% in custody since 1987), and sentences were short (for 64% the most recent period in custody lasted one month or less). Injecting during last period in custody was reported by 23%, and 75% of those who injected in custody reported that they had shared needles and syringes. Sexual activity in custody was reported by 6% of the custodial sample; HIV positivity by 12%. Of the custodial group, those who were HIV positive were more likely than the HIV negative group to report injecting and syringe-sharing in custody. Outside custody many (46%) had shared syringes during the previous three months, and 50% of these had sexual partners who did not themselves inject drugs. The findings suggest the possibility for HIV infection to occur in custodial settings. Levels of risk behaviour outside custody are an indication of the potential crossover from prison to the community, should HIV be transmitted within the custodial context.
Dolan K (1993). Drug injectors in prison and the community in England. International Journal of Drug Policy, 4 (4): 179-183.
Dye S, Isaacs C (1991). Intravenous drug misuse among prison inmates: implications for spread of HIV. British Medical Journal, 302, 1506.
Edwards A, Curtis S, Sherrard J (1999). Survey of risk behaviour and HIV prevalence in an English prison. Int J STD AIDS, 10(7): 464-6.
An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. 378 (68%) of the prisoners participated. HIV prevalence was 0.26%. Injecting drug use was the most significant HIV risk factor with 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two prisoners admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection. Injecting drug use and needle sharing represent the greatest risk.
Estebanez P et al. (1988). Prevalence and risk factors for HIV infection among inmates. IVth International Conference on AIDS. Abstract no 4202.
About half of prisoners in Madrid prisons tested HIV-positive.
Fotiadou M et al. (2004). Self-reported substance misuse in Greek male prisoners. European Addiction Research, 10(2): 56-60.
The aim was to determine levels and severity of self-reported alcohol and drug misuse and associated physical and mental health problems in Greek male prisoners. The sample consisted of 80 randomly selected convicted and remanded male prisoners in a prison in northern Greece. 27.5% of the prisoners were dependent on opiates, 26.3% on alcohol and 73.8% cannabis users, while 13.8% were misusing both alcohol and illicit drugs. Severity of dependence was rated as serious for all opiate and stimulant users. No prisoner was HIV-positive but 26.5% were hepatitis-B-positive.
Gore S, Bird A, Ross A (1995). Prison rites: Starting to inject inside. British Medical Journal, 311: 1135-1136.
The nature of injecting behaviours within prisons was examined through surveys of two Scottish prisons, Glenochil and Barlinnie. 25% of injectors in Glenochil and 6% at Barlinnie reported that they started injecting while in prison.
Gore SM et al. (1997). Anonymous HIV surveillance with risk factor elicitation at Perth (for men) and Cornton Vale (for women) prisons in Scotland. International Journal on STDs and AIDS, 8: 166-175.
434 male and 145 female prisoners were available to participate in cross-sectional, voluntary anonymous HIV surveillance (using saliva samples) with linked selfcompletion questionnaire at HMP (Her Majesty's Prison) Perth on 17 May and at HMP Cornton Vale on 18 May 1995. 304 men (70%) and 136 women (94%) completed a risk-factor questionnaire and 304 and 135 samples were received for HIV antibody testing. Six saliva samples from Perth (all injectors) out of 304 and none from Cornton Vale out of 134 tested were HIV antibody positive. Overall HIV prevalence was estimated at 2% compared to a known prevalence of 1.4% (6/434), giving a 1.5 ratio of overall: disclosed HIV prevalence at HMP Perth. At Cornton Vale, where both known HIV-infected prisoners abstained, overall and disclosed HIV prevalence, were equal at 1.4%. At Perth Prison, 29% of prisoners had injected drugs (82/278); 85% of injector-inmates reported having injected inside and 31% (25/80) had started to inject while inside, 7 during their present sentence. Of all 21 injector-inmates who first injected after 1991, 10 had started to inject inside, including one of 69 male inmates who had never been inside before. The corresponding figures for Cornton Vale, where 46% of inmates were injectors (58/132), were that 57% of injector-inmates had injected inside (32/56) but only one woman, for whom this was not her first sentence, had started to inject inside.
