Prisons In Queensland Research Articles

Striking subgroup differences in substance-related mortality after release from prison.

To compare the incidence, timing and risk factors for substance-related death between Indigenous and non-Indigenous ex-prisoners in Queensland, Australia. Retrospective cohort study. All adult prisons in the state of Queensland, Australia, linked to deaths registered in Australia. We obtained records for all adults released from prison in Queensland, Australia from 1 January 1994 to 31 December 2007. Among this cohort of 42 015 individuals we observed 82 315 releases from prison and 2158 deaths in the community by the end of 2007, of which 661 were substance-related deaths. Incarceration data were obtained from Queensland Corrective Services and linked probabilistically with deaths recorded in the Australian National Death Index. In the first year after release, Indigenous ex-prisoners were more likely to die from alcohol-related causes [hazard ratio (HR) = 1.9, 95% confidence interval (CI) = 1.1-3.1)] but less likely to die of drug-related causes (HR = 0.34, 95%CI = 0.21-0.53) than were non-Indigenous ex-prisoners. Among non-Indigenous prisoners only, the risk of substance-related death was significantly higher in the first 4 weeks [relative risk (RR) = 5.1, 95% CI = 3.7-6.9] when compared with the risk after 1 year post-release. Most evaluated risk factors for substance-related death were similar for Indigenous and non-Indigenous ex-prisoners; however, the hazard of death increased with age more for Indigenous ex-prisoners (HR = 1.7 per decade of age, 95% CI = 1.4-2.1) than for non-Indigenous ex-prisoners (HR = 1.3, 95% CI = 1.2-1.4). In Australia, patterns of substance-related death in ex-prisoners differ markedly according to Indigenous status. Efforts to prevent substance-related deaths in ex-prisoners should consider heterogeneity in the target population and tailor responses accordingly.

Medication use and knowledge in a sample of Indigenous and non‐Indigenous prisoners

To (a) characterise medication use and knowledge, according to Indigenous status, and (b) identify independent correlates of medication knowledge in a sample of adult prisoners. Cross-sectional survey of 1,231 adult prisoners in Queensland, interviewed within six weeks of release. Measures included self-reported demographic and health-related characteristics, self-reported use of medications, the Hayes Ability Screening Index (HASI) and the Short-Form Health Survey (SF-36). Objective medication data were abstracted from prison medical records. A medication knowledge score was calculated to reflect the agreement between self-reported and objective medication use. 46% of participants were taking at least one medication. The most common class of medication was Central Nervous System (30% of participants). Medication knowledge was generally poor, with one quarter of prisoners unable to accurately identify any of their medications. Independent correlates of poor medication knowledge included not taking Central Nervous System medications, identifying as Indigenous and age >54. Around half prisoners are taking medications in prison, but most have poor knowledge of what these medications are. Medication knowledge is associated with better adherence and may contribute to improved health outcomes post-release. Changes to prescribing and dispensing practices in prison may improve medication knowledge and health outcomes in this profoundly marginalised group.

Trends in HIV, hepatitis B and hepatitis C prevalence among Australian prisoners ‐ 2004, 2007, 2010

To report the prevalence of markers for HIV infection, hepatitis B and hepatitis C among Australian prison entrants. Cross-sectional survey conducted over 2-week periods in 2004, 2007 and 2010. Reception prisons in New South Wales, Queensland, Tasmania and Western Australia. Individuals entering prison from the community during the survey periods. Prevalence of anti-HIV antibody (anti-HIV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (anti-HBc) and anti-hepatitis C virus antibody (anti-HCV). The study included 1742 prison entrants: 588 (33.8%) in 2004, 536 (30.8%) in 2007 and 618 (35.5%) in 2010. The age-standardised prevalence estimates for anti-HIV, HBsAg and anti-HBc were 0.4%, 2.3% and 21.7% respectively, and remained stable over the three survey periods. The age-standardised prevalence estimate for anti-HCV was 29.0%; it decreased over time (33.3% in 2004 v 23.2% in 2010; P = 0.001), and this coincided with a decrease in prison entrants reporting injecting drug use (58.3% [343/588] in 2004 v 45.3% [280/618] in 2010; P < 0.001). Among injecting drug users, the prevalence of anti-HCV was 57.2% and did not change significantly over time. Of those who were anti-HCV positive, 33.7% (140/415) were unaware of their infection status, and 74.3% (185/249) of those who tested positive for anti-HBc reported that they had never had hepatitis B. HIV prevalence is low in the Australian prisoner population but transmission remains a risk. Despite a decrease in the proportion of prison entrants reporting injecting drug use, prevalence of hepatitis B and hepatitis C has remained high. Treatment and prevention initiatives should be prioritised for this population.

