High-risk Injection Drug Research Articles

Pre-Exposure Prophylaxis for HIV: Bioethical, Clinical, and Epidemiological Considerations.

Public health authorities are broadly promoting a strategy known as pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) transmission in the context of high-risk sexual activity and injection drug use. However, there are several limitations to this strategy that are underrecognized. This article reviews the primary literature supporting the use of PrEP and explores the unintended consequences associated with its use. Current public health messaging indicates that PrEP reduces the risk of HIV transmission during sex by 99 percent; however, this figure is based on modeling rather than study findings, and real-world efficacy may be significantly lower. PrEP has been associated with increased rates of sexually transmitted infections, risk compensation, HIV drug resistance, low adherence, and drug side effects. To make fully informed decisions, medical professionals and patients should be aware of these pitfalls. Additionally, this article explores the bioethical implications of prescribing PrEP from a Catholic perspective. Although not always morally illicit, PrEP is most often prescribed in the context of sexual activity outside of marriage between a biological male and female, placing the prescriber in cooperation with activity deemed to be immoral by the Catholic Church. While all medical professionals seeking the common good should aim to reduce the transmission of HIV, not all means are morally licit. Conscience protection for medical professionals opposed to this strategy has become increasingly relevant. Thoughtful discernment is necessary when considering PrEP. Summary: The use of CDC material (figure 1) in this article does not imply endorsement by CDC. The material is in the public domain and available on the CDC website free of charge.

High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa.

We conducted a mixed-methods study to understand current drug use practices and access to healthcare services for people who use injection drugs in KwaZulu-Natal, South Africa. We used respondent-driven sampling to recruit 45 people who used injection drugs within the past 6 months from KwaZulu-Natal, South Africa. We found high rates of practices that increase HIV/viral hepatitis risk including the use of shared needles (43%) and direct blood injections (bluetoothing) (18%). Despite 35% living with HIV, only 40% accessed antiretroviral therapy within the past year, and one accessed PrEP. None of the participants ever tested for Hepatitis C.

Impact of Mobility on Methicillin-Resistant Staphylococcus aureus among Injection Drug Users

In this study, we develop and present a deterministic model for the transmission dynamics of methicillin-resistant staphylococcus aureus (MRSA) among injection drug users. The model consists of non-injection drug users as well as low-and high-risk injection drug users (IDUs). The model further incorporates the movement of these individuals between large metro, suburban and rural areas. The model parameters were estimated by fitting the model to the 2008–2013 disease prevalence data for non-IDUs obtained from the Agency for Healthcare and Research and Quality (AHRQ), as well as the 2009–2013 Census Bureau data for the number of individuals migrating between three different counties in Kansas. Sensitivity analysis was implemented to determine the parameters with the most significant impact on the total number of infected individuals; the transmission probability, recovery rates, and positive behavioral change parameter for the subgroup have the most significant effect on the number of infected individuals. Furthermore, the sensitivity of the parameters in the different areas was the same when the areas are disconnected. When the areas are connected, the parameters in large-metro areas were the most sensitive, and the rural areas were least sensitive. The result shows that to effectively control the disease across the large metro, suburban and rural areas, it is best to focus on controlling both behavior and disease in the large metro area as this has a trickle-down effect to the other places. However, controlling behavior and disease at the same time in all the areas will lead to the elimination of the disease.

Mathematical Modeling of High-risk Behaviors in Reformation and Social Assistance Centers

There is an increasing rate of high-risk behaviors in women, particularly those in prisons and high-risk places. This study was aimed to determine the high-risk behaviors among women residing in reformation and social assistance centers of Kermanshah province, Iran.In this cross sectional study, 480 women living in reformation and social assistance centers, central prisons, social welfare centers, suburban areas, high-risk neighborhoods and hangouts; were randomly selected. The primary data were collected via demographic and high-risk behavior questionnaire. To detect HIV infection, a rapid test was used as well as ELISA test in suspected cases. Statistical analysis was performed using Chi Square and Pearson Correlation Coefficient tests. The most prevalent high-risk behaviors in the subjects were addictive drug abuse (73.5%), arrest by judicial centers (59.2%), illegitimate sexual contacts (52.3%), and suicide (52.3%), respectively. The rapid HIV test revealed a positive correlation co-efficiency between HIV-positive individuals with crystal meth abuse (r=0.119, P=0.035).Associations were also observed between smoking and narcotic drug abusing (p<0.001) and with drinking alcohol (r=0.265, p<0.001). A history of suicide with a history of imprisonment also showed a positive correlation. A high prevalence of drug abusing, illegitimate sexual contacts, as well as transmission of HIV infection due to high-risk sexual contacts and injection drug addiction among the women were among the most significant findings of the survey. These observations highlight the importance of the of authority’s attention to design better policies and to implement them in order to reduce or prevent the resulting social harms.