Gore SM et al (1999). Prevalence of hepatitis C in prisons: WASH-C surveillance linked to self-reported risk behaviours. Q J Med, 92: 25-32
The authors used cross-sectional willing anonymous salivary hepatitis C (WASH-C) surveillance linked to self-completed risk-factor questionnaires to estimate the prevalence of salivary hepatitis C antibodies (HepCAbS) in five Scottish prisons from 1994 to 1996. Of 2121 available inmates, 1864 (88%) participated and 1532/1864 (82%) stored samples were suitable for testing. Overall 311/1532 (20.3%, prevalence 95%CI 18.3-22.3%) were HepCAbS-positive. The authors concluded that the prevalence and potential transmissibility of hepatitis C in injector-inmates are both high. They say that promoting 'off injecting' before 'off drugs' (both inside and outside prison), methadone prescription during short incarcerations, alternatives to prison, and support of HepCAbS-positive inmates in becoming eligible for treatment, all warrant urgent consideration.
Keene J (1997). Drug use among prisoners before, during and after custody. Addiction Research, 4(4): 343-353.
This study examines the use of drugs in a Welsh prison. 27.5% of the study population as a whole injected a range of drugs in the community and 14% did so in custody, where 9% reported sharing needles and syringes.
Kennedy D et al. (1990). Illicit drug use, injecting and syringe sharing in Scottish prisons in the 1990's: Final report for the Nuffield Foundation. Ruchill Hospital: Glasgow.
A questionnaire was administered to 81 attenders at a needle exchange in Glasgow in January 1990. Unstructured follow-up interviews were conducted with 19 attenders at the same exchange in June 1990. Nearly all ex-inmates had been aware of other prisoners using illegal drugs, and a majority admitted that they had themselves used drugs in prison. This is reinforced by the statement of respondents in unstructured interviews: 'They have a bigger habit in than out' (Respondent B); 'There are more drugs in prison than out' (Respondent G); 'I did when I was in. I took tems, hash, valium, up-johns, DFs, smack' (Respondent R). Questionnaire respondents were less ready to admit that they had injected drugs in prison (25% did so), but again a great majority had seen others injecting. Those admitting injecting were all male, and those who had been imprisoned more recently and for longer periods were somewhat more likely to have injected. Although 80% of the group stated that they had seen others sharing needles and syringes, only 10% were prepared to admit that they had themselves shared equipment in prison.
Kennedy D et al. (1991). Drug misuse and sharing of needles in Scottish prisons. British Medical Journal, 302: 1507.
Most drug injectors attending Glasgow needle exchanges have been in prison. Six subjects (11%) admitted to sharing needles in prison. The true extent of sharing may be greater as the other eight who reported injecting drugs in prison were unlikely to have had exclusive access to their own equipment. Respondents in the semi-structured interviews emphasized this fact: "When you hide your needle, someone else might find it and it gets used in their circle, so you can't say how many get to use it." Estimates of the number of people sharing one needle varied between five and 100. The study concluded that "it therefore seems highly probable that when a drug misuser shares needles inside prison, this may occur more frequently and among a wider group of people than it would outside prison."
Korte T, Pykalainen J, Seppala T (1998). Drug abuse of Finnish male prisoners in 1995. Forensic Sci, 97(2-3): 171-183.
The purpose of the research was to estimate the extent and variety of use of illegal drugs, use and misuse of hypnotics and sedatives and anabolic steroids in the Finnish prison population. The study was undertaken during October-November 1995 at four prisons, three of which were closed institutions and one an open prison; one of the three closed institutions was a juvenile prison. 707 inmates in the prisons were selected for the study. Questionnaires were given personally to all prisoners in the open prison and in the young prisoners' division in the juvenile prison, but in two large central prisons only some divisions were selected for the study. The questionnaires were completed by 354 prisoners; 75 prisoners refused to respond. A total of 27.7% of subjects reported taking illegal drugs while in their current prison and 70.1% had sometimes used them. Of those who were drug-free before their first imprisonment, 21.7% began using drugs in prison. Cannabis and amphetamine were the most common illegal drugs reported. Intravenous drug use was reported by 19.2% of the respondents at some point in their lives, and 10.7% of prisoners had injected drugs in their current prison. Use of illegal drugs and misuse of drugs were significantly higher among young prisoners (< or = 25 years of age).
Koulierakis et al. (1999). Injecting drug use amongst inmates in Greek prisons. Addiction Research, 7(3): 193-212.
The authors present a national cross sectional comparative study of injecting drug use amongst male inmates in Greek prisons. 1,000 inmates were randomly selected from 10 correctional institutions. 861 questionnaires were included in the analysis. 290 inmates (33.6%) reported injecting drugs, of whom 174 (60%) had injected while in prison, and 146 (50.3%) had shared while in prison.
Long J et al. (2000) Hepatitis B, Hepatitis C and HIV in Irish Prisoners, Part II: Prevalence and risk in committal prisoners 1999. Dublin: The Stationary Office.
