Home > Hepatitis B, Hepatitis C and HIV in Irish prisoners: prevalence and risk.

Allwright, Shane and Barry, Joseph and Bradley, Fiona and Long, Jean and Thornton, Lelia (1999) Hepatitis B, Hepatitis C and HIV in Irish prisoners: prevalence and risk. Dublin: Stationery Office.

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Hepatitis B, hepatitis C and HIV are more prevalent in drug users than in the general population, and among drug users hepatitis C is the most common. In 1996 the Dept. of Justice estimated that 40% of the prison population had a history of serious drug misuse. The Department of has not published any systematic information on prevalence of hepatitis B, hepatitis C or HIV among the prisoner population. The Report of the Ministerial Task Force on measures to Reduce the Demand for Drugs estimated that approximately 70% of Prisoners in Mountjoy prison had a history of drug misuse.

This report hopes to determine the prevalence of hepatitis B, C and HIV in the Irish prison population, and to examine the association between the prevalence of these infections and factors such as age, prison history and risk behaviour, in particular injecting drug use, with a view to minimising transmission of hepatitis B, hepatitis C and HIV in Irish prisons. At the time of the survey the prison population consisted of 2,7000 prisoners located in 15 prisons. A cross sectional survey of hepatitis B, hepatitis C and HIV prevalence was carried out in the 5 prisons which had been classified as high risk for infection and four prisons (chosen by random sample) considered medium risk. All the high-risk prisons were in Dublin, while the medium risk prisons were outside of Dublin. A total of 1,205 prisoners took part in the study (response rate 88%) which consisted of completing a four page questionnaire and collecting a sample of oral fluid for testing for antibodies to hepatitis B, hepatitis C and HIV.

The fieldwork for the study was carried out between September and November 1998. Overall the prevalence rate for hepatitis B, C and HIV were 9%, 37% and 2% respectively. Infection rates for women prisoners were slightly, but not significantly, higher: prevalence rates for hepatitis B, C and HIV were 12%, 42% and 2% respectively. All infection rates were considerably higher in the high risk prisons, and, not unexpectedly, among drug users (where the prevalence of hepatitis B, C and HIV were 19%, 81% and 4%.) 630 respondents reported opiate use and 514 reported ever injecting drugs. 21% of injectors first started injecting in prison. Of those who injected in prison, 58% had shred drug-injecting equipment. The report concludes that major changes are needed in the organisation and delivery of the prison health service. Irish prisons vary significantly in their response to control of infection within them. What is required is a tailor made service for each prison within an overall framework of a co-ordinated response throughout the entire prison service. Hepatitis B vaccination is an effective preventative measure and should be promoted more actively.

Multivariate logistic regression analyses showed that injecting drug use was by far the most important predictor for both hepatitis B and hepatitis C infection. There is a case to be made for the provision of harm reduction strategies (methadone maintenance, needle exchange, condom availability) although the provision of such services is contentious. Health services for prisoners should be seen to be separate from the custodial service and responsibility for this service should be transferred to the Department of Health and Children.

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