Identifying high risk groups for sexually transmitted infections and blood borne viruses upon admission to prison in Western Australia

Abstract

Prisoners frequently engage in high risk behaviours for sexually transmitted infections (STIs) and blood borne viruses (BBVs) and effective interventions are required to control the transmission of STIs and BBVs among prisoners. The variation in engagement in high risk behaviours among prisoner sociodemographic sub-groups in Western Australia, including differences between prisoners admitted to metropolitan and regional prisons, has not been systematically described. The objective of this article was to describe self-reported engagement in unprotected sex and sharing injecting equipment among prisoners on admission to prison in Western Australia, using routinely collected data. A retrospective medical record audit was conducted for a total of 946 individuals admitted to prisons in Western Australia. Quota sampling was used to ensure adequate sampling of females, juveniles, and individuals from regional prisons. Initial health assessment records completed on admission to prison in Western Australia were audited to evaluate self-reported engagement in unprotected sex and the sharing of injecting equipment among prison entrants. Unprotected sex in the previous 12 months was reported by 48% of prisoners, and ever sharing injecting equipment was reported by 16% of prisoners. Adults were more likely to report both unprotected sex (52%) and sharing injecting equipment (18%) than juveniles (40% and 11%, respectively). Adults admitted to a metropolitan prison were significantly more likely to report sharing injecting equipment (23%) than adults admitted to a regional prison (10%). Associations between risk behaviours, sex and Aboriginality differed among prisoners admitted to metropolitan and regional prisons. There is distinct sociodemographic patterning of high risk behaviours among prisoners in Western Australia by age, sex, Aboriginality and prison location. The effectiveness of interventions to prevent STI and BBV transmission in prisoners may be enhanced by addressing the diversity in the prison population, including the differences identified in reported risk behaviours between prisoners admitted to metropolitan and regional prisons. Culturally appropriate and comprehensive interventions are required to promote risk-reducing behaviours and address the health needs of all prisoners in Western Australia.