Hepatitis A, B, C and HIV infections among Finnish female prisoners – Young females a risk group

doi:10.1016/j.jinf.2010.10.011

Journal of Infection

Volume 62, Issue 1, January 2011, Pages 59-66

https://doi.org/10.1016/j.jinf.2010.10.011 Get rights and content

Summary

Objectives

Previous prison studies have shown that the female gender is associated with higher hepatitis C prevalence. However, there are few prison studies of gender differences concerning the risk factors of hepatitis C infections. We studied the prevalence of hepatitis and HIV infections and the risk factors among Finnish female prisoners.

Methods

The material consisted of 88 females and 300 male prisoners as controls.

Results

The prevalence of hepatitis C virus antibodies was 52%, hepatitis B surface antigen 0%, hepatitis A virus antibodies 38% and HIV antibodies 1% among women, and 44%, 0.7%, 4% and 0.7% respectively among men. Among women, 71% of the age group 16–24 had HCV. There was no significant association between gender and HCV. Women were more commonly sharing syringes/needles and had unsafe sexual habits. Among women, HCV was associated only with IDU and syringe/needle sharing whereas among men also with tattoos, cumulative years in prison and age.

Conclusions

Especially young females had a high prevalence of HCV. The study showed that the risk factors are differentiated by gender. This should be taken into account when assessing earlier studies which mainly concentrate on men.

Introduction

In most western countries women are a small but growing minority of prisoners, as is also in Finland (from 3.5% in 1993 to 7% in 2008).¹ Very little is known of the health status of Finnish female prisoners. Prison studies conducted elsewhere show that women often have more health problems than male prisoners and they have many chronic and complex health conditions.² Especially mental disorders, infectious diseases and illicit drug use are common among female inmates.² Female prisoners are more severe drug users and experience more associated problems, according to a study by Holloway and Bennett.³ Female prisoners in the European Union are more likely to inject drugs than male prisoners.⁴ All in all, there are relatively few prison studies on the health-related problems and risk behaviour with a viewpoint on gender.

Intravenous drug use (IDU) presents a high risk for acquiring viral hepatitis and HIV infections among prisoner population5, 6, 7 and drug users.8, 9 In Finland, 80% of the intravenous drug users are hepatitis C positive.¹⁰ A recent meta-analysis among prisoners shows that in most studies the prevalence of HCV positivity has been 30–40%.¹¹ An important source of the heterogeneity among prison studies is the diverse proportion of IDU. In the same meta-analysis, female gender was associated with HCV positivity (odds ratio 1.44 compared with men), which is in contrast with observations made from general population where HCV prevalence is usually higher among men.¹¹ In different studies, the prevalence of HCV among female inmates has varied from 11% to 67%.6, 12, 13 The prevalence of HIV among female inmates has varied between 0 and 10% and the prevalence of hepatitis B virus core antigen (HBcAg) between 12 and 56%.5, 6, 7, 12, 14, 15

The presence of HCVAb and HBcAb (HBcAg antibody) has been associated with injecting drug use in prison and the number of previous imprisonments among male prisoners.⁶ According to Christensen and co-workers,¹⁶ among male Danish prisoners the duration of injecting drug use, number of imprisonments and injecting in prison were independently and positively associated with the presence of HBV antibodies among intravenous drug users (IDUs). Moreover, among prisoners, hepatitis C infection has been associated with age, tattooing and cumulative time of incarceration.11, 13, 14, 17, 18 These studies of HCV included both male and female inmates but the majority of subjects were men. Consequently, the results cannot be applied directly to females. In studies among male and female IDUs outside prison age and history of imprisonment were associated with hepatitis C seroconversion¹⁹ and syringe/needle sharing in prison was associated with hepatitis B, hepatitis C and HIV.²⁰

In Finland, the health of female offenders was never before appropriately researched. We had the opportunity to do so in context of a larger prison health survey of Finnish prisoners in 2006. For the first time, the prevalence of viral hepatitis A, B, C and HIV infection and the markers of hepatic disease among Finnish female prisoners and the risk factors of these infections were assessed, and the results compared with those concerning male prisoners.

Section snippets

Sample

In 2006, a total of 101 Finnish female prisoners participated in the nationally comprehensive prison health survey. It comprised over 40% of female prisoners (the average number of female prisoners in Finland in 2006 was 246, details can be found in the Criminal Sanctions Agency database²¹). The number of foreign female prisoners is low in Finland (in 2006, approx. 4–5%) and they did not enter the study. The Finnish female prisoners came from Hämeenlinna prison and consisted of a sample (N

Results

Characteristics of the participants and the bivariate comparisons between women and men are presented in Table 1. The mean age was 34.9 ± 10.2 SD (standard deviation) years among females, and 33.8 ± 10.4 SD among males (P = n.s.). It was more common for female prisoners to be married or cohabiting, have children and come from a lower social class. The male prisoners had more previous sentences and had spent longer times in prison. The female offenders had experienced sexual abuse, shared

Discussion

The main findings of this study were that female prisoners had high prevalence of HCV and intravenous drug use. Compared to men, females were more commonly prone to risk behaviour like syringe/needle sharing and unsafe sexual habits. The risk factors associated with HCV had gender differences. Hepatitis C was especially common among young females, which can cause continuous problems in the future. In both genders, HIV prevalence was on the same level as among Finnish IDUs.