A Descriptive Model of Patient Readiness, Motivators, and Hepatitis C Treatment Uptake among Australian Prisoners

BackgroundHepatitis C virus infection (HCV) has a significant global health burden with an estimated 2%–3% of the world's population infected, and more than 350,000 dying annually from HCV-related conditions including liver failure and liver cancer. Prisons potentially offer a relatively stable environment in which to commence treatment as they usually provide good access to health care providers, and are organised around routine and structure. Uptake of treatment of HCV, however, remains low in the community and in prisons. In this study, we explored factors affecting treatment uptake inside prisons and hypothesised that prisoners have unique issues influencing HCV treatment uptake as a consequence of their incarceration which are not experienced in other populations.Method and FindingsWe undertook a qualitative study exploring prisoners' accounts of why they refused, deferred, delayed or discontinued HCV treatment in prison. Between 2010 and 2013, 116 Australian inmates were interviewed from prisons in New South Wales, Queensland, and Western Australia. Prisoners experienced many factors similar to those which influence treatment uptake of those living with HCV infection in the community. Incarceration, however, provides different circumstances of how these factors are experienced which need to be better understood if the number of prisoners receiving treatment is to be increased. We developed a descriptive model of patient readiness and motivators for HCV treatment inside prisons and discussed how we can improve treatment uptake among prisoners.ConclusionThis study identified a broad and unique range of challenges to treatment of HCV in prison. Some of these are likely to be diminished by improving treatment options and improved models of health care delivery. Other barriers relate to inmate understanding of their illness and stigmatisation by other inmates and custodial staff and generally appear less amenable to change although there is potential for peer-based education to address lack of knowledge and stigma.

Predictive validity of the AUDIT for hazardous alcohol consumption in recently released prisoners

BackgroundThis study aimed to assess the predictive validity of the Alcohol Use Disorders Identification Test (AUDIT) among adult prisoners with respect to hazardous drinking following release, and identify predictors of post-release hazardous drinking among prisoners screening positive for risk of alcohol-related harm on the AUDIT. MethodsData came from a survey-based longitudinal study of 1325 sentenced adult prisoners in Queensland, Australia. Baseline interviews were conducted pre-release with follow-up at 3 and 6 months post-release. We calculated sensitivity, specificity and area under the receiver operating characteristic (AUROC) to quantify the predictive validity of the AUDIT administered at baseline with respect to post-release hazardous drinking. Other potential predictors of hazardous drinking were measured by self-report and their association with the outcome was examined using logistic regression. ResultsAt a cut-point of 8 or above, sensitivity of the AUDIT with respect to hazardous drinking at 3-month follow-up was 81.0% (95%CI: 77.9–84.6%) and specificity was 65.6% (95%CI: 60.6–70.3%). The AUROC was 0.78 (95%CI: 0.75–0.81), indicating moderate accuracy. Among those scoring 8 or above, high expectations to drink post-release (AOR: 2.49; 95%CI: 1.57–3.94) and past amphetamine-type stimulant (ATS) use (AOR: 1.64; 95%CI: 1.06–2.56) were significantly associated with hazardous drinking at 3 months post-release. Results were similar at 6 months. ConclusionsAmong adult prisoners in our sample, pre-release AUDIT scores predicted hazardous drinking six months after release with acceptable accuracy, sensitivity and specificity. Among prisoners screening positive on the AUDIT, expectations of post-release drinking and ATS use are potential targets for intervention to reduce future hazardous drinking.

