A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities

Abstract

BackgroundPrior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons.MethodsWe administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy.ResultsWe recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18–1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20–1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43–1.98), history of mental illness (AOR 1.52; 95% CI: 1.31–1.78) and previous surgery (AOR 1.31; 95% CI: 1.12–1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73–22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13–4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64–6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20–5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care.ConclusionsHIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.

Prevalence of human immunodeficiency virus infection and associated risk factors among prison inmates in the City of Florianópolis

“…Notably, in countries where this type of study has previously been performed, the rate of HIV infection in prison populations was higher than that found in the general population (8) . This has also been shown to be case in Brazil; studies using the same observational approach as the present study demonstrated that the infection rate in the general population was 0.8% among men (9) , while the rate of HIV infection among the male inmate population ranged from 1.54-5.7% (10) (11) (12) . A similar result was obtained in a study of 333 male inmates at the Penitentiary of Ribeirão Preto, where the prevalence of HIV infection was 5.7% (10) .…”

“…In the State of Santa Catarina, a study involving ~300,000 individuals who donated blood between 2007 and 2013 reported a prevalence of HIV positivity of 1.5% (13) , showing that the prevalence of this virus in the general population is lower than that found in inmate populations. The behavioral habits of the inmates ( Table 2) were not significantly associated with the prevalence of HIV infection (11) (12) . However, limitations inherent to the small sample size meant that it was difficult to analyze the relationship between the prevalence of HIV infection and behavioral habits.…”

“…Another study of 680 male inmates was conducted in a prison in São Paulo, and the prevalence of HIV infection was 1.8% (11) . Furthermore, a study involving 2,843 individuals from eight prisons in Mato Grosso do Sul showed a HIV infection prevalence of 1.5% (12) . These studies demonstrated that the prevalence of HIV infection in the Florianopolis State Penitentiary, which was 2.1%, was not different from that observed in other penal institutions.…”

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

“…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 .…”