This study of 600 remand prisoners found an overall HIV infection rate of two percent and HCV infection rate of nearly 22 percent. Among women prisoners, the HIV seroprevalence rate was nearly 10 percent, and the HCV infection rate was 56 percent.
Long J et al. (2001). Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey. British Medical Journal, 323(7323): 1209-13.
The objective was to determine the prevalence of antibodies to hepatitis B core antigen, HCV, and HIV in entrants to Irish prisons and to examine risk factors for infection. A cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing, was undertaken in five of seven committal prisons in the Republic of Ireland. 607 of the 718 consecutive prison entrants from 6 April to 1 May 1999 participated. Prevalence of antibodies to hepatitis B core antigen was 37/596 (6%; 95% confidence interval 4% to 9%); to HCV 130/596 (22%; 19% to 25%); and to HIV 12/596 (2%; 1% to 4%). 29% of respondents (173/593) reported ever injecting drugs, but only 7% (14/197) of those entering prison for the first time reported doing so compared with 40% (157/394) of those previously in prison. Use of injected drugs was the most important predictor of antibodies to hepatitis B core antigen and HCV. The study concluded that use of injected drugs and infection with HCV are endemic in Irish prisons, and that there is a need for increased infection control and harm reduction measures in Irish prisons.
Long J, Allwright S, Begley C (2004). Prisoners' view of injecting drug use and harm reduction in Irish prisons. International Journal of Drug Policy, 15(2): 139-149.
This qualitative study sought to examine prisoners' views of drug injecting practices and harm reduction interventions in Dublin prisons. 31 male prisoners were interviewed (16 injecting drug users and 15 non-injectors). Two themes relevant to drug use practices emerged. Respondents described increased health risks related to injecting drug use during detention and associated with a prison environment. These included: the low availability of heroin which encouraged a shift from smoking to injecting; the scarcity of injecting equipment which fostered sharing networks far wider than outside prison; inadequate injecting equipment cleaning practices; and the rent of needles and syringes in exchange for the drugs. Both noninjectors and injectors interviewed supported harm reduction interventions in prison and felt that the range of drug services available in prison should mirror those available in the community, although half opposed or had reservations about syringe exchange in prison. Prisoners' viewed their time in prison as an opportunity to address substance use related problems.
Martin V et al. (1990). Seroepidemiology of HIV-1 infection in a Catalonian penitentiary. AIDS, 4: 1023-1026.
Reported an HIV seroprevalence of 34% in 1989 in a Catalonian prison.
Montella M, Crispo A, Wynn-Bellezza J (2003). In search of the correct strategy for preventing the spread of HCV infection ... [electronic letter]. British Medical Journal, 6 November 2003.
Available at http://gut.bmjjournals.com/cgi/eletters/52/10/1500.
Reported an HCV prevalence rate of 37.4% among 524 male prisoners in Southern Italy in 2000/2001.
Perez-Agudo F, Alonso Moreno FJ, Urbina Torija J (1998). Prevalence of human immunodeficiency virus type 1 and Mycobacterium tuberculosis infections in a prison population in the years 1989 to 1995. Med Clin, 110(5):167-70. [article in Spanish]
1,173 men from a penitentiary center between 1989-1995 were included. 49.7% used illegal drugs. Prevalence of HIV infection was 24.3%. Using a multivariate test the authors found that the probability to be HIV-positive in a penitentiary center was 21.9 times higher in IVDU, 5.6 times in Spanish prisoners, 2.6 times in subjects with more than one prison stay and 1.7 times if they had tattoos.
Peters A, Davies T, Richardson A (1998). Multi-site samples of injecting drug users in Edinburgh: prevalence and correlates of risky injecting practices. Addiction, 93(2): 253-267.
Multivariate analysis indicated that risky injecting was associated with, among other things, injecting in prison.
Pickering H, Stimson G (1993). Syringe sharing in prison. The Lancet, 342(8871): 621-622.
This pilot study indicates frequent re-use of unsterile injecting equipment with consequent risks of infection with HIV and other blood-borne diseases, and the urgent need to implement appropriate prevent measures. Modelling of HIV transmission risk requires information on the number of individuals sharing each set of equipment and the frequency and order of use. Hitherto such information has been unavailable; this study shows it can be obtained.
Pont J et al. (1994). HIV epidemiology and risk behaviour promoting HIV transmission in Austrian prisons. European Journal of Epidemiology, 10: 285-289.
