A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population

Abstract

ObjectivesTo describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy.Materials and MethodsA cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral.Results76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found.ConclusionThe study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected will also enable the formulation of improved policy for this vulnerable group.

Prevalence of syphilis and HIV infection during pregnancy in incarcerated women and the incidence of congenital syphilis in births in prison in Brazil

“…Previous studies had already demonstrated worse social conditions 3,15,20,26 , the elevated prevalence of smoking 6,15,26,27 , alcohol and drug use 15,21,26,27 and mental disturbances 27 in incarcerated women.…”

“…A greater prevalence of syphilis infection in incarcerated women was also reported in a systematic review of studies undertaken across the period from 1996 to 2010 2 . Studies carried out in Peru 20 , Mexico 6 , and the USA 7 found an elevated prevalence of syphilis and HIV infection in incarcerated women.…”

“…Researchers have described the inadequate health care provided in prisons, with low access to serological diagnosis of sexually transmittable diseases 3,17 ; lack of knowledge and treatment of these infections 3,16,21 ; and a low rate of implementation of preventative measures, including immunisation and harm minimisation measures 13 . Health care in prisons has been recognised as a central item on the public health agenda and as a right of incarcerated individuals 2,4,6,7 , with adequate antenatal and birth care being part of this agenda 24,32 .…”

“…Studies carried out in several countries, including Brazil, showed a high prevalence of HIV and syphilis infections in incarcerated men 3,5,10,11,12,13 and women 2,3,6,14,15,16,17,18,19,20,21 , reinforcing the importance of serological diagnosis in prisons for the implementation of available intervention. However, Brazilian studies have been carried out in isolated prison units.…”

“…High prevalence of infectious disease is associated with greater social vulnerability of individuals prior to incarceration 2,3 , greater exposure to risk factors 4 , prison conditions that favor the transmission of these diseases 3,5,6 , and the lack of preventative and control measures such as diagnosis and treatment of infected individuals 3 . A higher prevalence of sexually transmittable diseases can persist throughout the post-incarceration period, as much due to an absence of diagnosis and/or treatment of diseases acquired before or during incarceration, as to the increasing risk of new infection upon re-entry into society 7 .…”