The Changing Landscape: Geospatial, Epidemiologic Characteristics and Infectious Diseases of Inmates Living in a Region with a High Number of Prisons, Brazil

Abstract

Objective: We determined the geospatial and epidemiologic characteristics and prevalence of HIV, tuberculosis, viral hepatitis, syphilis, and co-infections in inmates in 28 prisons. Design: This is a regional, observational, retrospective, and descriptive study conducted from November 2017 to October 2018. Setting Prisons are located in the western and northwestern regions of Sao Paulo state, Brazil. Methods: Data were obtained through a standard questionnaire from inmates with a diagnosis of infectious diseases and co-infections (HIV, hepatitis B virus, hepatitis C virus, syphilis, and tuberculosis), treatment, and time of incarceration. Locations of prisons and highways were obtained from shape file databases. Data on inhabitants, population growth, and Human Development Index were obtained from public agencies. Maps were constructed using geographic information system. Results: A total of 37,497 individuals were enrolled in the study and 741 (1.97%) were diagnosed. HIV was the most prevalent disease (0.68%), followed by tuberculosis (0.66%), syphilis (0.2%), HCV (0.2%), and HBV (0.04%). HIV-syphilis was the most prevalent co-infection (odds ratio, 63.7; 95% confidence interval: 41.4, 96.7). There was a statistical significance (P<0.001) for those with HIV acquiring co-infections. In 21 units, there was no relationship between the number of prisoners and the prevalence of infectious diseases.Mean age was 35.82 years (SD, 10.41 years) and 57.9% had been in prison previously. Strategically, most prisons were constructed beside radial highways. A higher than expected population growth was observed in 17 municipalities in which prisons were constructed (47.2%). Conclusions: This is one of the biggest studies in Brazil, and the prevalence of infectious diseases among inmates was lower than countrywide. Therefore, improvements in health care are necessary, mainly in screening for infectious diseases. Construction of large prisons beside the radial highways changed the landscape and prevented migration of people from small to large cities.