Burden of hepatitis C virus infection in India: A systematic review and meta-analysis.

Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti-hepatitis C virus (HCV) seroprevalence in the Indian population. We searched several publication databases for English language papers that reported data on anti-HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high-risk groups were extracted and subjected to meta-analysis. Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti-HCV seroprevalence data points. Pooled anti-HCV seroprevalence rates in community-based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00-3.98%), 0.44% (0.40-0.49), and 0.88% (0.21-1.90), respectively. Among groups considered at high risk of HCV, pooled anti-HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43-4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52-25.65]), people who inject drugs (46, 14; 44.71% [37.50-52.03]), multi-transfused persons (38, 12; 24.06% [20.00-28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98-9.04]), and those with high-risk sex behavior (6, 5; 4.06% [1.79-7.10]). Community-based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti-HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high-risk groups, anti-HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high-risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions.

The Impact of Methadone Maintenance Treatment on HIV Risk Behaviors among High-Risk Injection Drug Users: A Systematic Review

Injection drug users (IDUs) are at high risk of acquiring HIV infection through preventable drug- and sex-related HIV risk behaviors. In recent decade, there has been a growing evidence that methadone maintenance treatment (MMT) is associated with a significant decrease in both drug- and sex-related risk behaviors among this high-risk population. The better understanding of the relationship between MMT and HIV-related risk behaviors will help to better inform future HIV prevention strategies, which may have policy implications as well. In this systematic review, we therefore aimed to explore the relevant literature to more clearly examine the possible impact of MMT on HIV risks behaviors among high-risk IDUs. The findings thus far suggest that MMT is associated with a significant decrease in injecting drug use and sharing of injecting equipment. Evidence on sex-related risk behavior is limited, but suggest that MMT is associated with a lower incidence of multiple sex partners and unprotected sex. The literature also suggests that the most significant factor in reducing HIV risks was treatment adherence. As such, more attention needs to be given in future studies to ensure the higher rates of access to MMT as well as to improve the adherence to MMT.

Transmission dynamics for Methicilin-resistant Staphalococous areus with injection drug user

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a bacterial pathogen resistance to antibiotics including methicillin. The resistance first emerged in 1960 in a healthcare setting only after two years of using methicillin as a viable treatment for methicillin-susceptible Staphylococcus aureus. MRSA leads to infections in different parts of the body including the skin, bloodstream, lungs, or the urinary tract.MethodsA deterministic model for methicillin-resistant Staphylococcus aureus (MRSA) with injection drug users is designed. The model incorporates transmission of MRSA among non-injection drug users and injection drug users (IDUs) who are both low-and high-risk users. A reduced MRSA transmission model with only non-IDUs is fitted to a 2008-2013 MRSA data from the Agency for Healthcare and Research and Quality (AHRQ). The parameter estimates obtained are projected onto the parameters for the low-and high-risk IDUs subgroups using risk factors obtained by constructing a risk assessment ethogram. Sensitivity analysis is carried out to determine parameters with the greatest impact on the reproduction number using the reduced non-IDUs model. Change in risk associated behaviors was studied using the full MRSA transmission model via the increase in risky behaviors and enrollment into rehabilitation programs or clean needle exchange programs. Three control effectiveness levels determined from the sensitivity analysis were used to study control of disease translation within the subgroups.ResultsThe sensitivity analysis indicates that the transmission probability and recovery rates within the subgroup have the highest impact on the reproduction number of the reduced non-IDU model. Change in risk associated behaviors from non-IDUs to low-and high-risk IDUs lead to more MRSA cases among the subgroups. However, when more IDUs enroll into rehabilitation programs or clean needle exchange programs, there was a reduction in the number of MRSA cases in the community. Furthermore, MRSA burden within the subgroups can effectively be curtailed in the community by implementing moderate- and high-effectiveness control strategies.ConclusionsMRSA burden can be curtailed among and within non-injection drug users and both low-and high-risk injection drug users by encouraging positive change in behaviors and by moderate- and high-effectiveness control strategies that effectively targets the transmission probability and recovery rates within the subgroups in the community.