Finnish prisoners had

Declaration of interest

None.

Acknowledgements

Funding for this study was provided by the Ministry of Justice (Finland) with no further role in the research process. Pirkanmaa Hospital District provided funding for the first author to analyze the data and write the paper.

References (40)

E.R. Miller et al.
The prevalence of HCV antibody in South Australian prisoners
J Infect
(2006)
A. Mallat et al.
Environmental factors as disease accelerators during chronic hepatitis C
J Hepatol
(2008)
F. Pessione et al.
Cigarette smoking and hepatic lesions in patients with chronic hepatitis C
Hepatology
(2001)
A.J. Freeman et al.
Estimating progression to cirrhosis in chronic hepatitis C virus infection
Hepatology
(2001)
The Criminal Sanctions Agency. Making Women Visible. Helsinki; 2008. 3/2008 [in...
Women's health in prison, Correcting gender inequity in prison health
(2009)
K. Holloway et al.
Gender differences in drug misuse and related problem behaviors among arrestees in the UK
Subst Use Misuse
(2007)
European Monitoring Centre for Drugs and Drug Addiction. Annual report 2004: the state of the drugs problem in the...
S. Babudieri et al.
Correlates of HIV, HBV, and HCV infections in a prison inmate population: results from a multicentre study in Italy
J Med Virol
(2005)
A.R. Weild et al.
Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey
Commun Dis Public Health
(2000)

S. Allwright et al.

Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey

Br Med J

(2000)

S.J. Hutchinson et al.

Hepatitis C virus infection in Scotland: epidemiological review and public health challenges

Scott Med J

(2006)

O.E. Santana Rodriguez et al.

Prevalence of serologic markers of HBV, HDV, HCV and HIV in non-injection drug users compared to injection drug users in Gran Canaria, Spain

Eur J Epidemiol

(1998)

A. Karvonen

Virus hepatitis

M.F. Vescio et al.

Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis

J Epidemiol Community Health

(2008)

N. Crofts et al.

Spread of bloodborne viruses among Australian prison entrants

Br Med J

(1995)

M.E. Hellard et al.

The prevalence and the risk behaviours associated with the transmission of hepatitis C virus in Australian correctional facilities

Epidemiol Infect

(2004)

Long J, Allwright S, Barry J, Reaper-Reynolds S, Thornton L, Bradley F. Hepatitis B. Hepatitis C and HIV in Irish...

P.M. Ford et al.

Voluntary anonymous linked study of the prevalence of HIV infection and hepatitis C among inmates in a Canadian federal penitentiary for women

Can Med Assoc J

(1995)

P.B. Christensen et al.

Prevalence and incidence of bloodborne viral infections among Danish prisoners

Eur J Epidemiol

(2000)

Cited by (24)

