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PubMed1994

Prevalence of HIV infection in provincial prisons in British Columbia.

OBJECTIVE: To ascertain the prevalence of HIV infection among people entering provincial adult prisons in British Columbia and to study associations between HIV infection and specific demographic and behavioural characteristics. DESIGN: Prospective, unlinked, voluntary survey involving HIV antibody testing of saliva specimens. SETTING: All adult provincial prisons in British Columbia through which inmates are admitted to the provincial correctional system. PARTICIPANTS: All adult inmates admitted to provincial prisons in British Columbia between Oct. 1 and Dec. 31, 1992. OUTCOME MEASURES: Rate of HIV positivity. Independent variables included sex, native status (native or non-native), self-reported HIV status, age group and history of injection drug use. RESULTS: A total of 2482 (91.3%) of 2719 eligible inmates volunteered for testing. Refusal was not associated with sex, native status, self-reported HIV status or age group; inmates who reported a history of injection drug use were more likely than the others to refuse HIV antibody testing (12.9% v. 6.8%; p < 0.001). The 2482 inmates who were tested for HIV were similar to the general inmate population with regard to sex, native status and age group. A total of 28 inmates were confirmed to be HIV positive, for an overall prevalence rate in the study population of 1.1% (95% confidence interval 0.8% to 1.6%). The prevalence rates were higher among the women than among the men (3.3% v. 1.0%; p = 0.023, Fisher's exact test) and among the inmates who reported a history of injection drug use than among those who did not report such a history (2.4% v. 0.6%; p < 0.001). There was no association between HIV status and native status or age group. Logistic regression analysis revealed the higher prevalence rate among the women to be explained by more of the women than of the men reporting a history of injection drug use. Of the 30 people who stated that they were HIV positive and who were tested, 19 (63.3%) had a negative result; conversely, 17 who reported that they were HIV negative or had not been tested had a positive result. CONCLUSIONS: Unlinked, voluntary HIV antibody testing of inmates can achieve high participation rates. The overall prevalence rate of 1.1% and the rate among the female inmates of 3.3% confirm that HIV infection is a reality in prisons and that the virus has established a clear foothold in inmate populations. Harm-reduction interventions should include a comprehensive education program for inmates on infectious diseases, the availability of condoms throughout prisons and the distribution of bleach for sterilizing needles and syringes. From a public health perspective, these data suggest an urgent need for access to sterile injection equipment in addition to other preventive measures.

AIDS Serodiagnosis↗
PubMed1993

[Tuberculosis in a prison population: a study of 138 cases].

BACKGROUND: Tuberculosis continues to be a disease of great importance in Spain with few data known on prison populations. In the present study an analysis of the incidence and characteristics of tuberculosis in the prison population people is done. METHODS: The General Penitentiary Hospital attends a prison population from the penitentiary centers of Madrid and its surrounding areas. From 1 March 1991-31 August 1992 a retrospective study of the patients with tuberculosis diagnosed by culture isolation of Mycobacterium tuberculosis was performed. Demographic, clinical, analytical, microbiologic analysis as well as data concerning to associated infections, antituberculous treatment and its possible toxicity as well as the evolution of the patients were collected. RESULTS: During the period studied 138 patients--120 corresponding to the area of Madrid and 18 to patients referred from other penitentiary areas--were diagnosed. The rate of incidence of tuberculosis in the penitentiary population in the area of Madrid was of 1170.5 cases per 100,000 prisoners per year (confidence interval [CI] 95%; 961-1380). The mean age was 30 years (CI 95%; 29-31) and 97% were males. Eighty-four percent were positive for the human immunodeficiency virus (HIV) and 84% were intravenous drug addicts. The clinical form of presentation of the tuberculosis in the HIV positive patients was: pulmonary in 57% of the cases, disseminated in 29% and extrapulmonary in 14% and was pulmonary in all the cases of HIV negative patients. The mean CD4 lymphocytes count was 0.216 x 10(9)/l in HIV positive patients with pulmonary tuberculosis, and in disseminated tuberculosis was 0.062 x 10(9)/l (p < 0.001). The positivity of acid-alcohol resistant staining in the sputum samples and/or induced sputum was 67.4% in the patients with pulmonary tuberculosis and 77.4% in disseminated tuberculosis. Ten percent of the patients were found to abandon antituberculous treatment in the first trimester. CONCLUSIONS: The incidence of tuberculosis in the prison population in much higher than that for the general population in Spain, largely due to the high prevalence of HIV infection in this population.