PTH-100 A comparative gene expression study between individuals with apparent resistance, spontaneous clearance, or chronic infection from hcv

<h3>Introduction</h3> We have identified a group of high risk injection drug users who share needles, syringes and other injecting paraphernalia over a long period of time yet who remain uninfected by hepatitis C virus (HCV). These individuals appear to be resistant to HCV infection and we have termed them exposed uninfected (EU). Defining factors that may prevent HCV infection in these cohorts could give valuable insight into the mechanisms of natural resistance to HCV. <h3>Method</h3> Individuals at high risk of recurrent exposure to HCV infection from long term IDU were recruited in Plymouth and if HCV antibody and HCV RNA negative were termed exposed uninfected (EU). We have compared the transcriptional profiles of intravenous drug users (IDU) with 3 different outcomes following HCV exposure – chronic hepatitis C infection (CHCV; n = 6), spontaneously resolution of HCV (SR; HCV Ab positive but HCV RNA negative, n = 6) and exposed but uninfected (EU; n = 6). Agilent single channel microarray was performed on RNA isolated from peripheral blood mononuclear cells and the results were analysed on Ingenuity Pathway Analysis software (Qiagen). The identified targets were subsequently validated at a protein level. <h3>Results</h3> 1465 genes between the EU and CHCV group, 4377 between the CHCV and SR group and 4510 between the SR and EU group were significantly up or down regulated. Of the differentially regulated genes, the association with resistance to HCV was strongest for IL27 and CXCL7 which were significantly upregulated in EU (IL27 log fold change EU vs SR: 1.943, p = 1.72E-04 and CXCL7 log fold change EU vs CHCV 2.359, p = 6.04E-03) relative to the other 2 groups. At a protein level, the median IL27 serum level in the EU group (n = 13), detected by sandwich ELISA, was significantly higher (p = 0.008) compared to CHCV (n = 14), healthy control (HC; n = 8) and SR (n = 14) groups. The CD28 mediated T-helper cell signalling pathway was significantly upregulated in SR (ratio 0.348, p = 2.77E-05) relative to the 2 other groups. <h3>Conclusion</h3> Significant differences in gene expression were found in injection drug users with different outcomes from exposure to HCV infection. EU and SR exhibit differences related to innate and adaptive immunity compared to CHCV that likely contribute to natural resistance and spontaneous clearance of HCV. <h3>Disclosure of interest</h3> None Declared.

P5.023 Novel Emergency Department Registration Kiosk For HIV Screening Increases Engagement of High Risk Patients and is Cost-Effective

BackgroundHigh operating costs challenge sustainability of successful U.S. Emergency Department(ED) HIV screening programmes. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated a cost-effectiveness...

Peer-Education Intervention to Reduce Injection Risk Behaviors Benefits High-Risk Young Injection Drug Users: A Latent Transition Analysis of the CIDUS 3/DUIT Study

We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a time-matched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.

A Novel Combination HIV Prevention Strategy: Post-Exposure Prophylaxis with Contingency Management for Substance Abuse Treatment Among Methamphetamine-Using Men Who Have Sex with Men

Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of contingency management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.

Cytokine profiles in high risk injection drug users suggests innate as opposed to adaptive immunity in apparent resistance to hepatitis C virus infection

A cohort of injection drug users (IDU) have been identified who despite a long history of IDU and sharing of injecting equipment remain seronegative and aviraemic for hepatitis C virus (HCV). They have been termed HCV exposed uninfected (EU). The study of potential innate or adaptive immune mechanisms of resistance to HCV infection in this group is of interest. The aim of this study was to determine the levels of a broad range of cytokines in serum of exposed, uninfected individuals to ascertain whether there is a specific cytokine profile associated with apparent resistance to HCV. Sera from 22 EU individuals were analysed for a range of cytokines and chemokines, and compared to 16 treatment-naive chronic HCV cases (HCV Ab+ RNA+), 16 individuals with spontaneous resolution of HCV (HCV-Ab+ and HCV-RNA-) and 10 healthy unexposed controls. EU subjects had strikingly higher levels of both IL-6 (on average more than 100-fold, P = 0.001) and IL-8 (on average more than 10-fold, P < 0.001) than the comparison groups. Additionally higher levels of tumour necrosis factor-alpha (TNF-α; on average up to threefold, P = 0.02) were seen in EU individuals. The levels of interferon-alpha (IFN-α) were upregulated in all HCV exposed groups in comparison to healthy controls (P = 0.013). Adaptive immune cytokine levels were no different between the groups. Cytokine profiling demonstrated raised levels of pro-inflammatory innate immune cytokines and chemokines in EU IDU, in particular interleukin-6 and interleukin-8. These findings suggest innate immune activation may be the key to prevention of infection in this cohort.