Complex health-related needs among young, soon-to-be-released prisoners

BackgroundTo estimate the prevalence and co-occurrence of health-related needs among young people aged 18 to 24 years transitioning out of adult prisons.MethodsData came from face-to-face, confidential interviews with adult prisoners aged 18–24 years in seven adult prisons in Queensland, Australia. We identified the prevalence and co-occurrence of overlapping health-related needs using an Australian health performance framework with four domains: physical health, mental health, risky substance use and socioeconomic disadvantage.ResultsMost young prisoners experience multiple and complex health problems prior to their release: 98% of young prisoners reported at least one indicator of poor health, and 30% reported at least one indicator of poor health in all four evaluated domains.ConclusionsYoung people in adult prisons report a high prevalence of health problems across multiple domains. Addressing these complex needs will require coordinated service delivery across health-related sectors both in custody and after release.

Risk of death for young ex‐prisoners in the year following release from adult prison

In the community, all-cause mortality rates among those younger than 25 years are considerably lower than those of older adults and are largely attributable to risk-taking behaviours. However, given the unique health profiles of prisoners, this pattern may not be replicated among those leaving prison. We compared rates and patterns of mortality among young and older ex-prisoners in Queensland, Australia. We linked the identities of 42,015 persons (n=14,920 aged <25 years) released from adult prisons in Queensland, Australia with the Australian National Death Index. Observations were censored at death or 365 days from release. We used Cox proportional hazards regression to explore associations between mortality and demographic and criminographic characteristics. We used indirect standardisation to compare rates of all-cause mortality for both age groups with those for the general population. We calculated proportion of deaths across specific causes for each age group and relative risks for each cause for young versus older ex-prisoners. Being young was protective against death from all causes (AHR=0.7, 95% CI 0.5-0.8); however, the elevation in risk of all-cause death relative to the general population was greater for those aged less than 25 years (SMR=6.5, 95% CI 5.3-8.1) than for older ex-prisoners (SMR=4.0, 95% CI 3.5-4.5). Almost all deaths in young ex-prisoners and the majority of those in older ex-prisoners were caused by injury or poisoning. Young people are at markedly increased risk of death after release from prison and the majority of deaths are preventable.

Non-fatal overdose among adult prisoners with a history of injecting drug use in two Australian states

BackgroundRecently released prisoners are at markedly increased risk of death and drug-related causes predominate. Non-fatal overdose (NFOD) is considerably more common than fatal overdose, but has received relatively little research attention and most studies of NFOD in this population have suffered from small samples of unknown representativeness. This study aimed to estimate the prevalence and correlates of lifetime NFOD among prisoners in NSW and Queensland. MethodsCross-sectional surveys of adult prisoners in two Australian states: New South Wales (n=972) and Queensland (n=1316). Use of similar measures and methods in the two states made direct comparison of findings possible. ResultsIn both NSW and Queensland, 23% of participants reported a lifetime history of NFOD and prisoners with a history of injecting drug use were significantly more likely to report lifetime NFOD. The lifetime prevalence of NFOD among prisoners with a history of injecting drug use was significantly higher in NSW than in Queensland (44% vs. 35%; p<0.01). Independent correlates of lifetime NFOD were similar across the two states and included ever attempting suicide, ever injecting heroin, and ever injecting opioids. ConclusionsThe risk of NFOD among prisoners with a history of injecting drug use is high. An understanding of the risk factors for NFOD in this population can inform targeted, evidence-based interventions to reduce this risk.

Randomised controlled trial of a service brokerage intervention for ex-prisoners in Australia

BackgroundHealth outcomes after release from prison are typically poor with elevated rates of morbidity and mortality widely documented. Under-utilisation of health services contributes to these outcomes, but interventions to increase health service utilisation in ex-prisoners are in their infancy and few have been rigorously evaluated. MethodsSingle-blinded randomised controlled trial of a service brokerage intervention (the ‘Passports study’) for N=1325 adult ex-prisoners in Queensland, Australia. Participants in the intervention group received a personalised booklet summarising their health status and identifying appropriate community health services; trained workers made weekly telephone contact in the first 4weeks post-release to identify health needs and facilitate health service utilisation. Participants in the control arm received usual care. Baseline data were collected within 6weeks of expected release from custody with follow-up telephone interviews 1, 3 and 6months post-release. Participant identities were linked with federal health service utilisation records, a national death register and corrective services records, two years post-release. The primary outcome was self-reported health service utilisation in the first 6months post-release. ResultsBetween 2008 and 2010 1976 prisoners were screened for eligibility, 1665 met eligibility criteria and 1325 were recruited; 665 were randomised to the intervention and 660 to the control condition. Participants were broadly representative of adults being released from prison in Queensland except that women were intentionally oversampled (21% vs. 11%). ConclusionsOutcomes from this large RCT will provide the first robust evidence of the effect of service brokerage on health service utilisation and health outcomes for ex-prisoners.

