HIV, hepatitis B and C, and syphilis share common transmission routes of which primarily unsafe sexual contact and injecting drug use are important. Impulsivity is a major factor contributing to this transmission risk behavior; however comprehensive studies within female, prison, and Asian populations are scarce. This cross-sectional study aims to delineate the contributions of different aspects of impulsivity to risk behavior, among female inmates living in a prison in Jakarta (N = 214). The relationships between various aspects of impulsivity, risk behaviors and seropositivity were tested using analyses of variance and logistic regression analyses. Motor impulsivity was related to alcohol use, reward-related impulsivity to drug use, and cognitive/goal-directed impulsivity to sexual risk behavior. Finally, goal-directed impulsivity was also directly associated with seropositivity. Specific aspects of impulsivity are associated with different types of risk behavior in Indonesian female prisoners, which can be relevant for future studies on infection prevention strategies for such a population.

Associations between impulsivity, risk behavior and HIV, HBV, HCV and syphilis 2 seroprevalence among female prisoners in Indonesia: A cross-sectional study 3 Impulsivity, risk behavior and infections in female prisoners 4 5 Abstract 36 HIV, hepatitis B and C, and syphilis share common transmission routes of which 37 primarily unsafe sexual contact and injecting drug use are important. Impulsivity is a major 38 factor contributing to this transmission risk behavior, however comprehensive studies within 39 female, prison, and Asian populations are scarce. This cross-sectional study aims to delineate the 40 contributions of different aspects of impulsivity to transmission risk behavior, among female 41 inmates living in a prison in Jakarta (N=214). The relationships between various aspects of 42 impulsivity, risky behavior and seropositivity were tested using analyses of variance and logistic 43 regression analyses. Motor impulsivity was related to alcohol use, reward-related impulsivity to 44 drug use, and cognitive/goal-directed impulsivity to sexual risk behavior. Finally, goal-directed 45 impulsivity was also directly associated with seropositivity. Specific aspects of impulsivity are 46 associated with different types of risky behaviors in Indonesian female prisoners, what can be 47 relevant for future studies on infection prevention strategies for such a population. 48 49 54 Indonesia is among the most afflicted countries in this region, with some of the highest numbers 55 of new infections and people living with HIV [4].56 The prevalence of syphilis and hepatitis also remain high in key populations across the 57 globe . With globally around 6 million new cases of syphilis infections, syphilis still poses a 58 major health burden [2]. Moreover, viral hepatitis remains a leading cause of death and 59 disability-adjusted life years (DALYs) worldwide, with the greatest burden in south-east Asia 3 60 [5]. As such, these infections as HIV, HBV, HCV and syphilis have a serious impact on sexual 61 and public health across the globe, particularly in Southeast Asian countries like Indonesia [6]. 62 HIV, HBV, HCV and syphilis share common ways of transmission through blood or other 63 body fluids, mainly as a result of unsafe sexual intercourse or intravenous drug use (IDU) [6]. In 64 Southeast Asia 21% of the burden of HIV cases and 28% of HCV were attributable to IDU in 65 2013, frequently found among populations such as sex workers, men who have sex with men 66 (MSM) or inmates [1]. 67 General prevention programmes often fail to reach these specific key populations and the 68 decline in those HIV infections has slowed down in recent years, also among inmates [7]. The 69 prevalence of HIV infection in 2016 was estimated to be five times higher in prison populations 70 and 24 times higher when inmates inject drugs, compared to the general population [7], possibly 71 due to persisting or increasing risks such as drug use, rape and unsafe sex [8]. As 30 million 72 people spend time in prisons every year, it is crucia...