The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States.

Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral therapy (ART) are limited, and all eligible persons are not currently receiving treatment. To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior. Dynamic mathematical model of HIV transmission and disease progression and cost-effectiveness analysis. Published literature. High-risk (injection drug users and men who have sex with men) and low-risk persons aged 15 to 64 years in the United States. Twenty years and lifetime (costs and quality-adjusted life-years [QALYs]). Societal. Expanded HIV screening and counseling, treatment with ART, or both. New HIV infections, discounted costs and QALYs, and incremental cost-effectiveness ratios. One-time HIV screening of low-risk persons coupled with annual screening of high-risk persons could prevent 6.7% of a projected 1.23 million new infections and cost $22,382 per QALY gained, assuming a 20% reduction in sexual activity after screening. Expanding ART utilization to 75% of eligible persons prevents 10.3% of infections and costs $20,300 per QALY gained. A combination strategy prevents 17.3% of infections and costs $21,580 per QALY gained. With no reduction in sexual activity, expanded screening prevents 3.7% of infections. Earlier ART initiation when a CD4 count is greater than 0.350 × 10(9) cells/L prevents 20% to 28% of infections. Additional efforts to halve high-risk behavior could reduce infections by 65%. The model of disease progression and treatment was simplified, and acute HIV screening was excluded. Expanding HIV screening and treatment simultaneously offers the greatest health benefit and is cost-effective. However, even substantial expansion of HIV screening and treatment programs is not sufficient to markedly reduce the U.S. HIV epidemic without substantial reductions in risk behavior. National Institute on Drug Abuse, National Institutes of Health, and Department of Veterans Affairs.

High-risk drug use and sexual behaviors among out-of-treatment drug users: An aging and life course perspective

High-risk injection drug use and its accompanying sexual behaviors have large social and financial costs. However, little is known about how age and age at first drug use are related to high-risk injection or sex behaviors. The current study draws on life course perspectives and data from the NIDA Cooperative Agreement to examine the relationship between eight high-risk behavior variables and age and age at first drug use. Random effects negative binomial regression models reveal that the frequency of high-risk sexual behaviors in the past month decreases up to 28% with each decade of age, although the frequency of high-risk injection behaviors in the past month increases by up to 62% with each decade of age. Both high-risk injection and high-risk sex behaviors are lower among those who initiated first drug use at later ages. Previous research has indicated the importance of interventions to reduce the high-risk sexual behaviors of older drug users. The current study suggests a refocusing of public health efforts on their high-risk injection habits.

Street Youth in Toronto, Canada: An Investigation of Demographic Predictors of HIV Status Among Street Youth Who Access Preventive Health and Social Services

Street youth are increasingly at risk for HIV infection due to high-risk sexual behaviors and injection drug use. The purpose of this study was to assess the extent to which demographic characteristics of street youth in Toronto were predictive of HIV status. Age, gender, and ethnicity, education, length of time street-involved, and income were measured among a cross-sectional sample of 18- to 30-year-old street youth (N = 140). Results revealed statistically significant relationships between Age and HIV status (β = 2.413, p < .001, OR = 11.169, 95.0% CI = 3.344–37.303), as well as Ethnicity and HIV status (β = 2.051, p = .005, OR = 7.773, 95.0% CI = 1.836–32.900). Findings suggest that HIV prevention intervention programs may need to be refined or extended appropriately to older street youth in those 26–30 years of age, especially to meet the cultural needs of Black, Aboriginal, and other ethnic homeless youth populations. Further investigation of the duration of street involvement relating to HIV-risk–taking behaviors is necessary.

Sex Risk Behaviors of Drug Users: A Dual Site Study of Predictors Over Time

Reducing sex risk behaviors among high-risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow-up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self-efficacy for reducing sex risk behaviors and being HIV-negative, and these predictors were significant at both postbaseline periods. In Puerto Rico, short-term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self-efficacy. However, only having primary partners was significant in longer-term behaviors. Results indicated the need for enhancing self-efficacy and for developing risk reduction strategies related to community differences.

