Prior 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.
We 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.
We 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,
completed more than four years of schooling,
history of previous incarceration, history of
mental illness and previous surgery. 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,
self-report of mental illness, history of
sexually transmitted infections, and syphilis
sero-positivity. 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.
HIV 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.
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By:
- 1University Hospital, Federal University of Grande Dourados, Dourados, Brazil.
- 2Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil.
- 3Faculty of Ambiental and Biological Sciences, Federal University of Grande Dourados, Brazil.
- 4Department of Biochemical Pharmacy, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
- 5Department of Biochemical Pharmacy, Federal University of Mato Grosso do Sul, Campo Grande, Brazil; Oswaldo Cruz Foundation, Campo Grande, Brazil.
- 6Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
- 7Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, Connecticut, United States of America.
- 8Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, Connecticut, United States of America; Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.
- 9Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
- 10Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil; Oswaldo Cruz Foundation, Campo Grande, Brazil.
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