Lifetime Syphilis Prevalence and Associated Risk Factors Among Female Prisoners in Brazil

Abstract

Background In 2016, approximately 42,000 women were incarcerated in Brazil. The objectives of this study were to measure the lifetime prevalence of syphilis and sociodemographic and behavior correlates of antibody positivity among female prisoners in Brazil. Methods We conducted a cross-sectional survey of 1327 incarcerated women in 2014 to 2015 sampled through a multistage cluster design to represent the penitentiary system throughout Brazil. A rapid treponemal antibody test approved by the Ministry of Health (Rapid Test DPP Sífilis Bio-Manguinhos) was used to detect lifetime history of infection. Analyses were adjusted using weights based on the inverse of the product of the probabilities of the sampling units at each stage of the design. Variables significantly associated with syphilis infection at P < 0.05 in multivariate analyses were retained in the final model. Results Prevalence of syphilis antibody among female prisoners in Brazil was 11.6% (95% confidence interval [CI], 9.8%–13.8%). Higher syphilis prevalence was associated with black/Afro-Brazilian or mixed race/ethnicity (adjusted odds ratio [AOR], 1.78; 95% CI, 1.10–2.87), homelessness (AOR, 4.58; 95% CI, 2.78–7.56), abortion (AOR, 1.56; 95% CI, 1.02–2.38), and sexual violence (AOR, 1.59; 95% CI, 1.01–2.49). Syphilis prevalence was lower among women who had received condoms in school (AOR, 0.28; 95% CI, 0.08–1.00) as a marker for reproductive health education. Conclusions Women within the vast Brazilian prison system demonstrate a high lifetime cumulative incidence of syphilis. Our data advocate for increased screening and treatment of syphilis of incarcerated women and help identify women at higher risk within the prison system and within their communities of origin.

High Lifetime Prevalence of Syphilis in Men Who Have Sex With Men and Transgender Women Versus Low Lifetime Prevalence in Female Sex Workers in Lima, Peru

“…Compared with female sex workers in other countries, the lifetime prevalence of syphilis among the female sex workers in our study (3.4%) is lower than what has been reported in female sex workers in Moscow (13.9%) 22 and in female prisoners who report having ever received money for sex in Brazil (12.5%). 23 Our findings were higher than a study of female sex workers in Iran (0.4%). 24 Notably, none of the female sex workers in our population were infected with HIV while HIV prevalence was reported in Moscow (3.1%) 22 and Iran (2.1%).…”

Epidemiological serosurvey and molecular characterization of sexually transmitted infections among 1890 sheltered homeless people in Marseille: Cross-sectional one day-surveys (2000–2015)

“…No data on the seroprevalence of syphilis is available regarding the general French population; however, a 35% increase in early syphilis cases was observed in 2014-2015 with the vast majority presenting among men who have sex with men [27] . High rates of syphilis infections, ranging from 0.3 to 33.2%, were reported in homeless populations from Brazil, Iran and England [8][9][10] . Similar to HBV infection, we identified Asian and sub-Saharan African origins as being independent risk factors for syphilis infection.…”

“…The prevalence of past HBV infection (positive anti-HBc antibodies) ranged from 10.4% to 80.3% and that of ongoing infection (positive HBsAg) ranged from 0.4% to 4.7% [6,7] . Syphilis was observed in approximately 0.5% of homeless people in Iran (2012), in 1.1% in England (2004), in 7% in Brazil (2000-2011) [8,9] , and in 33.2% of Brazilian female prisoners with a history of homelessness (2014-2015) [10] . Human immunodeficiency virus (HIV) infection is frequent in the homeless population and has been extensively studied [5] .…”

The HIV and Syphilis Seroprevalence and Associated Risk Factors among Incarcerated Individuals in Port Harcourt

“…Infection with HIV has been shown to be prevalent among inmates globally [10,17], within the African continent [18,19], and in Nigeria as well [20][21][22], with prevalence rates ranging from 2.76% in Northern Nigeria to 3.9% in Southern Nigeria [20,22]. Studies have also shown that a higher burden of syphilis exists among prisoners than in the general population [23,24], reporting a prevalence of 2.89% [25], to as high as 11.6% [23], with an even higher prevalence of 31.7% reported in a Pakistani study [26]. This recorded prevalence of HIV and syphilis can be attributed to several factors, including the high rate of unprotected sexual contact, limited access to healthcare services, and inadequate public health interventions.…”