Abstract
Prisons are considered high-risk environments for HIV transmission. This study aimed to measure HIV and syphilis prevalence and risk behaviors among inmates in Indonesia. An integrated HIV and syphilis biological and behavior survey was conducted on random samples of 900 male and 402 female inmates in 2010. Male inmates from 18 general prisons and detention centers were randomly selected using probability proportional to size. Female inmates were randomly selected from nine eligible institutions. HIV tests included two rapid tests and enzyme-linked immunosorbent assay (ELISA) for quality control. A rapid test was used for syphilis. Audio computer-assisted self-interview was used for collecting risk behavior information. HIV prevalence was 1.1% among male and 6.0% among female inmates. Syphilis prevalence was 5.1% for male and 8.5% for female inmates. A history of injecting drugs was the most important risk factor for HIV infection in male inmates; for females, it was co-infection with syphilis and being sentenced for illicit drug use. Inmates’ high-risk activities in prison included tattooing, piercing and inserting genital accessories without sterile equipment, and sex without condoms. The study found high-risk practices by male inmates and high HIV and syphilis prevalence in female inmates. Inmates need harm reduction initiatives.
Highlights
Most men and women in Indonesia who have acquired HIV have a history of either injecting drug use, sex work, or of being a client of a sex worker (Indonesian National AIDS Commission, 2012)
The survey findings of a HIV prevalence of 1.1% in male prisoners is consistent with the monthly prison data reported by more than 120 prisons to the Directorate of Corrections, with HIV prevalence in male prisoners ranging from 0.8% to 1.2% per month from January to September in 2011
The finding of a HIV prevalence of 6.0% corresponds with the high prevalence of syphilis at 8.5%. This demonstrates the additional risk of HIV from sexual transmission for female prisoners with 17.6% of those with HIV testing positive for syphilis, whereas for HIV positive men, only 2.2% tested positive for syphilis
Summary
Most men and women in Indonesia who have acquired HIV have a history of either injecting drug use, sex work, or of being a client of a sex worker (Indonesian National AIDS Commission, 2012). Given that some prisoners have a history of injecting drug use or sex work, some will already have HIV and/or syphilis before they enter prison. There were 10 male and 24 female participants found to have HIV in the prisons and detention centers, giving a prevalence of 1.1% and 6.0%, respectively. For those with a history of injecting drugs, the HIV prevalence was 8.0% in males and 12.0% in female prisoners compared with 0.5% and 5.6% who did not
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