Acquiring hepatitis C in prison: the social organisation of injecting risk

Abstract

AimThe potential for transmission of hepatitis C virus (HCV) in prison settings is well established and directly associated with sharing of injecting and tattooing equipment, as well as physical violence. This study is one of the first to examine the circumstances surrounding the acquisition of HCV in the prison setting via inmates’ own accounts.MethodThis is a sub-study of a cohort of prison inmates in New South Wales, Australia. Cohort participants were inmates who had reported ever injecting drugs and who had a negative HCV serological test within 12 months prior to enrolment. Cohort participants were monitored every 3 to 6 months for HCV antibodies and viraemia and via behavioural risk practices questionnaire. Participants with a documented HCV seroconversion were eligible to participate in in-depth interviews with a research nurse known to them.ResultsParticipants included six inmates (four men, two women) with documented within-prison HCV seroconversion. Participants reported few changes to their injecting practices or circumstances that they attributed to HCV acquisition. Participants believed that they were sharing syringes with others who were HCV negative and trusted that others would have declared their HCV status if positive. Some participants described cleaning equipment with water, but not with disinfectant. In a departure from usual routine, one participant suggested that he may have acquired HCV as a result of using a syringe pre-loaded with drugs that was given to him in return for lending a syringe to another inmate. Participants described regret at acquiring HCV and noted a number of pre- and post-release plans that this diagnosis impacted upon.ConclusionsAcquiring hepatitis C was not a neutral experience of participants but generated significant emotional reactions for some. Decisions to share injecting equipment were influenced by participants’ assumptions of the HCV status of their injecting partners. The social organisation of injecting, in trusted networks, is a challenge for HCV prevention programs and requires additional research.

Self‐reported injection practices among people who use drugs in French prisons: Public health implications (ANRS‐Coquelicot survey 2011–2013)

“…Similar findings already exist in the literature . Although fewer PWID inject inside prison , injection practices come with increased risk, as there is an absence of needle exchange programs in French prisons, and the prevalence of HIV and HCV are high . Disinfectants show limited efficacy for HCV prevention , and are not always accessible .…”

“…Disinfectants show limited efficacy for HCV prevention , and are not always accessible . Furthermore, PWID may not request them for fear of stigmatisation .The absence of needle exchange programs is only one of the reasons why PWID decide to stop injection during incarceration . Injection practices inside prison may concern repeated short‐term (‘revolving door’) or long‐term prison stays, the mean duration of incarceration of the PWID reporting injection practices inside prison in our study being 87 months (i.e.…”

Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005‐2014: The HITS‐p study

“…With regard to bleach cleansing, it is noteworthy that among injectors, no association with reduced HCV incidence was found in those who reported “always” using bleach to clean injecting equipment. A qualitative analysis of within‐prison incident infection episodes in HITS‐p revealed the substantial challenges in negotiating HCV transmission risk among PWID in prison . In this study, individuals believed that despite the high prevalence of HCV in the prison setting, they were sharing syringes with others who were uninfected, and one subject reported that he may have acquired HCV as a result of using a syringe preloaded with drugs that was given to him in return for lending a syringe to another inmate.…”

Public health and international drug policy

“…In Australia, for example, the prevalence of HCV infection among people entering prison in 2010 was 22% and among those with a history of drug injection 51%. 209 Phylogenetic and spatial analysis in Australia located a number of clusters of in-prison HCV transmission and suggested high transmission risk when people move from between prisons or from prison to the community. 210 …”