Gender-specific associations between psychological distress and injecting risk behaviours among people who inject drugs in Montreal, Canada
2021, International Journal of Drug Policy
Citation Excerpt :
Both qualitative and quantitative studies have documented lower agency of women relative to men who inject drugs, including within domestic or injecting partnerships and in the context of street-based risk environments and economies (El-Bassel & Strathdee, 2015; Marshall et al., 2008). Women are often “secondary” users of drugs relative to their male partners (Armstrong et al., 2017; Bryant et al., 2010; El-Bassel et al., 2014), and are therefore at higher risk of receptive needle sharing and exposure to contaminated equipment (Evans et al., 2003; Folch et al., 2013; Iversen et al., 2010; Mackesy-Amiti et al., 2014; Morris et al., 2014; Tracy et al., 2014; Viitanen et al., 2011) and blood-borne virus infection (Des Jarlais et al., 2012; Esmaeili et al., 2017; Iversen et al., 2010; Tracy et al., 2014). They are also at greater risk of feeling unsafe and experiencing stigmatization and/or physical and sexual violence within drug use scenes (El-Bassel & Strathdee, 2015).
Psychological distress is common among people who inject drugs (PWID) and may be associated with HCV-related risk behaviours. Previous studies have documented increased vulnerability to both psychological distress and HCV infection among female relative to male PWID. It is, however, unclear whether behavioural responses to distress differ by gender. This study estimated gender-specific associations between psychological distress and i) binge drug injection, and ii) sharing of injection materials.
Data were drawn from HEPCO, a longitudinal cohort study involving three-monthly interviews with active PWID in Montreal, Canada. Past-month psychological distress was assessed with the Kessler (K10) scale, categorized for descriptive analyses as minimal (score 10-15), moderate (16-21), high (22-29), or severe (30-50). Binge was defined as injecting large quantities of drugs until participants could no longer continue (past 3 months). Sharing was defined as injection with previously-used needles or equipment (past 3 months). Generalized additive models were fit to estimate smooth, nonlinear associations between K10 scores and risk behaviours, by gender. Models were adjusted for known determinants of drug-related harms and included random intercepts to model within-subject correlation.
805 individuals (82% male) provided 8158 observations (2011-2020). High to severe levels of distress were common and more frequent among women (55% vs 37%). Among men, the odds of binge and sharing monotonically and non-linearly increased with increasing scores of psychological distress. Associations for binge among women were attenuated relative to men but nevertheless increased with distress, albeit in a linear fashion. Sharing was not associated with distress among women.
Psychological distress was differentially associated with injecting risk behaviours among men and women who inject drugs. Assessment of distress may provide novel prevention opportunities for select PWID. Further investigation into gender differences is warranted to inform development and tailoring of interventions.
Prevalence, incidence and associated factors for HBV infection among male and female prisoners in Central Brazil: A multicenter study
2020, International Journal of Infectious Diseases
Prison populations are at high risk for hepatitis B virus (HBV) infection. The aim of this study was to assess the prevalence, incidence, HBV associated factors and circulating genotypes/subtypes.
A total of 3,368 prisoners from 12 closed prisons were randomly recruited for a cross-sectional study. In addition, a cohort study was conducted 12 months later and included 1,656 individuals. Participants underwent an interview and blood collection for the detection of HBV serological markers and HBV-DNA phylogenetic analysis.
HBV exposure (anti-HBc + ) was 9.8% (95% CI: 8.8-10.8); 11.2% were female and 9.6% were male. HBsAg+ was 0.6%. Only 31.4% of the participants had HBV vaccination-like profile (anti-HBs+ alone; 30.4% male vs. 36.8% female; p = 0.004). Most individuals were susceptible to HBV (60.2% female vs. 52.2% male, p = 0.001). HBV isolates were classified as genotypes A (45.4%), D (27.3%) and F (27.3%). In males, HBV exposure was associated with increased age. Male prisoners had more evidence of HCV/HBV co-infection (10.7%) than females (3.4%) and the frequency of Treponema pallidum infection among prisoners who had been exposed to HBV was higher in female prisoners when compared with male (39.7% vs. 19.1%). The incidence of HBV was 0.18/100 person-years (95% CI: 0.12%–0.25%).
Our results indicate a high prevalence of HBV exposure in prisoners. Despite the low incidence of this infection, the occurrence of new cases indicates the need to implement preventive measures.
Hepatitis C infection and psychiatric burden in two imprisoned cohorts: Young offenders and opioid-maintained prisoners
2018, Health Policy
Citation Excerpt :
Duration of heroin, cocaine, and amphetamine use (lifetime) [60,61] Months spent in prison (lifetime) [50,58,62] Drug use while in prison (past 30 days; only drugs that had been injected by the participants, lifetime: heroin, cocaine, amphetamines) [63,64]
Prisoners constitute a considerable gap in the hepatitis C virus (HCV) tested population. The present study examined HCV prevalence in imprisoned opioid-maintained patients (OMT-P) and adolescents and young adults (AYA, 14–26 years). In addition, HCV testing and treatment provision, knowledge of HCV status and psychiatric comorbidity were assessed. Data collection took place in six Austrian prisons. Participants were N = 133 for OMT-P (78% male, mean age 35.7 years) and N = 71 for AYA (100% male, mean age 19.8 years). Analysis of HCV serology was conducted. Psychiatric comorbidity and addiction severity were assessed applying standardized questionnaires and interviews. Antibodies were detected in 74.4% of OMT-P, and in 45.0% HCV infection was confirmed. Only one AYA was infected with HCV. None of the participants was receiving treatment for HCV. Eleven percent of OMT-P (50.7% of AYA) did not know their HCV status, and 14.3% of OMT-P (36.6% of AYA) had not been tested in prison. Among OMT-P, lifetime IDU [OR = 330.33, CI = 25.91–4433.20] and age at first IDU [OR = 0.90, CI = 0.82–0.98] significantly predicted HCV status. In both samples, a high prevalence of affective disorders was observed. Despite the high prevalence of HCV among opioid-dependent detainees, the unique opportunities for comprehensive testing and treatment of HCV are substantially underutilized. This is in stark contrast to the UN Basic Principles for the Treatment of Prisoners.
Tattooing in prison: a risk factor for HCV infection among inmates in the Quebec's provincial correctional system
2018, Annals of Epidemiology
Citation Excerpt :
Injection drug use and, more particularly, sharing injection equipment are the most important risk factor associated with HCV infection in most epidemiological surveys [1,3–5,9,10]. Tattooing, especially if performed in prisons or in nonlicensed settings, is also known as a risk factor [2–5,11–14]. However, some surveys among inmates reported that HCV prevalence was not independently associated with tattooing [6,8,15].
To determine the prevalence of hepatitis C virus (HCV) and identify related risk factors among inmates in Quebec provincial prisons.
Anonymous cross-sectional data were collected between May 2014 and March 2015 for 1315 men and 250 women who completed a questionnaire and provided oral fluid samples.
The global prevalence of HCV infection was 11.9% in male participants and 19.2% in female participants (P = .003). Among people who inject drugs (PWID), the prevalence was much higher compared to that in persons who does not: 51.0% versus 2.4% in men (P < .001) and 61.4% versus 2.8% in women (P < .001). In the multivariable analysis, lifetime history of injection drug use was the most important risk factor for HCV infection (adjusted odds ratio [AOR]: 14.2; 95% confidence interval [95% CI]: 9.5–21.4), with needle sharing significantly associated with HCV among PWID (AOR: 1.4; 95% CI: 1.1–1.7). Tattooing in prison was frequent, especially among men (37.2%), and independently associated with HCV infection among non-PWID (AOR: 2.8; 95% CI: 1.4–5.6).
Inmates are at high risk for HCV infection especially because of a high proportion of active or past PWID among them. In addition, tattooing while in prison seems to contribute to HCV infection among non-PWID.
Age-Specific Global Prevalence of Hepatitis B, Hepatitis C, HIV, and Tuberculosis Among Incarcerated People: A Systematic Review
2018, Journal of Adolescent Health
This study aims to compare the global prevalence of hepatitis B, hepatitis C, HIV, and tuberculosis in incarcerated adolescents and young adults (AYAs) and older prisoners.
This study is a systematic review and meta-analysis of studies reporting the age-specific prevalence of each infection in prisoners. We grouped age-specific prevalence estimates into three overlapping age categories: AYA prisoners (<25 years), older prisoners (≥25 years), and mixed category (spanning age 25 years). We used random effects meta-analysis to estimate the relative risk (RR) of each infection in AYAs versus older prisoners.
Among 72 studies, there was marked heterogeneity in prevalence estimates among AYA prisoners for all infections: hepatitis B (.4%–25.2%), hepatitis C (.0%–70.6%), HIV (.0%–15.8%), and active tuberculosis (.0%–3.7%). The pooled prevalence of HIV (RR = .39, 95% confidence interval .29–.53, I² = 79.2%) and hepatitis C (RR = .51, 95% confidence interval .33–.78, I² = 97.8%) was lower in AYAs than in older prisoners.
The prevalence of HIV and hepatitis C is lower in AYA prisoners than in older prisoners. Despite lower prevalence, acquisition begins early among incarcerated populations. There is an urgent need for targeted, age-appropriate prevention, treatment, and harm reduction measures in and beyond custodial settings to reduce the incidence of infection in these extremely vulnerable young people.
Prevalence and characteristics of mental and physical disorders among female prisoners: a mixed-methods systematic review
2023, International Journal of Prisoner Health

