SPREAD OF BLOODBORNE VIRUSES AMONG AUSTRALIAN PRISON ENTRANTS

Objectives-To assess spread of bloodborne viruses among prison entrant s in Victoria, Australia. Design-Voluntary confidential testing of all prison entrants for markers of exposure to bloodborne viruses with co llection of minimal data on demography and risk factors over 12 months . Setting-Her Majesty's Prisons, Pentridge and Fairlea, Victoria, Aust ralia. Subjects-3429 male and 198 female prison entrants (> 99% of all prison entrants); 344 entered prison and were tested more than once. Main outcome measures-Prevalence and incidence of antibodies to HIV, h epatitis B, and hepatitis C viruses, and minimal data on risk factors. Results-1562 (46%) gave a history of use of injected drugs, 1171 (33% ) had antibody to hepatitis B core antigen, 1418 (39%) were anti-hepat itis 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%) w ere positive for antibody to HIV. Incidence rates for infection with h epatitis B and C virus were 12.6 and 18.3 per 100 person years, respec tively; 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. S eroconversion to hepatitis B or C was associated with young age and sh orter stay in prison. Only 5% of those who were not immune to hepatiti s B reported hepatitis B immunisation. Conclusions-Hepatitis B and C a re 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 constitu tes a sizeable at risk population for spread of HIV. This spread is oc curring in a context of integrated harm reduction measures outside pri sons for prevention of viral spread but few programmes within or on tr ansition from prisons; it poses an urgent challenge to these programme s.