Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis

Abstract

IntroductionThe status of HIV and hepatitis C virus (HCV) infections among incarcerated populations in the Middle East and North Africa (MENA) and the links between prisons and the HIV epidemic are poorly understood. This review synthesized available HIV and HCV data in prisons in MENA and highlighted opportunities for action.MethodsThe review was based on data generated through the systematic searches of the MENA HIV/AIDS Epidemiology Synthesis Project (2003 to December 15, 2015) and the MENA HCV Epidemiology Synthesis Project (2011 to December 15, 2015). Sources of data included peer-reviewed publications and country-level reports and databases.Results and discussionWe estimated a population of 496,000 prisoners in MENA, with drug-related offences being a major cause for incarceration. Twenty countries had data on HIV among incarcerated populations with a median prevalence of 0.6% in Afghanistan, 6.1% in Djibouti, 0.01% in Egypt, 2.5% in Iran, 0% in Iraq, 0.1% in Jordan, 0.05% in Kuwait, 0.7% in Lebanon, 18.0% in Libya, 0.7% in Morocco, 0.3% in Oman, 1.1% in Pakistan, 0% in Palestine, 1.2% in Saudi Arabia, 0% in Somalia, 5.3% in Sudan and South Sudan, 0.04% in Syria, 0.05% in Tunisia, and 3.5% in Yemen. Seven countries had data on HCV, with a median prevalence of 1.7% in Afghanistan, 23.6% in Egypt, 28.1% in Lebanon, 15.6% in Pakistan, and 37.8% in Iran. Syria and Libya had only one HCV prevalence measure each at 1.5% and 23.7%, respectively. There was strong evidence for injecting drug use and the use of non-sterile injecting-equipment in prisons. Incarceration and injecting drugs, use of non-sterile injecting-equipment, and tattooing in prisons were found to be independent risk factors for HIV or HCV infections. High levels of sexual risk behaviour, tattooing and use of non-sterile razors among prisoners were documented.ConclusionsPrisons play an important role in HIV and HCV dynamics in MENA and have facilitated the emergence of large HIV epidemics in at least two countries, Iran and Pakistan. There is evidence for substantial but variable HIV and HCV prevalence, as well as risk behaviour including injecting drug use and unprotected sex among prisoners across countries. These findings highlight the need for comprehensive harm-reduction strategies in prisons.

Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio‐behavioural surveillance survey in 2015

“…and Heijnen et al . reported the HCV prevalence among incarcerated populations in Iran as 34.7% and 37.8% . Our results provide more accurate estimates and more up‐to‐date information for policy makers owing to the large sample size, nationwide coverage, design and bias control.…”

Who to Test for Hepatitis C Virus in the Middle East and North Africa?: Pooled Analyses of 2,500 Prevalence Measures, Including 49 Million Tests

“…The database also incorporates recent updates to these systematic reviews as well as unpublished country‐level routine data and thus is the most complete database for HCV infection in the MENA region. All HCV prevalence measures were subject to a detailed quality assessment as described and as informed by the Cochrane Collaboration Handbook guidelines…”

“…Prevalence studies were classified into six epidemiologic population categories based on an established population classification for the perceived risk of being exposed to HCV infection and as informed by existing literature . Based on this classification, prisoners were considered a population at intermediate risk because they can be exposed to HCV through practices such as tattooing, piercing, or anal sex.…”

“…Based on this classification, prisoners were considered a population at intermediate risk because they can be exposed to HCV through practices such as tattooing, piercing, or anal sex. Importantly, a proportion of prisoners also could be people who inject drugs (PWID), with this proportion varying immensely from one setting to another . Patients with HIV were classified based on the status of the HIV epidemic in each country.…”

Ensuring HIV Data Availability, Transparency and Integrity in the MENA Region Comment on "Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward"

“…Prospective follow-up is feasible, molecular phylogeny is obtainable and interpretable for understanding transmission dynamics and surveillance can guide improved policies. [21][22][23][24][25][26] History teaches time and time again that epidemics ignored are epidemics unleashed. A dearth of relevant data will simply misrepresent the true epidemic profile, misleading public health and clinical practitioners and policy-makers.…”