View all citing articles on Scopus

View full text

Hepatitis A, B, C and HIV infections among Finnish female prisoners – Young females a risk group

Summary

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Sample

Results

Discussion

Declaration of interest

Acknowledgements

J Infect

J Hepatol

Hepatology

Hepatology

Women's health in prison, Correcting gender inequity in prison health

Gender differences in drug misuse and related problem behaviors among arrestees in the UK

Subst Use Misuse

Correlates of HIV, HBV, and HCV infections in a prison inmate population: results from a multicentre study in Italy

J Med Virol

Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey

Commun Dis Public Health

Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey

Br Med J

Hepatitis C virus infection in Scotland: epidemiological review and public health challenges

Scott Med J

Prevalence of serologic markers of HBV, HDV, HCV and HIV in non-injection drug users compared to injection drug users in Gran Canaria, Spain

Eur J Epidemiol

Virus hepatitis

Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis

J Epidemiol Community Health

Spread of bloodborne viruses among Australian prison entrants

Br Med J

The prevalence and the risk behaviours associated with the transmission of hepatitis C virus in Australian correctional facilities

Epidemiol Infect

Voluntary anonymous linked study of the prevalence of HIV infection and hepatitis C among inmates in a Canadian federal penitentiary for women

Can Med Assoc J

Prevalence and incidence of bloodborne viral infections among Danish prisoners

Eur J Epidemiol