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Health in prisons

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.

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Health in prisons

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  1. 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

  2. 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

  3. 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

  4. Incarceration and HIV in the US • Causal link between male incarceration rate and HIV prevalence in the US • Incareration rates among africanamerican population explain most of the disproportionate HIV prevalence among africanamerican women

  5. 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

  6. 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

  7. 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 • Blood samples and antrhopometry to measure HIV, HVB HVC, syphilis, gloucose, lypids, hipertension and obesity • For a representative sample (10%): sociodemogrsaphics and risk behaviors using ACASI • All results where delivered to participants and for the positive follow-up for treatment or referrals to health care

  8. Results

  9. Distribution of population by age Less than 30 30 to 40 More than 40 Men Women

  10. Schooling Men Women * Prisons General Population

  11. Infectious diseases Women Men * Prisons General Population

  12. Syphilis, by age Women Men

  13. Obesity Prevalence

  14. Diabetes and hypertension previously diagnosed

  15. Violence and sexual risk behavior before and in prison

  16. Substance use

  17. Drug use before and in prison (%)

  18. 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

  19. Thankyou sbautista@insp.mx

  20. References 1. Dolan K, Kite B, Black E, Aceijas C, Stimson GV. HIV in prison in low-income and middle-income countries. The Lancet infectious diseases. 2007;7(1):32-41. 2. Subsecretaría de Sistema Penitenciario G de DF2010. Movimiento Diario de Población Penitenciaria, 2010. Available at: http://www.reclusorios.df.gob.mx/reclusorios/estadisticas/index.html?anio=2010&mes=6. 3. Azaola E, Bergman M. El Sistema Penitenciaro Mexicano. USMEX 2003-04 Working Paper Series. 2003. 4. Salla F, Rodriguez Ballesteros P, Espinoza O, et al. Democracy, Human Rights and Prison Conditions in South America. 2009. 5. WHO. Health in Prisons: A WHO guide to the essentials in prison health. 2007. 6. Jürgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. The Lancet infectious diseases. 2009;9(1):57-66. 7. Vescio MF, Longo B, Babudieri S, et al. Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. Journal of epidemiology and community health. 2008;62(4):305-13. 8. Weinbaum CM, Sabin KM, Santibanez SS. Hepatitis B , hepatitis C , and HIV in correctional populations : a review of epidemiology and prevention. Aids. 2005:41-46. 9. de la Hoya PS, Bedia M, Murcia J, Cebriá J, Sánchez-Payá J, Portilla J. Factores predictivos de infección por el VIH, VHC y coinfección en la población reclusa de una prisión española. Enfermedades Infecciosas y Microbiología Clínica [Internet]. 2005 Feb;23(2):53–7. 10. Leddy M a, Schulkin J, Power ML. Consequences of high incarceration rate and high obesity prevalence on the prison system. Journal of correctional health care : the official journal of the National Commission on Correctional Health Care [Internet]. 2009 Oct [cited 2011 Dec 7];15(4):318–27.

  21. References 11. Binswanger I a, Krueger PM, Steiner JF. Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. Journal of epidemiology and community health . 2009 Nov [cited 2011 Dec 7];63(11):912–9. 12. Nara K, Igarashi M. Serum of Prison Life Style to Blood Pressure , Lipids and Obesity in Women Prisoners in Japan. Industrial Health. 1998;:1–7. 13. CENSIDA. (2009). El VIH/SIDA en México 2009. 14. Valdespino, J., Conde-González, C., Olaiz-Fernández, G., Palma, O., & Sepúlveda, J. (2007). Prevalencia en México de la infección y el estado de portador de la hepatitis B en adultos. Salud Publica de Mexico, 49(3), 404-411. 15. Valdespino, J., Conde-González, C., Olaiz-Fernández, G., Palma, O., Kershenobich, D., & Sepúlveda, J. (2007). Seroprevalencia de la hepatitis C en adultos de México:¿ un problema de salud pública emergente? Salud Publica de Mexico, 49(Supl. 3), 395-403. 16. Conde-González, C. J., J. L. Valdespino, et al. (2007). "Prevalencia de anticuerpos antitreponémicos y características sociodemográficas de la población mexicana adulta en el año 2000." Salud Publica de Mexico 49(Supl. 3): S395-S403.

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