During the period 1989 - 1992 between 10 and 19% of all prisoners recently admitted to prisons and penitentiary institutions in Austria underwent HIV antibody tests. HIV prevalence rates were determined on the basis of tests in certain prisons in which more than 80% of the newly admitted inmates were tested. The results showed that prevalence rates among inmates in Austria are five times higher than rates in the general Austrian population. Approximately 5% of all inmates belong to the high risk group of intravenous drug users and enquiries into the HIV risk behaviour among prison inmates showed that, just as in other countries, intravenous drug use and sexual contacts are common practices. Since disposable needles and condoms are not available to prison inmates, these practices carry a particularly high risk of HIV transmission.
Pont J (1997). HIV epidemiology and risk behaviour in Austrian prisons. In: O'Brien O (ed). 1997, Report of the 3rd European Conference on Drug and HIV/AIDS Services in Prison. Cranstoun Drug Services: London, 12-14.
Injecting drug use and sexual contacts continue to occur in prisons. The associated risk of contracting HIV, HBV and HCV during such exposures is higher than in the general population because prisoners have no ready access to clean injecting equipment or condoms. In Austrian prisons there are currently no needle exchange programs. Since 1994, there has been free access to condoms by law in all prisons.
Data on HIV prevalence in prisons (collected through voluntary testing) were collected in 1989, 1990, 1992, 1994 and 1996. Information on risk behaviours for HIV, HBV and HBC transmission was obtained during medical entry examinations. There are no accurate figures on the number of drug users in Austrian prisons, but it can be estimated that around 10% of the 6700 sentenced prisoners are IDUs. This would suggest that about 7% of the estimated 10,000 IDUs in Austria are in prison.
Power K et al. (1992) Intravenous drug use and HIV transmission amongst inmates in Scottish prisons. British Journal of Addiction, 87: 35-45.
The intravenous drug use behaviour and HIV risk reduction strategies used by a group of Scottish inmates prior to prison, during imprisonment and as expected after release was investigated. From a sample of 559 inmates (490 males and 79 females) 27.5% were involved in IVDU prior to imprisonment, 7.7% on at least one occasion during a period of imprisonment and 14.7% expected to do so after release. Prior to imprisonment, 17.3% shared needles, 5.7% at some time during imprisonment and 4.3% expected to do so after release. Some form of HIV risk reduction strategies were practiced by the majority of IVDU inmates prior to imprisonment, during imprisonment and were expected to continue after release. The most at risk inmates were those who continued to share injecting equipment without reduction and without sterilizing. The reduction in IVDU and needle sharing during imprisonment in comparison to prior imprisonment was paralleled by a self-perceived reduction of personal risk from HIV during imprisonment.
Rotily M et al. (1994). HIV testing, HIV infection and associated risk factors among inmates in south-eastern French prisons. AIDS, 8(9): 1341-4.
The objective of the study was to estimate HIV seroprevalence in the two main remand and short-stay prisons of south-eastern France and to gather linked anonymous risk factor information. The setting is the Baumettes prison, Marseille, France between 16 November and 21 December 1992. Using a self-administered questionnaire about HIV testing and risk factors for HIV infection, 295 male and 137 female prisoners were interviewed. The response rate was 96%. 279 of 432 (65%) prisoners were tested for HIV; 153 (35%) declined to provide a blood sample. HIV status was available for 356 prisoners (82%; 65% from blood samples and 17% from the questionnaire); 39 were HIV-positive (10.9%; 95% confidence interval, 7.7-14.2). HIV seroprevalence was significantly higher among recidivist prisoners (19.9 versus 4.4%; P < 0.0001). The authors concluded that the higher seroprevalence rate among recidivist prisoners might be the result of risk behaviours during imprisonment. Another hypothesis is that recidivist prisoners are at greater risk of HIV infection because of higher levels of drug use.
Rotily M et al. (1998). Survey of French prison found that injecting drug use and tattooing occurred. British Medical Journal, 316(7133): 777.
Rotily M et al. (2001) Surveillance of HIV infection and related risk behaviour in European prisons. A multicentre pilot study. Eur J Public Health, 11(3): 243-250.
A cross-sectional survey was carried out in six European prisons (France, Germany, Italy, The Netherlands, Scotland and Sweden). 27% of 817 prisoners reported that they had ever injected drugs and 49% of these reported they had injected whilst in prison. 18% reported that they had been tattooed in prison. 1 and 16% reported that they had ever had homosexual and heterosexual intercourse in prison respectively. The HIV prevalence among IDUs was 4% (versus 1% among non-IDUs) (p = 0.02). The authors concluded that the continuing high HIV prevalence and potential for HIV spread in prisons should encourage decision makers in implementing or enhancing harm reduction and education programs and substance use treatment services in prison.
