HIV and Viral Hepatitis Among Imprisoned Key Populations

Abstract

Prisons and other closed facilities create opportunities for transmission of human immunodeficiency virus (HIV) and viral hepatitis during detention and after release. We conducted a systematic review and meta-analysis of peer-reviewed publications (2005-2015) to describe the prevalence of HIV, hepatitis C virus, and hepatitis B virus among key populations in prisons worldwide and to compare estimates of infection with those of other prison populations. Most data were reported for people who inject drugs (PWID; n = 72) and for men who have sex with men (MSM; n = 21); few data were reported on sex workers (SW; n = 6), or transgender women (n = 2). Publications were identified from 29 countries, predominantly middle- and high-income countries. Globally, PWID had 6 times the prevalence of HIV (pooled prevalence ratio (PPR) = 6.0, 95% CI: 3.8, 9.4), 8 times the prevalence of hepatitis C virus (PPR = 8.1, 95% CI: 6.4, 10.4), and 2 times the prevalence of hepatitis B virus (PPR = 2.0, 95% CI: 1.5, 2.7) compared with noninjecting prisoner populations. Among these articles, only those from Iran, Scotland, Spain, and Italy included the availability of methadone therapy; 2 articles included information on access to needle exchange programs by PWID detainees. HIV prevalence was more than 2 times higher among SW (PPR = 2.6, 95% CI: 2.2, 3.1) and 5 times higher among MSM (PPR = 5.3, 95% CI: 3.5, 7.9) compared with other prisoners. None of these articles reported HIV prevention coverage among SW or transgender women; 1 described HIV and sexually transmitted infection screening for MSM in prison. Prevention programs specific to key populations are important, particularly for populations that are criminalized and/or may cycle in and out of prison.

Figure 1.

Countries for which articles or reports were found that provided prevalence or incidence data for human immunodeficiency virus, hepatitis C virus, and/or hepatitis B virus among key populations. Sources were published between January 2005 and July 2017. Black indicates data available; gray, data not identified.

Figure 2.

Meta-analysis of prevalence ratios (PRs) of human immunodeficiency virus (HIV) and 95% confidence intervals from research in prisons and closed settings published between January 2005 and July 2017 that compared prisoners who used injection drugs with noninjecting prisoners. Articles lacking HIV prevalence information for either people who inject drugs or their noninjecting counterparts were excluded from PR estimates.

Figure 3.

Meta-analysis of prevalence ratios (PRs) of hepatitis B virus (HBV) and 95% confidence intervals from research in prisons and closed settings published between January 2005 and July 2017 that compared prisoners who used injection drugs with noninjecting prisoners. Articles lacking HBV prevalence information for either people who inject drugs or their noninjecting counterparts were excluded from PR estimates.

Figure 4.

Meta-analysis of prevalence ratios (PRs) of human immunodeficiency virus (HIV) and 95% confidence intervals from research in prisons and closed settings published between January 2005 and July 2017 that compared sex workers with those who did not report a history of engaging in sex work. Articles lacking HIV prevalence information for either sex workers or their counterparts who were not engaged in sex work were excluded from PR estimates.

Figure 5.

Meta-analysis of prevalence ratios (PRs) of human immunodeficiency virus (HIV) and 95% confidence intervals from research in prisons and closed settings published between January 2005 and July 2017 that compared men who have sex with men (MSM) with men who did not report engaging in same-sex acts. Articles lacking HIV prevalence information for either MSM or their counterparts who were not engaged in same-sex practices were excluded from PR estimates.

Figure 6.

Meta-analysis of prevalence ratios (PRs) of hepatitis B virus (HBV) and 95% confidence intervals from research in prisons and closed settings published between January 2005 and July 2017 that compared men who have sex with men (MSM) with men who did not report engaging in same-sex acts. Articles lacking HBV prevalence information for either MSM or their counterparts who were not engaged in same-sex practices were excluded from PR estimates.

Figure 7.

Meta-analysis of prevalence ratios (PRs) of hepatitis C virus (HCV) and 95% confidence intervals from research in prisons and closed settings published between January 2005 and July 2017 that compared men who have sex with men (MSM) with men who did not report engaging in same-sex acts. Articles lacking HCV prevalence information for either MSM or their counterparts who were not engaged in same-sex practices were excluded from PR estimates.