Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees

Abstract

The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population. Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-scale outbreaks. Our model indicates that decreasing the incarceration rate in people who inject drugs and providing opioid agonist therapy could reduce the burden of HIV in this population. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The most effective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.

Fatores associados à prevalência do vírus da imunodeficiência humana em população privada de liberdade

“…The result of low investment in care and little political will to implement efforts to try to solve existing problems is clear. Health care in prisons is solely the responsibility of prison administration, and is disconnected from the recommendations laid down in the protocols of public health programs (11)(12)(13)(14) . Although international organizations have shown a decline in the rate of HIV prevalence among prisoners, reaching an average of 3.0% a year (15) , official data indicate that it is still higher than in the general population, demonstrating that it is a public health problem that is difficult to tackle.…”

“…The determinant risk factors that affect the health needs of prison populations include: overpopulation; unsafe sexual practices, especially those involving violence; use of drugs; and sharing sharp objects (12)(13)(14) . Regarding drug use, more than half of those infected with HIV reported using or having used drugs at some point in their lives.…”

Attention-Deficit Hyperactivity Disorder Symptom Status in a Mixed Gender Population of Opioid-Maintained Prison Inmates

“…This particularly applies to substance use disorders (SUDs), with up to 84% of inmates reporting abuse of some illicit substance prior to incarceration [2]. The high proportion of inmates with former substance abuse is attributable to a lack of adequate treatment for substance dependence in some countries, and to high rates of drug-related crime [3]. Attention-deficit hyperactivity disorder (ADHD) is frequently linked to criminal activities [4,5].…”

Speaker Abstracts

“…The registered growth in the period of 2000–2014 was on average 7% per year, an amount 10 times bigger than the Brazilian population growth, 94% of the quota being male [1,2]. Populations deprived of freedom are considered high-risk for sexually transmitted diseases, due to the favourable conditions encountered in prison for the propagation of diseases [3,4]. The State of Paraná presents the fifth biggest jail population in Brazil accounting for 4.61% of that population and has tried over the years to develop health attention policies to the convicted within the National Health Plan at the Penitentiary System (PNSSP) [5].…”