Shewan D, Gemmell M, Davies JB. Drug Use and Scottish Prisons: Full Report. Scottish Prison Service Occasional Paper, no 6. See also Shewan D, Gemmell M, Davies JB (1994). Drug Use and Scottish Prisons: Summary Report. Scottish Prison Service Occasional Paper, no 5.
The report urges governments and prison systems to address the possible adverse effects of sending drug users to prison, in particular the potential impact of prisons in increasing risk in terms of HIV and AIDS. It concludes that it "would be advantageous if prison authorities were to adopt the aims and objectives of a harm reduction response to drug use and HIV. This would involve a pragmatic response, and the realisation that the idea of a drug free prison does not seem to be any more realistic than the idea of a drug free society, and that stability may actually be better achieved by moving beyond this concept. In addition, adopting a harm reduction perspective puts prisons in the best position to ensure that they are not identified with major areas of concern for public health, such as the spread of HIV."
Shewan D, Gemmell M, Davies JB (1994). Prison as a modifier of drug using behaviour. Addiction Research, 2(2): 203-216.
Shewan D, Gemmell M, Davies JB (1994). Behavioural change amongst drug injectors in Scottish prisons. Soc Sci Med, 39(11): 1585-1586.
A study of injecting behaviour amongst a purposive sample of drug-users in Scottish prisons found that 32% reported injecting prior to current sentence. The percentage of these who were injecting during their current prison sentence had fallen to 11%. Of those who were injecting prior to imprisonment, 24% reported sharing injecting equipment at that time. Of those who were still injecting in prison, however, 76% reported sharing equipment. Overall, therefore, there were fewer injectors in prison, but a higher proportion of these shared needles. Factors most closely identified with current sharing of injecting equipment in prison were: having injected a wider range of drugs in prison (during both current and previous sentences); frequency of Temgesic use; and being prescribed methadone in the community, then having that prescription discontinued on entry to prison.
Shewan D et al. (1995). HIV infection in prisons. Most drug injectors stop injecting on entry to prison. British Medical Journal, 310: 1264.
Says that studies have shown that the extent and pattern of injecting and needle sharing vary among prisons; that many or even most people who inject before imprisonment stop injecting when they enter prison; and that those who inject in prison are much more likely to share injecting equipment than are drug injectors in the community. Points out that implementation of the appropriate preventive measures in a particular prison should take account of the characteristics of drug using behaviour within that prison and within the prison catchment area.
Shewan D et al. (1995). Patterns of injecting and sharing in a Scottish prison. Drug and Alcohol Dependency, 39(3): 237-243.
Smyth BP (2000). Many injectors stop injecting while imprisoned. British Medical Journal, 321: 1406.
For a summary, see the section on "injection drug use - needle and syringe programs"
Strang J et al. (1998). HIV/AIDS Risk Behaviour among Adult Male Prisoners. Research Findings No. 82. London: Home Office Research, Development and Statistics Directorate.
Available via www.homeoffice.gov.uk/rds/rf1998.html.
A survey of HIV risk behaviours among adult males was undertaken in 13 prisons in England and Wales. The survey looked at the behaviour associated with drug injecting, sexual practices and tattooing. It also examined the life histories of those concerned, the impact of imprisonment on them and their intentions in the future. The study concluded that, in general, "the bulk of HIV/AIDS risk behaviours cease on coming into prison, although the residual behaviour tends to be more risky."
Turnbull PJ, Dolan KA, Stimson G (1992). Prison Decreases the Prevalence of Behaviours but Increases the Risks (Poster Abstract No. PoC 4321). VIIIth International Conference on AIDS, Amsterdam.
Turnbull P, Stimson G, Dolan K (1992). Prevalence of HIV infection among ex-prisoners in England. British Medical Journal, 304: 90-91.
Turnbull PJ, Stimson GV (1994). Drug use in prison. British Medical Journal, 308(6945): 1716.
From a sample of 507 IDUs in London interviewed in 1993, 99 were randomly selected to answer questions about their prison experiences. 76 had experienced imprisonment. Of these, 45 had received no treatment, advice, or help for their drug problem the last time they were in prison. Injection in prison was reported by 21, and, of these, 14 shared needles and syringes on a mean of 20.2 (range 2- 100) occasions.
Turnbull PJ, Power R, Stimson G (1996). "Just using old works": injecting risk behaviour in prison. Drug and Alcohol Review, 15: 251-260.