Co-occurring mental disorder and intellectual disability in a large sample of Australian prisoners

Prisoners with intellectual disability who have a coexisting mental health issue often have unmet health needs and are more likely to reoffend than those with intellectual disability alone. The aims of this study were to estimate the prevalence of co-occurring mental disorder among prisoners with intellectual disability and to explore the association between intellectual disability and mental disorder. Cross-sectional study of adult prisoners within 6 weeks of release from custody in seven prisons in Queensland, Australia between August 2008 and July 2010. Intellectual disability was assessed using a practical composite screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and reported either having attended a special school or having been diagnosed with intellectual disability were identified as having an intellectual disability. Mental health was assessed using self-reported psychiatric diagnoses, the Kessler Psychological Distress Scale (K-10), and the Mental Component Summary score of the Short-Form-36 health survey version 2. The association between intellectual disability and mental health was assessed using univariate and multivariate logistic regression. Overall, 1279 prisoners completed the HASI: 316 (24%) scored below the recommended cut off for further diagnostic assessment of intellectual disability, 181 (14%) reported attending a special school, and 56 (4%) reported that they had been diagnosed with an intellectual disability. On our composite measure, 115 (9%) participants were identified as having an intellectual disability. Among prisoners with intellectual disability, the estimated lifetime and current prevalence of co-occurring mental disorders was 52.5% (95% CI 43.3-61.5) and 37.2% (95% CI 28.8-46.5), respectively. Of those with intellectual disability, 13.5% (95% CI 8.3-21.1) reported very high psychological distress, as measured by the K10. Prisoners with intellectual disability were significantly more likely than their non-disabled peers to report a current diagnosis of depression [adjusted odds ratio (AOR) 1.8, 95% CI 1.1-3.2] or substance dependence (AOR 3.7, 95% CI 1.6-8.4], after adjusting for potentially confounding variables. Prisoners with intellectual disability were also significantly more likely than their non-disabled peers to use antipsychotic medication (AOR 1.7, 95% CI 1.0-2.8). Prisoners with an intellectual disability were more likely than their non-disabled peers to have elevated rates of psychiatric comorbidity and unmet treatment needs. There is a need for enhanced collaboration between specialist intellectual disability psychiatric services and mainstream prison mental health services, to ensure coordinated service delivery for this dually disadvantaged group.

Opiate substitution treatment to reduce in-prison drug injection: A natural experiment

BackgroundThere is emerging evidence that opiate substitution treatment (OST) in prison is associated with reduced injecting drug use (IDU). In Australia OST is available in prison for men and women in all jurisdictions except Queensland, where it is available only for women. The aim of this study was to examine the association between in-prison OST and in-prison IDU in New South Wales (NSW) and Queensland. MethodsCross-sectional survey of Australian prisoners in NSW (N=1128) and Queensland (N=1325). Lifetime IDU and in-prison IDU measured by self-report. ResultsLifetime history of IDU was significantly more common among females than males in both jurisdictions. Among those with a lifetime history of IDU, the lifetime prevalence of in-prison IDU was significantly higher for males than females in both jurisdictions, however the magnitude of this sex difference was considerably greater in Queensland than in NSW. ConclusionProvision of OST in prison is associated with a reduced lifetime prevalence of in-prison drug injection, among those with a lifetime history of IDU. Irrespective of OST policies, women with a history of IDU are less likely than their male counterparts to inject in prison; reasons for this novel and replicable sex difference require further examination.

Penile Implants among Prisoners—A Cause for Concern?

BackgroundWe report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison.MethodsComputer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, “Have you ever inserted or implanted an object under the skin of your penis?” If they responded Yes: “Have you ever done so while you were in prison?” Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants.ResultsA total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05).ConclusionsPenile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.

Condoms for prisoners: no evidence that they increase sex in prison, but they increase safe sex

ObjectivesTo determine if the provision of condoms to prisoners in two Australian state prison systems with different policies affects sexual behaviour. In New South Wales’ (NSW) prisons, condoms are freely...

