A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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 (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18–1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20–1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43–1.98), history of mental illness (AOR 1.52; 95% CI: 1.31–1.78) and previous surgery (AOR 1.31; 95% CI: 1.12–1.52). 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 (AOR 6.20, 95% CI: 1.73–22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13–4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64–6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20–5.39). 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.</p><p>Conclusions</p><p>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.</p></div

Sociodemographic and risk behaviors variables in 4 female Brazilian prisons.

<p>Abbreviations: HIV- Human Immunodeficiency vírus, SD–Stardard deviation, IDU–Intravenous drug user, STI–Sexually transmitted infections, EPFCAJG—Estabelecimento Penal Feminino Carlos Alberto Jonas Giordano, EPFTL—Estabelecimento Penal Feminino de Três Lagoas, EPFPP—Estabelecimento Penal Feminino de Ponta Porã, EPFIIZ—Estabelecimento Penal Feminino Irmã Irma Zorzi.</p><p>Sociodemographic and risk behaviors variables in 4 female Brazilian prisons.</p

Variables associated with previous HIV testing among prisoners (N = 3,362).

<p>Abbreviations: OR—odds ratio, IDU—intravenous drug user, STI—sexually transmitted infections.</p><p>Variables associated with previous HIV testing among prisoners (N = 3,362).</p

Risk factors associated with HIV among male and female prisoners (N = 3,362).

<p>Abbreviations: OR—odds ratio, IDU—intravenous drug user, STI—sexually transmitted infections.</p><p>Risk factors associated with HIV among male and female prisoners (N = 3,362).</p

Flow chart of the study enrollment and screening process for HIV.

<p>Flow chart of the study enrollment and screening process for HIV.</p

Sociodemographic and risk behaviors variables in 8 male Brazilian prisons.

<p>Abbreviations: HIV- Human Immunodeficiency vírus, SD–Stardard deviation, IDU–Intravenous drug user, STI–Sexually transmitted infections, EPC—Estabelecimento Penal de Corumbá, PTL—Penitenciária de Três Lagoas, EPRB—Estabelecimento Penal Ricardo Brandão, CTAL—Centro de Triagem Anízio Lima, PTCG—Presídio de Transito de Campo Grande, IPCG—Instituto Penal de Campo Grande, PHAC—Penitenciária Harry Amorim Costa and EPJFC—Estabelecimento Penal Jair Ferreira de Carvalho.</p><p>Sociodemographic and risk behaviors variables in 8 male Brazilian prisons.</p