In this study, 44 drug injectors who had been released from prison were recruited and interviewed in England. Interviewees were asked to recount their experiences of drug use
during their most recent period of imprisonment. All respondents reported drug use when imprisoned and drug injecting was reported by 16 interviewees. Most injected at irregular intervals and at a reduced level, compared with injecting when in the community. Nine reported using needles and syringes that others had previously used.
Van Haastrecht H, Bax Anneke JS, Van Den Hoek AR (1998) High rates of drug use, but low rates of HIV risk behaviours among injecting drug users during incarceration in Dutch prisons. Addiction, 93(9): 1417-25.
This study aimed to determine levels of injecting drug use and sexual risk behaviours in injecting drug users during and immediately following imprisonment in The Netherlands. A cross-sectional survey of drug injectors attending methadone clinics, a sexually transmitted disease clinic and a central research site in Amsterdam was undertaken. 78% were male and 34% had HIV antibodies. A period of imprisonment in the preceding 3 years was reported by 188 (41%) of 463 interviewed drug injectors. The mean duration of last imprisonment was 3.6 months. Any use of cannabis, heroin or cocaine during imprisonment was reported by 55%, 37% and 20%, respectively. Five injectors (3%) admitted to having injected in prison, but no sharing of needles and syringes was reported. Vaginal or anal sex was reported by two (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 78/186 (42%) participants, in most cases (34%) on the very first day of release. The study emphasized that, contrary to findings from other countries, low levels of HIV risk behaviours occur among imprisoned drug injectors in The Netherlands.
Russian Federation
Drobniewski FA et al. (2005). Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners. Eur Respir J, 26(2): 298-304.
Prisoners with TB were studied in order to identify prevalence of HIV, and risk factors for HIV and other blood-borne virus infections; and clinical and social factors that might compromise TB treatment effectiveness and/or patient adherence and, hence, encourage treatment failure. A 1-year cross-sectional prevalence study of 1,345 prisoners with TB was conducted at an in-patient TB facility in Samara, Russian Federation. HIV and hepatitis B and/or C co-infection occurred in 12.2% and 24.1% of prisoners, respectively, and rates were significantly higher than in civilians. Overall, 48.6% of prisoners used drugs, of which 88.3% were intravenous users. Prisoners were more likely to be intravenous drug users and HIV positive compared with civilians with TB, and 40.2% of prisoners shared needles. Two-thirds of prisoners (68.6%) had received previous TB drug therapy (frequently multiple, interrupted courses) and were significantly more likely than civilians to have had previous therapy consistent with the high drug-resistance rates seen. The study concluded that prisons are major drivers of the tuberculosis and HIV epidemics, and that novel strategies are needed to reduce the spread of blood borne diseases, particularly in intravenous drug users.
Human Rights Watch (2004). Russian Federation. Lessons Not Learned - Human Rights Abuses and HIV/AIDS in the Russian Federation. New York: HRW.
Available via www.hrw.org/doc/?t=hivaids_pub.
Reports that "[f]ormer inmates interviewed by Human Rights Watch in Saint Petersburg confirmed the presence of all kinds of narcotics in prisons, obtained mostly from the guards, who they said also supplied inmates with needles for a fee. Fyodor N ... said: 'There was a lot of drug use in prisons [in 2002 and 2003] - all kinds of drugs. The guards who had been paid off supplied the prisoners with drugs and needles. People could get anything through from the outside; the guards would turn a blind eye for money." Ekaterina S., a person living with HIV/AIDS whose boyfriend was incarcerated in 2002, said he was able to get a greater variety of drugs in prison than when he was out of jail, but all of them were much more expensive in prison than outside."
Frost L, Tchertkov V (2002). Prisoner risk taking in the Russian Federation. AIDS Eduction and Prevention, 14 (Suppl B): 7-23.
Among a few publications on the prevalence of risky behaviour in Russian prisons, special attention deserves this study performed in 2000 by MSF at 10 Russian penitentiary institutions. Ten percent of the surveyed prisoners reported at least one injection of illegal drugs during imprisonment, with nearly 2 percent of the total prison population injecting on a regular basis. Two thirds of those who injected drugs in prison also admitted needle-sharing. Tattooing in prison was reported by 26 percent of prisoners, with 62% sharing tattooing equipment. Sexual intercourse during imprisonment was admitted by 9.7 percent of prisoners. Considering the extreme sensitivity of the issues related to illegal drugs and sex the authors of the study recommended that the results of the research be interpreted conservatively as minimal estimates of potential risk.
