In 2010, around 1200 prisoners were infected with HIV in France and 3000 with HCV. Data which confirms the interest of a risk reduction policy in prisons.
Estimate for the 1time the prevalence of HIV and HCV infection in prisons nationally, this was the objective of the Prévacar 2010 survey, the results of which have just been published in the weekly Epidemiological Bulletin. Until then, the data available on the subject were old or fragmented and did not make it possible to characterize the infected people on a national level.
Conceived and implemented jointly by the General Directorate of Health (DGS) and the Institute for Public Health Surveillance (Invs), this analysis carried out in June 2010 therefore selected by lot, 2,154 people detained in 27 penitentiary establishments. For each detained person selected at random, an individual questionnaire was completed using the data contained in the medical file on the day of the investigation. The information included demographic characteristics, HIV and HCV infection status, modes of infection, clinical stage and treatments. In order to preserve anonymity, a random number was assigned to each inmate.
24% of patients discover their HIV status in prison
Although the vulnerability of detainees in terms of infectious diseases is known, the results of this survey confirm this reality in French prisons. In 2010, HIV prevalence was estimated at 2% and was higher in women than in men, although they only represent 3% of all French prisoners. In comparison, in 2009, that in the general population was estimated at 0.35%. In the prison environment, this prevalence increased with age up to 50 years and varied according to the continent of birth: the highest was found among people born in sub-Saharan Africa (15.4%). It was 1.1% for people born in France. When the mode of contamination was known, transmission was linked to heterosexual intercourse in 75% of cases. The average time since discovery of HIV was 9 years and 24% of detainees discovered their HIV status in prison.
Regarding hepatitis C, this survey reveals that the prevalence was 4.8% in 2010 in French prisons, when it was 0.8% in the general population in 2004. Prisoners most affected by this virus were people born in Asia and Eastern Europe, respectively 12.4% and 12.3%. The probable mode of contamination was drug use in 70% of cases, unknown for 22% of the detainees and linked to a transfusion or tattoo for 8%.
¾ of HIV + under treatment and half of HCV +
This survey also looked at the treatment of detainees infected with these different viruses. In the case of HIV, antiretroviral therapy was underway for 75% of people with HIV. Among people with AIDS, 94% were treated. Of those with HCV infection, almost half were receiving or had received treatment. Finally, among people with chronic hepatitis, 40.7% had been assessed for fibrosis in the past 12 months and 36% were receiving treatment.
For a risk reduction policy in prison
The unpublished results of this survey therefore confirm the importance of the prevalence of HIV and hepatitis C in prison. “This study has shown the feasibility of surveys at the national level in prisons in France, in order to improve the monitoring of the health of detained persons”, specifies the authors of this study.
Although screening for HIV and HCV infection is systematically offered to each detainee during their entry medical examination, the authors of this work insist on the importance of repeating the offer of these tests. screening. In fact, the “care offer” part of this survey showed that the renewal of this offer only concerns half of the penitentiary establishments. On the other hand, these data confirm the interest of a risk reduction policy in prisons, in order to limit the transmission of these infections and improve their prognosis.
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