HIV TESTING, HIV-INFECTION AND ASSOCIATED RISK-FACTORS AMONG INMATES IN SOUTH-EASTERN FRENCH PRISONS

Objectives: To estimate HIV seroprevalence in the two main remand and short-stay prisons of south-eastern France and to gather linked anonym ous risk-factor information. Setting: Baumettes prison, Marseille, Fra nce between 16 November and 21 December 1992. Participants: Using a se lf-administered questionnaire about HIV testing and risk factors for H IV infection, 295 male and 137 female inmates were interviewed. The re sponse rate was 96% (100 and 90% for men and women, respectively). At the same time, 279 of a total of 432 (65%) inmates were serologically tested for HIV; 153 (35%) declined to provide a blood sample. Design: Anonymous cross-sectional and surveillance survey. Results: Twenty per cent of participants (84 out of 432) were intravenous drug (heroin) u sers (IVDU), 51% of whom reported needle-sharing prior to incarceratio n; 23% reported more than two sexual partners during the last year, an d 13% sexual intercourse with an IVDU during the last 5 years. HIV sta tus was available for 356 inmates (82%; 65% from blood samples and 17% from the questionnaire); 39 were HIV-infected (10.9%; 95% confidence interval, 7.7-14.2). The inmates not tested for HIV reported proportio nally less risky behaviours than non-HIV-infected inmates. HIV seropre valence was significantly higher among recidivist inmates (19.9 versus 4.4%; P < 0.0001). The rate of HIV infection was particularly high am ong IVDU (34 out of 84; 40%). More female non-IVDU were HIV-infected t han male non-IVDU (4.1 versus 0.6%; P = 0.04). Conclusions: This study demonstrates the high prevalence of HIV infection in south-eastern Fr ench prisons, especially among IVDU. The rates may be related to the h igh prevalence of risky drug practices and to delays in the developmen t of HIV prevention programmes for IVDU in France. The higher seroprev alence rate among recidivist inmates might be the result of risk behav iours during imprisonment. Another hypothesis is that recidivist inmat es are at greater risk of HIV infection because of higher levels of dr ug use.