Spread of bloodborne viruses among Australian prison entrants

Abstract

Objectives: To assess spread of bloodborne viruses among prison entrants in Victoria, Australia. Design: Voluntary confidential testing of all prison entrants for markers of exposure to bloodborne viruses with collection of minimal data on demography and risk factors over 12 months. Setting: Her Majesty's Prisons, Pentridge and Fairlea, Victoria, Australia. Subjects: 3429 male and 198 female prison entrants (>99% of all prison entrants); 344 entered prison and were tested more than once. Main outcome measures: Prevalence and incidence of antibodies to HIV, hepatitis B, and hepatitis C viruses, and minimal data on risk factors. Results: 1562 (46%) gave a history of use of injected drugs, 1171 (33%) had antibody to hepatitis B core antigen, 1418 (39%) were anti-hepatitis C positive including 914 (64%) of the men who injected drugs, 91 (2.5%) were positive for hepatitis B surface antigen, and 17 (0.47%) were positive for antibody to HIV. Incidence rates for infection with hepa Conclusions: Hepatitis B and C are spreading rapidly through some populations of injecting drug users in Victoria, particularly among men aged less than 30 years at risk of imprisonment in whom rates of spread are extreme; this group constitutes a sizeable at risk population for spread of HIV. This spread is occurring in a context of integrated harm reduction measures outside prisons for prevention of viral spread but few programmes within or on transition from prisons; it poses an urgent challenge to these programmes. Key messages These programmes are seen to be effective in controlling the spread of HIV among injecting drug users among whom prevalence of HIV remains low There is, however, continued spread at high rates of hepatitis C and B among young injecting drug users entering prisons in Australia The highest rates (41% a year for hepatitis C and 21% a year for hepatitis B) are occurring among young male injecting drug users There is an urgent need to refocus harm reduction programmes to cope with the challenge of hepatitis C and to ensure prisoners are at no greater risk inside or on transition from prisons than they are outside