Morozov A, Fridman A (2000). HIV testing, prevalence and risk behaviours among prisoners incarcerated in St Petersburg, Russia. 13th International AIDS Conference, Durban, South Africa (abstract MoPpCI1103).
The authors reported 46 percent HIV prevalence among a sample of 9727 IDU prisoners in Saint Petersburg in 1999, 58 percent of whom had injected in the last 12 months. 22 percent reported injecting with a used shared syringe in the last 12 months.
Rhodes T et al. (2003). Injecting equipment sharing among injecting drug users in Togliatti City, Russian Federation. 14th International Conference on the Reduction of Drug Related Harm, Chiang Mai, Thailand (Abstract 571).
IDUs arrested or detained by police in the past, and who on the last occasion had been arrested or detained for drugs, had over four times the odds of needle and syringe sharing in the last 4 weeks.
South-East Asia
Ministry of Law and Human Right of Republic Indonesia (2005). National Strategy Prevention and Control HIV/AIDS and Drug Abuse Indonesian Correction and Detention, 2005 - 2009. Jakarta: Directorate General Correction.
Reports an increase of HIV prevalence rates in prisons in Indonesia, with rates in 2003 ranging from 0.36 to 21.3 percent. States that in 2002, it was estimated that between 8 and 12 percent of all prisoners were HIV-positive.
Singh S, Prasad R, Mohanty A (1999). High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a district jail in Northern India. Int J STD AIDS, 10(7): 475-8.
A study conducted to establish the seroprevalence rate of sexually transmitted and blood-borne infections among district jail inmates in Northern India. The subjects (240 males and 9 female inmates), aged 15 to 50 years, were asked to answer a questionnaire comprising their background characteristics, alleged criminal background, period of confinement in jail, sexual activity, and sexual partners. Serum samples were obtained and were tested for antibodies against HIV and HCV. 71.2% had had sex only with women, while 28.8% were homosexual or bisexual. 126 (52.75%) were addicted to alcohol, 44 (18.33%) to smack/charas, and 8 (3.33%) used intravenous drugs. 11.6% had active hepatitis and 1.3% were HIV-1 positive.
Singh S (2002). High prevalence of viral and other sexually transmitted diseases was found in Indian prisons. British Medical Journal, 324: 850.
The letter describes a study of viral and sexually transmitted diseases in Indian prisons. It indicates a high prevalence of such diseases, most noticeably hepatitis B, hepatits C and HIV, related mostly to homosexual activity. Injecting drug use was a far less significant factor, mainly due to the low number of IDUs among the Indian prison population. The letter stresses the need for activities promoting increased STD awareness in Indian prisons.
Sundar M, Ravikumar KK, Sudarshan MK. (1995). A cross-sectional seroprevalence survey for HIV-1 and high risk sexual behaviour of seropositives in a prison in India. Indian J Public Health, 39(3): 116-118.
A sero-epidemiological period prevalence survey was conducted in Central Prison, Bangalore, South India covering 1007 undertrials and 107 permanent convicts during January to December 1993. Twenty (1.98%) undertrials and none of the permanent convicts were HIV-positive.
Western Pacific
Australia
Butler T et al. (2003). Drug use and its correlates in an Australian Prisoner Population. Addiction Research and Theory, 11: 89-101
The prevalence of past and present tobacco, alcohol, and illegal drug use is examined in a cross sectional random sample of prisoners. 789 male and female prisoners from 27 correctional centres across New South Wales (NSW) participated in the survey. Information was collected using a face-to-face interview. 64% of prisoners had used illegal drugs at some time in the past with cannabis and heroin the most common. 44% had a history of injecting drug use, with injecting prevalence significantly higher in females than males (64 vs. 40%). Approximately half of both male and female injectors reported that they had injected while in prison. The study concluded that correctional authorities need to ensure than drug treatment programs are available to prisoners and that consideration should be given to piloting needle and syringe exchange programs in prisons.
Cregan J (1998). Hepatitis C, prisons, and public health. Aust N Zealand J Public Health, 22: 5-7.
Crofts N et al. (1996). Risk behaviours for blood-borne viruses in a Victorian prison. Australia and New Zealand Journal of Criminology, 29: 20-28.
Dolan K, Donoghue M, Stimson G (1990). Drug injecting and syringe sharing in custody and in the community: an exploratory survey of HIV risk behaviour. Howard Journal of Criminal Justice 29(3): 177-186.
Found HIV positive prisoners were significantly more likely to inject than prisoners who were uninfected or unsure of the HIV status.
Dolan K et al. (1996). HIV risk behaviour of IDUs before, during and after imprisonment in New South Wales. Addiction Research, 4(2): 151-160.
