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BMJ No 7099 Volume 315 Papers Saturday 5 July 1997
Prevalence of HIV and injecting drug use in men entering Liverpool prisonMark A Bellis, Andrew R Weild, Nick J Beeching, Ken J Mutton, Qutub Syed See Papers p 18, p 21, Letters p 61, and Personal view p 65 Studies in countries other than England and Wales suggest that a comparatively high proportion of people entering prison have a history of injecting drug use before imprisonment and that drug use does not always stop once people are incarcerated.(1) Consequently the sharing of injecting equipment by drug users in a Scottish prison led to the infection of at least 13 inmates with HIV.(2) Currently, little information is available on the number of drug users entering prisons in England and Wales, their HIV prevalence, or their levels of injecting drug use once incarcerated. Therefore, discussion about the potential for injecting related HIV transmission within these prisons often requires extrapolation from data gathered in other countries.(3) To examine the potential role of English prisons in drug related transmission of HIV and other bloodborne viruses we administered questionnaires to new prisoners at a large men's prison and tested them for HIV antibodies. Subjects, methods, and resultsWe defined new prisoners as men arriving at prison for the first
occasion relating to their current remand (that is, awaiting trial
or sentencing) or sentence. Over 10 weeks in early 1996, 969 such
prisoners at reception to HM prison, Liverpool, were asked to complete
a short, anonymous questionnaire on their drug related and sexual
behaviour and provide a saliva sample.(4) Though
participation was voluntary, compliance was high - 921 (95.0%) subjects
completed all or part of the questionnaire and 905 (93.4%) provided a
matched saliva s Of 219 subjects with a history of injecting drugs and
incarceration, only 36 (16.4%; table 1) had ever injected in prison.
Though this suggests that imprisonment reduces injecting behaviour, for
those who continue to inject while incarcerated levels of risk
behaviour are substantially increased. Thus the prevalence of ever
sharing injecting equipment rose from 31.5% (82/260) among all new
arrivals with a history of injecting to 55.6% (20/36) sharing when
injecting while incarcerated (chi2=8.08; P<0.005).
Furthermore, men who had ever injected as well as current injectors
(that is, those who had injected in the past month) were
disproportionately represented among those returning for second (26.0%
ever, 19.7% current) or further sentences (42.0% ever, 29.9%
current). Consequently, incarceration may reduce the numbers of
subjects injecting drugs but only at the cost of increasing the risks
of infection among those who inject while imp
Of roughly 7,000 men received into HM prison, Liverpool, every
year, over a quarter (table 1) may previously have injected drugs. In
this survey only one such subject was HIV positive (an injecting drug
user currently unaware of his infection), reflecting low levels of HIV
in the local injecting communities.(5) However, the frequent
exchange of subjects between such communities and the prison population
means that drug use in prison cannot be taken in isolation. Indeed,
prisons represent a valuable opportunity to educate drug users,
familiarising them with safe injecting practice and the range of health
services (community drugs teams, syringe exchange schemes) available,
if not when incarcerated then certainly on release. Alternatively, if
levels of HIV or other bloodborne viruses increase outside prison the
high levels of sharing that occur when drugs are injected in prison may
multiply numbers of infections and redistribute these among different
drug using groups when inmates are released.
We are grateful for the support of Cathy James, Mike Jenkins,
Norman Tucker, and Robert Lyons from Liverpool prison and to the Home
Office for permitting this study, the prison inmates for participating,
and Sheila Gore and Graham Bird for advice.
Funding: orth West Regional Health Authority.
(Accepted 21 May 1997)
Sexual
Health and Environmental Epidemiology Unit, Liverpool School of
Tropical Medicine, Liverpool
Public Health Laboratory, Communicable
Disease Surveillance Centre (North West),
Correspondence to: Dr Bellis
(m.a.bellis@liv.ac.uk).
References
1 Ford B T, Derrickson J. AIDS in prison: a review of
epidemiology and preventive policy. AIDS 1992;6:623-8.
2 Yirrell D L, Robertson P, Goldberg D J, McMenamin J, Cameron S,
Leigh Brown A J. Molecular investigation into outbreak of HIV in a
Scottish prison. BMJ 1997;314:1446-50.
3 Curtis S P, Edwards A. HIV in UK prisons: a review of
seroprevalence, transmission and patterns of risk. Int J STD
AIDS 1995;6:387-91.
4 Johnson A M, Parry J V, Best S J, Smith A M, DeSilva M, Mortimer
P. HIV surveillance by testing saliva. AIDS
1988;2:369-71.
5 Morrison C L, Ruben S M. The development of healthcare services
for drug misusers and prostitutes. Postgrad Med J
1995;71:593-7.
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