Survey of French prison found that injecting drug use and tattooing occurred

Editor—Injecting drug use in prison is common in several northern European countries,¹ though the proportion of cases of AIDS attributable to injecting drug behaviour is higher in prisons in southeastern France (42%).² In 1996 about a fifth of the 58 000 prisoners in French prisons were injecting drug users. A study in Marseilles prison (2000 prisoners) in 1992 estimated the seroprevalence of HIV to be 7.1% among male prisoners and 13.1% among female prisoners and showed it to be higher among people who had been in prison previously.³ We investigated risk behaviours among injecting drug users in Marseilles prison.

We invited inmates who had been in Marseilles prison for three months to answer an anonymous self administered questionnaire. Altogether 520 (55%) of 942 male and 54 (77%) of 70 female inmates responded; 455 inmates (410 male, 45 female) answered the questionnaire about risky behaviours in prison. Among the 120 inmates who had ever injected drugs, 68 had injected during the 12 months before being imprisoned (active injecting drug users). Among the 102 injecting drug users who declared having been tested for HIV and informed us about their HIV status, 31 were infected. Nine of 68 active injecting drug users declared having injected drugs during the first three months of their imprisonment; female inmates injected more commonly than male inmates (5/12 (42%) v 4/56 (7%), P=0.006). Of these nine injecting drug users, four shared paraphernalia in prison, of whom one was HIV positive. Inactive injecting drug users did not report injecting in prison.

Thirty eight of 427 inmates reported having been tattooed during the first three months of imprisonment; six of these were HIV positive. Tattooing was more common among those who did than those who did not inject drugs (17/118 (14%) v 20/307 (7%) P=0.009) and among injecting drug users who injected inside prison than injecting drug users who did not (4/9 (44%) v 7/59 (12%), P=0.03).

This survey shows that injecting drug use was commonly reported by users in a prison in France, with a large excess among women. These results must be confirmed by a larger systematic study, but they support the policy of the French Penitentiary Administration, which has authorised use of bleach in prison since January 1997. This policy should be implemented rapidly and sustained by health education, access to medicated withdrawal, and maintenance treatment for opiate dependence. Because of the high prevalence of HIV infection and hepatitis C among injecting drug users (91%),⁴ pilot needle exchange programmes should be started, especially among women, and safe equipment for tattooing made available.⁵

We acknowledge the prison staff and inmates who participated in this study, which was supported by grants from the Agence Nationale de Recherche sur le Sida and the European Commission.