Prevalence of transmissible infections, chronic illnesses, socio-demographic and behavioural risk factors amongst prison inmates in Mexico City: A cross-sectional study of 17,084 inmates

Sergio Bautista-Arredondo, Edson Serván, Fenella Beynon, Ruy López, Andrea González, Juan Sierra-Madero, Carlos Conde, Luis Juárez, Patricia Volkow

National Institute of Public HealthMexico

Health in prisons

• Most people serving prison sentences come from the poorest and most marginalized sectors of the population– Many of them in a poor state of health and with untreated

diseases– Many of them engage with higher frequency in risky activities

• The living conditions in most prisons of low- and middle-income countries are unhealthy and inadequate– Overcrowding, lack of light, fresh air and clean water, poor

food, suboptimal care and services and violence

• Globally transmissible infections such as HIV, Hepatitis, Syphilis and Tuberculosis much higher in prison

Prison health and public health

• The vast majority of people in prison eventually return to society

• Most of them receive visits while in prison • Prison staff have contact with inmates every

day• Diseases contracted in prison and conditions

that worsened during the confinement can become public health issues

Incarceration and HIV in the US

• Causal link between male incarceration rate and HIV prevalence in the US

• Incareration rates among african american population explain most of the disproportionate HIV prevalence among african american women

Mexico

• One of the biggest prison populations in LAC: incarceration rate 182 per 100,0001

• Mexico City, around 40,000 inmates (>400 per 100,000) 2

• High levels of overcrowding, poor living standard conditions, limited access to water, sanitation and medical care, drug use, corruption3

– Similar conditions have been documented in other countries in LAC 4

Objective

• Document health status of infeccious diseases, cronic conditions, sociodemographic and risk behavior characteristics in penitenciary centers in Mexico City

• Unique in size and scope

Methods• 4 penitenciary centers in Mexico City: from June to

December, 2010– Approximately 20,000 men and 2,000 women

• Voluntary and confidential participation, with informed consent1. Blood samples and antrhopometry to measure HIV, HVB

HVC, syphilis, gloucose, lypids, hipertension and obesity2. For a representative sample (10%): sociodemogrsaphics and

risk behaviors using ACASI3. All results where delivered to participants and for the

positive follow-up for treatment or referrals to health care

Results

010

2030

4050

Por

cent

aje

Menor de 30 años Entre 30 y 40 años Mayor de 40 años

Grupo de edad

Hombres Mujeres

Distribution of population by age

Men Women

Less than 30 30 to 40 More than 40

05

1015

2025

3035

4045

50

Sin estudiosPrimaria

SecundariaMedia superior

Superior Sin estudiosPrimaria

SecundariaMedia superior

Superior

Mujeres Hombres

Reclusorios Nacional

Por

cent

aje

Nivel educativo*

Schooling

Prisons General Population

MenWomen

*

0.5

11.

52

2.5

33.

54

4.5

55.

56

VIHVHC

HBcAbHBsAg

Anti-TP+/VDRL-VDR+

VIHVHC

HBcAbHBsAg

Anti-TP+/VDRL-VDRL+

Mujeres Hombres

Reclusorio Nacional*

Por

cent

aje

Infección de transmisión

Infectious diseasesWomen Men

Prisons General Population

Syphilis, by age0

24

68

1012

1416

20-29 30-39 40-49 50-59 60-69 20-29 30-39 40-49 50-59 60-69

Anti TP + VDRL -

Mujeres Hombres

Por

cent

aje

Grupo de edad

Women Men

0

20

40

60

80

Pre

vale

nce

/100

inha

bita

nts

20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69

Females Males

Prison General population

Age group

Obesity Prevalence

Diabetes and hypertension previously diagnosed0

1530

4560

015

3045

600

1530

4560

20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 All

All

Females

Males

Prison General population

Age group

Diabetes

Pre

vale

nce

/100

inh

abit

ants

20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 All

All

Females

Males

Prison General population

Age group

High blood presure

Violence and sexual risk behavior before and in prison

Substance use

Drug use before and in prison (%)

Findings

• Prevalence of HIV, HVC and syphilis higher than general population

• Chronic conditions, compared with national figures:– Obesity: similar among women, lower among men– Previously diagnosis: similar to GP

• Sociodemographic and behavior: – Lower levels of education– Higher use of drugs, tobacco, unsafe tatoos– Violence, sexual risk behavior and drug use

Thank yousbautista@insp.mx

References

1. Dolan K, Kite B, Black E, Aceijas C, Stimson GV. HIV in prison in low-income and middle-income countries. The Lancet infectious diseases. 2007;7(1):32-41. 2. Subsecretaría de Sistema Penitenciario G de DF2010. Movimiento Diario de Población Penitenciaria, 2010. Available at: http://www.reclusorios.df.gob.mx/reclusorios/estadisticas/index.html?anio=2010&mes=6. 3. Azaola E, Bergman M. El Sistema Penitenciaro Mexicano. USMEX 2003-04 Working Paper Series. 2003.4. Salla F, Rodriguez Ballesteros P, Espinoza O, et al. Democracy, Human Rights and Prison Conditions in South America. 2009.5. WHO. Health in Prisons: A WHO guide to the essentials in prison health. 2007.6. Jürgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. The Lancet infectious diseases. 2009;9(1):57-66. 7. Vescio MF, Longo B, Babudieri S, et al. Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. Journal of epidemiology and community health. 2008;62(4):305-13. 8. Weinbaum CM, Sabin KM, Santibanez SS. Hepatitis B , hepatitis C , and HIV in correctional populations : a review of epidemiology and prevention. Aids. 2005:41-46.9. de la Hoya PS, Bedia M, Murcia J, Cebriá J, Sánchez-Payá J, Portilla J. Factores predictivos de infección por el VIH, VHC y coinfección en la población reclusa de una prisión española. Enfermedades Infecciosas y Microbiología Clínica [Internet]. 2005 Feb;23(2):53–7. 10. Leddy M a, Schulkin J, Power ML. Consequences of high incarceration rate and high obesity prevalence on the prison system. Journal of correctional health care : the official journal of the National Commission on Correctional Health Care [Internet]. 2009 Oct [cited 2011 Dec 7];15(4):318–27.

References

11. Binswanger I a, Krueger PM, Steiner JF. Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. Journal of epidemiology and community health . 2009 Nov [cited 2011 Dec 7];63(11):912–9. 12. Nara K, Igarashi M. Serum of Prison Life Style to Blood Pressure , Lipids and Obesity in Women Prisoners in Japan. Industrial Health. 1998;:1–7. 13. CENSIDA. (2009). El VIH/SIDA en México 2009.14. Valdespino, J., Conde-González, C., Olaiz-Fernández, G., Palma, O., & Sepúlveda, J. (2007). Prevalencia en México de la infección y el estado de portador de la hepatitis B en adultos. Salud Publica de Mexico, 49(3), 404-411.15. Valdespino, J., Conde-González, C., Olaiz-Fernández, G., Palma, O., Kershenobich, D., & Sepúlveda, J. (2007). Seroprevalencia de la hepatitis C en adultos de México:¿ un problema de salud pública emergente? Salud Publica de Mexico, 49(Supl. 3), 395-403.16. Conde-González, C. J., J. L. Valdespino, et al. (2007). "Prevalencia de anticuerpos antitreponémicos y características sociodemográficas de la población mexicana adulta en el año 2000." Salud Publica de Mexico 49(Supl. 3): S395-S403.