Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates

Abstract

Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.

Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis

“…One reason for this is that people who experience incarceration are also more likely to engage in risk behaviors for these infections, including injection drug use, unprotected sex, and unsterile tattooing and piercing. In their review, Moazen et al ( 14 ) considered what is known about the prevalence of these BBV risk behaviors among prisoners globally. Across 53 countries, they observed a high prevalence of BBV risk behaviors in prison, with marked heterogeneity in estimates only partially explained by regional differences.…”

A systematic review on models of care effectiveness and barriers to Hepatitis C treatment in prison settings in the EU/EEA

“…Such elevated HCV prevalence among those in prisons reflects a concentration of high‐risk individuals in the prison setting, especially drug users and people who inject drugs (PWID), who form a large part of the imprisoned population . The risk of infection persists further during incarceration, as prison settings amplify adverse health conditions through overcrowding, poor physical infrastructure and often inadequate access to health care services, and due to the common occurrence of high‐risk behaviours, such as sharing of needles and other sharp objects, tattooing and unprotected same‐sex intercourses …”

Blood-borne and sexually transmitted infections: a cross-sectional study in a Swiss prison

“…Second, this study focused on men, so data among women are needed, even if women represent only 5% of the total prison population in Switzerland. Third, because participants were asked to answer sensitive questions (e.g., sexual practices), this information may be less reliable due to reporting bias, social desirability [ 37 ], and because the questionnaire was completed face-to-face with a physician. Fourth, for HCV and HSV-2, only serological markers were tested, indicating previous contact with the virus, but not necessarily current infection.…”

“…Safer tattooing strategies should also be implemented, as tattooing is currently done in a clandestine and unsafe way by using inappropriate handcrafted equipment. Moreover, inmates share these tattoo devices, enhancing the risk of BBD transmission [ 37 , 40 ]. Identification of BBDs and STIs must be strengthened in detention facilities in a way that makes it possible to ethically screen as many people as manageable, ensuring individual autonomy and access to treatment [ 39 , 41 ].…”