HIV AND HCV PREVALENCE IN PRISONS IN TUZLA CANTON Sana Šabović-OlićClinic for Infectious Diseases, University Clinical Center Tuzla, Bosnia and Herzegovina SARAJEVO, may 17-18, 2012
Prisons in B&H, besides fighting against entry of drugs, cellphones and other prohibited items, are confronting with one notso negligible problem, and it is about prisoners infected withHIV and hepatitis B and C.The situation with the number of infected prisoners in B&H isnot alarming, but the problem exists, and is notfor underestimation.Testing in prisons is voluntary, confidential and free of charge inorder to prevent spreading HIV and HCV infection, and todetect infected prisoners, so their treatment can be started inoptimal time.
The aim of this study is to show theprevalence of HIV, HCV & HBV infection in inmates of prisons in Tuzla Canton.
In period from january 1, 2007 to december 31, 2011, in Tuzlaprison were 483 inmates tested for HIV and HCV. The total numberff inmates that could be tested was much higher. For inmates underinvestigation we needed special permission, so we did not test them,as well as inmates in an outpost of prison, which was in city ofOrašje.
Testing was volontery, with pre-test and post-test counseling, andwith partially filled encrypted questionnaire. The questionnairecovered all the risky moments by which one person could get HIVand HCV.Blood of inmates was tested by ELISA HIV Combo assay, anti HCVand HBsAb, rapid HIV tests and ORA QUICK tests for HCV.
First testing in the prison was made in 1999. 34 prisoners were tested.
In years after, we tested prisoners 2 times per year.
From 2005, we tested prisoners 4-6 times per year.
Among the tested were 2% ofprisoners who were previously tested, and they were not included in this study.
Table 1. Age ond sex of prisoners in the prison in TuzlaAge Both sexes Male Female < 20 years 51 (10,56%) 40 (12,46%) 11 (6,72%)21-30 years 154 (31,88%) 92 (28,66%) 62 (38,27%)31-40 years 184 (38,1%) 110 (32.27%) 74 (45,67%)41-50 years 34 (7,03%) 29 (9.03%) 5 (3,08%)51-60 years 41 (8,48%) 32 (9,96%) 9 (5.55%) > 60 years 19 (3.93%) 18 (5,60%) 1 (0,61%)Total 483 (100%) 321 (64,4%) 162 (35,6%)
Table 2. Education of prisonersTYPE OF EDUCATION NUMBER OF PRISONERSWithout any education 21 (4,34%)Elementary school 131 (27,12%)High school 328 (67,95%)College 3 (0,62)Total number 483 (100,0%)
Table 3. Some characteristics of the tested prisonersTYPE OF CHARACTERISTIC NUMBER OF PRISONERSIntravenous drug users 106 (21,9 %)Users of other drugs 51 (10,55%)Unprotected sexual contacts 217 (44,92 %)MSM 11 (2,28 %)LB 4 (0,82)SWs 31 (6,41%)Contact with blood 37 (7,66 %)Fear 27 (5,59 %)Curiosity 37 (7,66 %)Total 483 (100,0 %)
In Tuzla prison 41 prisoner were positive for HCV, which is8,49% of total number of 483 inmates. Newly discovered HCVpositive inmates did not have any of symptoms.In 12 inmates, in consultation with prison doctor, liver testswere controlled.After coming out from prison, 5 ex inmates were admitted toClinic for Infectious Diseases for starting treatment.
In B&H there is no new data about the number of HIV and HCVpositive prisoners, so each one of prison institutions has its ownstatistic. According to available data, in prisons in B&H there are2 to 5% HCV positive inmates. There were no HIV positiveinmates.In Sarajevo prison, according to available data, 49 prisoners weretested for HIV, HBV and HCV. Among them 13 were positive forHCV and 12 for HBV. All of them were inravenious drug users.There were no HIV positive inmates. Total number of prisoners inSarajevo prison were 250, so percentage of infected with HCV is5,2%, which is pointing on a situation were prisoners are sharingneedles and other equipment for drug injecting.
According to available data:- In Zenica prison, prevalence of HCV in inmates is 6%, one inmate is HIV positive (HIV positive before coming to prison).- In Banja Luka prison, prevalence of HCV is 5-7 %, no HIV infected.- Conclusion is that HCV infection is bigger problem than HIV in prisons in BiH.- Similar situation is in many other countries, were HCV prevalence ranges up to 35%, but there are also countries were HIV is bigger problem, like USA, Brasil, Spain.
Prevalence of viral hepatitis infection among inmates in prisons inCroatia is much higher than in general population according tostudy done by professor Vitomir Burek from Clinic for InfectiousDiseases in Zagreb.Studies, which lasted for 3 years, were conducted on 4800 from atotal of 10300 prisoners. While HBV prevalence in generalpopulation is 11%, prevalence in prisons is 17%, and amongintravenous drug users even 30%. Among 4800 tested prisonershepatitis B was detected in 379.Data is even more dramatic when it is about HCV prevalence. Ingeneral population HCV prevalence is 1,1 %, among prisoners it is14,5%, and among intravenous drug users is 50%. 279 prisonerswere detected to be HCV positive.
Study coducted in 25 european prisons from 1996 to 1998(Rotilly& Weilandt,1999.) showed prevalence of HIV to be5,7%, and highest prevalence was in Portugal (19,7%) and inSpain (12,9%). Study showed also that HBV and HCVprevalences were much higher than in general population.
Inravenous drug use is still the most important risk factor forgetting HCV infection, and there is an estimation thatintravenous drug use is responsible for more than 90% of newinfections.If someone has ever shared equipment for intravenous druguse, even if it was long time ago, and only once – he or she hasa risk to become HCV positive.
Although there is some thoughts that the drug use is less frequent inprisons than in the community, every episode of drug injecting ismuch more dangerous in prison because of lack of the sterileequipment and high frequency of sharing the same equipment.Inspite efforts done to prevent drugs to come in to prisons, drugs issomehow in there. Because the smuggling of equipment for injectingis much more difficult, often just few syrenges and needles are inuse, which enhances possibilities that more inmates use the sameequipment.
Some quantity of blood which come in to the syrenges can betransffered to next user, and in that way make possibletransmission of agents, which are causing blood transmittedinfections. High concentration of HBV and HCV in blood, andtheir possibility to survive outside the body, makes them to beeasier and more frequent transmitted than HIV.
We wil continue with testing, counceling and education of prisoners and prison personnel, all in purpose to preventtransmission of blood transmitted agents, and early detection of infected. We have support and help of prison management.
References:Canadian HIV/AIDS Legal Network www.aidslaw.ca/EN/index.htmHow the UN Office on Drugs and Crime (UNODC) deals with HIVwww.unodc.org/unodc/en/hiv-aids/index.htmlInternational Guidelines on HIV/AIDS and Human Rights, 2006 Consolidated Version,UNAIDS data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdfWHO guidelines on HIV infection and AIDS in prisonsdata.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdfHIV/AIDS Prevention, Care, Treatment and Support in Prison Settings, WHO andUNAIDS data.unaids.org/pub/Report/2006/20060701_hiv-aids_prisons_en.pdfHIV and AIDS, and vulnerability, Eldis HIV and AIDS Resource Guidewww.eldis.org/go/topics/resource-guides/hiv-and-aids/vulnerabilityHarm reduction key issues guide, Eldis HIV and AIDS Resource Guide www.eldis.org/go/topics/resource-guides/hiv-and-aids/key-issues/harm-reduction