Spread of bloodborne viruses
among Australian prison entrants.
Crofts N, Stewart T, Hearne P, Ping XY, Breshkin AM, Locarnini
Epidemiology and International Health Unit, Macfarlane Burnet
Centre of Medical Research, Fairfield, Victoria, Australia.
OBJECTIVES: To assess spread of bloodborne viruses among prison
entrants in Victoria, Australia.
DESIGN: Voluntary confidential testing of all prison entrants
for markers of exposure to bloodborne viruses with collection of
minimal data on demography and risk factors over 12 months.
SETTING: Her Majesty's Prisons, Pentridge and Fairlea, Victoria,
SUBJECTS: 3429 male and 198 female prison entrants (> 99% of all
prison entrants); 344 entered prison and were tested more than
MAIN OUTCOME MEASURES: Prevalence and incidence of antibodies to
HIV, hepatitis B, and hepatitis C viruses, and minimal data on
RESULTS: 1562 (46%) gave a history of use of injected drugs,
1171 (33%) had antibody to hepatitis B core antigen, 1418 (39%)
were anti-hepatitis C positive including 914 (64%) of the men
who injected drugs, 91 (2.5%) were positive for hepatitis B
surface antigen, and 17 (0.47%) were positive for antibody to
HIV. Incidence rates for infection with hepatitis B and C virus
were 12.6 and 18.3 per 100 person years, respectively; in men
who injected drugs and were aged less than 30 years (29% of all
prison entrants) these were 21 and 41 per 100 person years.
Seroconversion to hepatitis B or C was associated with young age
and shorter stay in prison. Only 5% of those who were not immune
to hepatitis B reported hepatitis B immunisation.
CONCLUSIONS: Hepatitis B and C are spreading rapidly through
some populations of injecting drug users in Victoria,
particularly among men aged less than 30 years at risk of
imprisonment in whom rates of spread are extreme; this group
constitutes a sizeable at risk population for spread of HIV.
This spread is occurring in a context of integrated harm
reduction measures outside prisons for prevention of viral
spread but few programmes within or on transition from prisons;
it poses an urgent challenge to these programmes.