Infections and risk factors in entrants to Irish prisons

Editor—Long et al report a high prevalence of viral and other sexually transmitted diseases in Irish prisons and conclude that use of injecting drugs could be the single most important factor for the high infection with hepatitis C virus there.¹ They suggest that increased infection control and harm reduction measures are needed in Irish prisons. But they fail to acknowledge other, similar reports, particularly from the countries where HIV infection is highly epidemic.

I and colleagues from the Indian subcontinent conducted a study in 1998 among Indian prisoners.² Altogether 240 male and nine female prison inmates in a district prison near Delhi were screened for sexually transmitted and bloodborne diseases including HIV, syphilis, and hepatitis B and C viral infections. The inmates were aged 15-50 (mean (SD) 24.8 (0.11)). Of the 240 male prisoners, 115 were married and 184 gave a history of penetrative sex. Of the 184, 53 were homosexual or bisexual and the remainder had sex with women only.

Sixty of 131 prisoners were faithful to their partners, while 124 gave a history of having multiple sexual partners and 100 of them had unprotected sex. Eighty three of these 100 had had sex with commercial sex workers. Altogether 126 were addicted to alcohol and 44 to smack/charas; only eight had a history of injecting drug use.

On examination 28 of the 240 had active hepatitis with or without a history of jaundice in the past two years, 25 had active pulmonary tuberculosis, and 11 had syphilitic ulcers on the penis. Four fifths of the teenagers confined to a particular barrack had moderate to severe scabies. Three male prisoners (1%) were positive for HIV-1 (confirmed by western blotting) while 28 (11%) male and two (22%) female prisoners were positive for hepatitis B surface antigen. Twelve (5%) male but no female prisoners were positive for antibodies to hepatitis C virus. Of the three HIV positive prisoners, one was an injecting drug user, one was a drug user and frequent commercial sex worker, and the third was homosexual.

This study showed that sexually transmitted and bloodborne infections are highly prevalent in prisons in India and may spread rapidly because of injecting drug use and homosexuality. Interestingly, unlike Long et al we found more hepatitis B than hepatitis C infection. Injecting drug use was less frequent than in Irish prisons, and homosexuality was probably the most important risk factor in Indian prisons. The study emphasised that more awareness about HIV and hepatitis virus infection is needed in Indian prisons.