Found HIV positive prisoners were significantly more likely to engage in sex than prisoners who were uninfected or unsure of the HIV status.
Dolan K, Crofts N (2000). A review of risk behaviours, transmission and prevention of blood borne viral infections in Australians prisons. In: Shewan D, Davies J (eds). Drug Use and Prisons. An International Perspective. Amsterdam: Harwood, 215- 232.
Douglas RM et al. (1989). Risk of transmission of the human immunodeficiency virus in the prison setting [letter]. Medical Journal of Australia, 150: 722.
Reports an Australian study estimating that during their incarceration 25% to 44% of prisoners occasionally injected illegal drugs, 14% to 34% engaged in occasional anal intercourse and 5% to 18% did both.
Gaughwin MD et al. (1991). HIV prevalence and risk behaviours for HIV transmission in South Australia prisons. AIDS, 5: 845-51.
Hellard ME, JS Hocking, N Crofts (2004). The prevalence and the risk behaviours associated with the transmission of hepatitis C virus in Australian correctional facilities. Epidemiology and Infection, 132: 409-415.
See the summary in the section on "HIV and HCV Transmission."
Indermauer D, Upton K (1988). Alcohol and drug use patterns of prisoners in Perth. Australian and New Zealand Journal of Criminology, 3: 144-167.
Estimated that 36% of prisoners had injected themselves intravenously, and 12 % had participated in anal intercourse at least once while in prison
Kevin M (2000). Addressing the Use of Drugs in Prison: A Survey of Prisoners in New South Wales. Sydney: NSW Department of Corrective Services (Research Publication No. 44) and Kevin M (2003). Addressing the Use of Drugs in Prison: Prevalence, Nature and Context. Sydney: NSW Department of Corrective Services (Research Publication No. 45)
Available via www.dcs.nsw.gov.au/Documents/index.asp.
The aim was to obtain data on the patterns of drug use by prisoners prior to and while serving a custodial sentence; and to provide a greater understanding of the contextual/cultural factors associated with drug use in prison. Data for the first study was collected in 1998 and data for the second in 2001. The studies found that the vast majority of people who shared injection equipment in prison had not shared in the community.
McDonald AM et al. (1999). HIV prevalence at reception into Australian prisons, 1991-1997. Medical Journal of Australia, 171: 18-21.
The objective was to measure the extent and outcome of HIV antibody testing at reception into Australian prisons. A cross-sectional survey at reception into Australian prisons from 1991 to 1997 was undertaken. In this period, HIV antibody testing was carried out for 72% of prison entrants in Australia; the percentage tested declined significantly from 76% in 1991 to 67% in 1997 (P <0.001). HIV prevalence was 0.2% among people received into Australian prisons in 1991-1997. Most people with HIV infection (242/378; 64%) received into prison in 1991-1997 had been diagnosed at a previous entry; 136 people (36% of the total number of diagnoses) were newly diagnosed at reception into prison.
Seamark RW, Gaughwin M (1994). Jabs in the dark: Injecting equipment found in prisons, and the risks of viral transmission. Australian Journal of Public Health, 18(1): 113-116.
Seamark RW et al (1997). HIV infection among male prisoners in South Australia, 1989 to 1994. Aust N Z J Public Health, 21(6): 572-6.
The prevalence of HIV in male prisoners in South Australia from July 1989 to June 1994 was ascertained from a repeated cross-sectional study. The authors also compared the criminological and demographic characteristics and histories of drug use of 39 HIV-infected prisoners and a randomly selected sample of 86 uninfected prisoners admitted at the same time. The numbers of HIV-infected prisoners in prison in any month ranged from 4 to 12. Prevalence among the total prison population ranged from 0.4 per cent to 1.4 per cent, and among the subpopulation of injecting drug users from 1.25 per cent to 4.36 per cent. Many HIV-positive prisoners continued after their diagnosis to have lifestyles that resulted in imprisonment. Infected prisoners were significantly older, had spent longer in prison and were more likely to be users of heroin (OR = 13.1) and methadone (OR = 25.4) than controls. The study concludes that the recidivism among many of the infected prisoners contributes to the variation in prevalence but also raises concerns about their management; and that greater effort to minimize the recidivism of the HIV-positive prisoners could reduce the prevalence of HIV in the prison population.
Wodak A (1990). Behind Bars: HIV Risk-Taking Behaviour of Sydney Male Drug Injectors While in Prison. In J. Norberry et al. (Eds), HIV/AIDS and Prisons. Canberra: Australian Institute of Criminology, 181-191.
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