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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 Health Mexico 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 consent 1. Blood samples and antrhopometry to measure HIV, HVB HVC, syphilis, gloucose, lypids, hipertension and obesity 2. For a representative sample (10%): sociodemogrsaphics and risk behaviors using ACASI 3. All results where delivered to participants and for the positive follow-up for treatment or referrals to health care Results 50 0 10 20 30 40 Distribution of population by age Less 30 Menor dethan 30 años 30 yto40 40años Entre 30 Morede than Mayor 40 40 años Grupo de edad Hombres Men Mujeres Women Schooling Men Hombres 0 5 10 15 20 25 30 35 40 45 50 Mujeres Women Sin estudios Secundaria Superior Primaria Media superior Sin estudios Secundaria Superior Primaria Media superior Nivel educativo Prisons Reclusorios * General Population Nacional Infectious diseases Men Hombres 0 .5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 Women Mujeres VIH HBcAb VHC Anti-TP+/VDRLHBsAg VDR+ VIH HBcAb VHC Anti-TP+/VDRLHBsAg VDRL+ Infección de transmisión * Prisons Reclusorio General Population Nacional* Syphilis, by age VDRL - 20-29 30-39 40-49 50-59 60-69 20-29 30-39 40-49 50-59 60-69 0 2 4 6 8 10 12 14 16 Anti TP + Grupo de edad Women Mujeres Men Hombres Obesity Prevalence Females Males 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 80 60 40 20 0 Age group Prison General population Diabetes and hypertension previously diagnosed Diabetes High blood presure All Females Females Males Males 0 0 15 30 45 60 0 15 30 45 60 Prevalence /100 inhabitants 15 30 45 60 All 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 All 20 - 29 30 - 39 Age group Prison 40 - 49 50 - 59 60 - 69 All Age group General population Prison General population Violence and sexual risk behavior before and in prison Physical violence Victim Offender Sexual violence Victim Offender Sexual risk behavior Used condom last sexual enc. Used alcohol/drugs last sex. enc. Transactional sex Gave money/favor for sex Received money/favor for sex In prison (%) Men Women Before prison (%) Men Women 26.8 15.8 23.5 10.2 ---18.7 ---14.1 0.2 0.3 1.3 1.3 3.0 2.8 21.9 4.4 20.5 4.1 18.3 8.1 20.9 19.1 16.9 21.4 2.0 0.6 2.6 2.6 22.1 8.9 0.9 18.8 Substance use Drug use before and in prison (%) Six months before prison / last month in prison Marijuana Every day Three times a week Solvents Every day Three times a week Cocaine / Crack Every day Three times a week Heroin Every day Three times a week Injected drugs Every day Three times a week Men before in prison prison Women before in prison prison 35.4 10.6 38.3 11.3 25.7 7.6 26.9 9.0 14.0 11.5 4.4 6.6 16.4 13.7 1.4 0.0 27.9 11.8 6.6 4.4 48.5 11.2 7.6 4.5 ------- 0.0 2.6 ------- 0.0 0.0 25.0 3.3 4.5 3.4 6.7 13.3 0.0 0.0 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 you [email protected] References 1. 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