Childhood abuse and initial presentation for HIV care: An opportunity for early intervention

An alarmingly high prevalence of childhood sexual and physical abuse has been observed in HIV-infected men and women, with rates several times higher than observed in the general population. Childhood abuse history has been associated with worse antiretroviral adherence and negative health behaviours in HIV-infected patients. This study evaluates the relationship between childhood abuse and the timing of presentation for HIV care. Participants in a multi-center prospective cohort study, who established initial HIV care after January 1996 and had a CD4 count available within six months of initial presentation, were included in this analysis. Bivariate contingency tables and multivariate logistic regression were used to evaluate the association of childhood abuse with early presentation for HIV care (initial CD4 count≥200/mm3). Among the 186 subjects included in this analysis, 33% had childhood abuse histories and 58% had an initial CD4 count≥200/mm3. Participants with a history of childhood abuse were more likely to present early for HIV care (AOR=2.12; p=0.03), perhaps because survivors of abuse tend to have higher utilization of health services. Because HIV-infected patients with childhood abuse histories have worse antiretroviral medication adherence and are more likely to engage in high-risk sexual and injection drug use behaviours, early presentation affords clinicians the opportunity for timely institution of interventions that may improve patient outcomes and prevent secondary HIV infections.

HIV Incidence, Retention, and Changes of High-Risk Behaviors Among Rural Injection Drug Users in Guangxi, China

Background: A prospective observational study of HIV seroincidence among high-risk injection drug users (IDU) was carried out in Guangxi, China. The primary objectives of this study were (1) to estimate HIV seroincidence, (2) to estimate participant retention rate, and (3) to evaluate changes in drug use and sexual behavior over a one year period. Methods: Five hundred HIV seronegative IDU were enrolled. HIV-1 incidence and retention rates were analyzed as a function of sociodemographic, behavioral, and recruitment variables. Changes in drug use and sexual behavior were analyzed at the baseline, 6-monfh and 12-monfh follow-up visits. Results: At 12 months of follow-up, the HIV-1 incidence rate was 3.1 per 100 person years, [95% CI: (1.6%; 5.2%)] and participant retention rate was 87%. Reported changes in high-risk behaviors over 12-monfhs included significant decreases in the frequency of heroin injection, in direct or indirect sharing of injection equipment, and in the number of sexual partners. Conclusions: HIV incidence is high among IDU in Guangxi, China despite a self-reported decrease in some high risk behaviors over the course of the Study.

HIV incidence, retention rate, and baseline predictors of HIV incidence and retention in a prospective cohort study of injection drug users in Xinjiang, China

To determine HIV seroincidence, study participant retention rate, and baseline predictors of HIV incidence and study retention among high-risk injection drug users (IDUs) in Xinjiang, China. A total of 508 eligible seronegative high-risk IDUs were enrolled. Study participants were tested for HIV-1 and counseled at the baseline, 6-month, and 12-month follow-up visits. Sociodemographic and behavioral data were collected during each study visit. The HIV-1 incidence rate and the retention rate were analyzed as a function of sociodemographic, behavioral, and recruitment variables. At 12 months of follow-up, the HIV-1 incidence rate was 8.8 per 100 person-years (95% CI 6.3-12.0%) and the participant retention rate was 93%. Marital status at baseline was the only predictor of HIV incidence. No baseline variables were predictive of study retention. HIV incidence is high among IDUs in Xinjiang, China. Baseline predictors of incidence and retention were minimal. The participant retention rate in this study is promising for the undertaking of future HIV intervention studies.

Prevention of infectious disease transmission in correctional settings: A review

To review studies defining risk factors for infectious disease transmission in correctional settings, to determine target objectives, and to assemble recommendations for health promotion in prisons and jails. Electronic databases were searched, using a specific search strategy, from 1993 to 2003. The principal risk factors in correctional facilities are proximity, high-risk sexual behaviour and injection drug use. Based on the type of disease transmissions and epidemics reported in the literature, four diseases were targeted for which preventive measures should be implemented: tuberculosis, human immunodeficiency virus, hepatitis and sexually transmitted diseases. Knowledge of risk factors helps define effective preventive measures along five main themes of action: information and education, screening, limiting harm from risk behaviour by distributing condoms and exchanging syringes, treatment and vaccinations. The effectiveness and feasibility of each of these actions have to be assessed in relation to the specificities of the correctional setting.