Anna's story of life in prison

Accessible summaryThis is the story ofAnnaBoodle. Anna told her story toKathyEllem about her time in prisons inQueensland,Australia.Anna has an intellectual disability. Living in prison was very hard for her.Anna has survived prison and now has a good life in the community.Anna wants to tell other people they can survive prison and have a good life.SummaryPeople with an intellectual disability in prison can be at increased risk of victimisation, segregation and isolation (Mullen). Prison systems usually have very few resources to cater to this group's particular needs, and many people may re‐enter the community with little or no rehabilitation, poor social connections, poor mental health and little chance in finding employment and living a crime‐free life (Baldryet al.). Gathering the lived expertise of ex‐prisoners with an intellectual disability can help others to better understand these experiences. This article is aboutAnnaBoodle's story of imprisonment inQueensland,Australia. Anna participated in a largerPhDstudy on the life stories of ex‐prisoners with an intellectual disability. It is apparent from her story, and the other stories in the study, that there is a need for more humane responses to people with an intellectual disability who offend. Anna's story is a tale of hope to others that a good life is possible after imprisonment.

Physical health outcomes in prisoners with intellectual disability: a cross‐sectional study

People with intellectual disability (ID) in the general population and people in prison experience unrecognised medical conditions and inadequate disease prevention. Among prisoners, those with an ID may be particularly disadvantaged. The aim of this study was to identify demographic, health and health-related characteristics of adult prisoners who screened positive for ID. Cross-sectional data were collected via face-to-face administration of a structured questionnaire in seven prisons in Queensland, Australia, between 2008 and 2010. Participants were adult prisoners within 6 weeks of release from custody. We identified ID using a pragmatic screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and either (a) reported having attended a special school or (b) reported having been diagnosed with an ID were considered to have screened positive for ID. We compared the characteristics of participants who screened positive and negative for ID using univariable and multivariable logistic regression. Screening positive for ID was associated with younger age, identifying as Indigenous and lower educational achievement. Prisoners who screened positive for ID were more likely to have been diagnosed with medical conditions such as heart disease (odds ratio; 95% confidence interval = 2.1; 1.0-4.2) and hearing problems (2.2; 1.3-3.7), after adjustment for age, sex, education level and Indigenous status. Screen-positive prisoners were less likely to have received preventive care interventions such as testing for hepatitis A infection (0.4; 0.2-0.6), and immunisation for tuberculosis (0.4; 0.2-0.8). Prisoners with possible ID were more likely to be obese (1.7; 1.1-2.7). Adult prisoners who screen positive for ID have worse health outcomes than their non-disabled peers. An improved understanding of physical health characteristics prior to release can direct treatment and support pathways out of the criminal justice system and inform transitional planning of health services for this profoundly disadvantaged group.

Sexual coercion prior to imprisonment: prevalence, demographic and behavioural correlates

Little is known about experiences of sexual coercion among prisoners prior to incarceration. Prisoner populations are routinely excluded from national surveys of sexual health which also tend to under-represent marginalized groups. We surveyed 2351 randomly selected men and women, aged 18-64 years, in New South Wales and Queensland prisons who participated in a computer-assisted telephone interview. Around 60% of women and 14% of men self-reported having been sexually coerced prior to incarceration, with 60% of these experiences occurring before the age of 16 years. Factors independently associated with a self-reported history of sexual coercion were: homosexual and bisexual identity, being unable to work, separated marital status, higher level of education (among women), having been paid for sex, a past sexually transmissible infection (among men), drug use (among women) and a history of mental health problems. Prior sexual coercion was associated with unwanted sexual contact and physical assault while in prison. The high prevalence of sexual coercion reported by prisoners and its association with a range of factors indicates a need for a greater acknowledgement of the potential consequences of this within the criminal justice system. This could entail providing counselling and support services within the correctional setting.

Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons

To estimate the prevalence of mental disorder in a representative sample of Aboriginal and Torres Strait Islander people in Queensland prisons. Cross-sectional assessment of mental health using the Composite International Diagnostic Interview (CIDI) and clinical interviews, conducted by Indigenous mental health clinicians who undertook specific training for this purpose, with support from forensic psychiatrists when indicated. We assessed adults who self-identified as Indigenous and were incarcerated in six of the nine major correctional centres across Queensland (housing 75% of all Indigenous men and 90% of all Indigenous women in Queensland prisons) between May and June 2008. Diagnoses of anxiety, depressive and substance misuse disorders using the CIDI; diagnosis of psychotic illness determined through psychiatrist interviews supplemented by a diagnostic panel. We interviewed 25% of all Indigenous men (347/1381; mean age, 31.5 years) and 62% of all Indigenous women (72/116; mean age, 29.2 years) incarcerated at the time of our study. The recruitment fraction was 71% for men and 81% for women. Among the 396 individuals who completed both the interview and the CIDI, the 12-month prevalence of mental disorder was 73% among men and 86% among women. This comprised anxiety disorders (men, 20%; women, 51%); depressive disorders (men, 11%; women, 29%); psychotic disorders (men, 8%; women, 23%) and substance misuse disorders (men, 66%; women, 69%). The prevalence of mental disorder among Indigenous adults in Queensland custody is very high compared with community estimates. There remains an urgent need to develop and resource culturally capable mental health services for Indigenous Australians in custody.

Prevalence and correlates of alcohol dependence in adult prisoners vary according to Indigenous status

Objective : To estimate the prevalence and identify independent correlates of alcohol dependence among Indigenous and non-Indigenous adult prisoners in Queensland. Methods : A confidential, cross-sectional survey of 1,155 adult prisoners (n=274 Indigenous, n=881 non-Indigenous) in seven adult prisons in Queensland. The usual alcohol consumption in the year before prison was assessed using the Alcohol Use Disorders Identification Test (AUDIT); scores =20 are considered consistent with alcohol dependence. Results : Indigenous prisoners were significantly more likely than non-Indigenous prisoners to report patterns of alcohol consumption consistent with dependence. Separate multivariable analyses revealed different independent correlates of alcohol dependence according to Indigenous status. Among Indigenous prisoners, significant independent correlates of alcohol dependence included income below the poverty line and daily cannabis use before incarceration. Daily heroin use and history of injecting drug use were protective. Among non-Indigenous prisoners, significant independent correlates included history of mental illness or self harm, and daily tobacco or cannabis use before incarceration. Older age and daily heroin use before incarceration were protective. Conclusions and Implications : The prevalence of risky alcohol use and dependence is high in Australian prisoner populations, particularly among Indigenous prisoners. Risk factors for alcohol dependence differ according to Indigenous status, indicating that separate, culturally appropriate interventions to reduce alcohol-related harm for Indigenous prisoners may be required.

High-risk drug-use practices among a large sample of Australian prisoners

Background: Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia. Methods: Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination. Results: We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR=3.07, 95%CI 1.83–5.12), being unemployed prior to incarceration (ARR=1.34, 95%CI 1.01–1.76), use of three or more drug types prior to incarceration (ARR=1.80, 95%CI 1.40–2.31), a history of needle/syringe sharing (ARR=5.00, 95%CI 3.06–8.16), receiving a tattoo during the current prison sentence (ARR=2.19, 95%CI 1.67–2.86) and HCV exposure (ARR=1.47, 95%CI 1.08–2.02). Older age was protective (ARR=0.90 per 5 years older, 95%CI 0.83–0.99). Conclusion: Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings.

‘I go out Worse Every Time’ Connections and Corruption in a Female Prison

‘When they are all thrown together it is impossible to improve them’, declared turnkey Sarah Ann Nixon of the female prisoners at the Toowoomba Gaol during the 1887 inquiry into Queensland prisons. Nixon was articulating a paradox that authorities struggled with throughout the Victorian era. During the late nineteenth century, a variety of institutions were established to contain female disorderliness and effect the reform of criminal and immoral women. Yet in facilitating the development of relationships between women from the social margins, incarcerative settings threatened to act as breeding grounds, rather than repositories, of unruly women. An inquiry into Queensland prisons in 1887 revealed rebellious and subversive inmate subcultures in which women banded together to sing, dance, laugh, talk and tell each other stories; arrange the smuggling of supplies; defy authorities; and engage in emotional and sexual relationships with each other. These activities represented traditions and encompassed relationships imported from an external underclass community.This article has been peer-reviewed.