Adult↗
PubMed1993

Loss of body mass in ex-prisoners of war.

Body mass was examined in the defenders of Vukovar (n = 71) from eastern Slavonia, Republic of Croatia, immediately on release from enemy concentration camps. The sample consisted of a group of 33 male smokers who had been imprisoned for (mean +/- SD) 127.4 +/- 18.4 days (age 31.6 +/- 7.2 years) and 38 male smokers, imprisoned for 271.6 +/- 14.4 days (age 30.8 +/- 6.5 years). According to subjective estimations the prisoners of war had lost 18.4 +/- 6.1% and 21.6 +/- 10.2% respectively, in relation to body mass before the war. For comparison data were used on a healthy population of male smokers from eastern Slavonia (Vinkovci, Republic of Croatia (n = 75) aged 32.4 +/- 5.2 years taken from a study carried out in 1976. Data were analysed on body mass, body mass index, triceps, subscapular skinfolds and percentage of body fat. All parameters were statistically significantly lower in males imprisoned for 271.6 +/- 14.4 days in relation to the comparative group (P < 0.0001-0.05). A negative deviation from body mass nomogram was registered in prisoners of war in relation to the comparative group (5-16%). Basic biochemical parameters were examined in the prisoners of war. In the group imprisoned for 127.4 +/- 18.4 days statistically significant differences and pathological values of mean corpuscular volume and haematocrit were verified in relation to the group of prisoners with longer duration of imprisonment (P < 0.001). Although the prisoners of war had lost weight during imprisonment in the camps due to the frugal diet no clinical signs of malnutrition were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1995

[Tuberculosis in the prison milieu at Antananarivo from 1990 to 1993].

Within 42 months, from June 1990 to December 1993, 454 cases of tuberculosis have been recorded in the central remand home of Antananarivo. The tubercular prevalence observed was there eight times superior to that of the global population of Madagascar. Among the 360 pulmonary tuberculosis, only one did not have any bacteriological proof; among the 94 extrapulmonary tuberculosis, 37 have been proved by histology or bacteriology. Among the extrapulmonary tuberculosis, pleurisies were obviously preeminent (79/94). Association of tubercular localizations could be observed with 21% of the patients. New cases of smear-positive pulmonary tuberculosis (PMT+) represented 81% of all the PMT+, recurrences were 9% and revivals 10%. Since February 1991, the 8 months short course regimen was the standard applied; before, the lack of stock did not allowed any standardization. The PMT+ new cases recovery rate increased from 42.5% in 1990 to 74% in 1993, whereas lethality decreased from 23% in 1990 to 8% in 1993. Patient dropouts were noted only with released or escaped individuals. Treatment failure rate was 4%. The diminution of cases despite the constancy of prisoners number and the carrying out of activities by the same health team make questionable the explanatory factors of the burst of tuberculosis-diseases in a prison milieu. Because of the importance of prison tubercular foci in terms of public health and the satisfactory results obtained, the Programme proposes to apply the model of partnership developed between the Tonga soa NGO and the prison administration to other prisons in Madagascar.

Adolescent↗
PubMed1997

Self-mutilation and suicide attempt: distinguishing features in prisoners.

Nonlethal forms of self-injury are often discussed together with suicide attempts as though they belonged on a continuum of self-harm. Both types of self-injury are common in prisons, which have a predominantly male population; however, most studies of nonlethal self-injury have been done with female subjects. This exploratory study tested the hypothesis that prisoners who injured themselves without intending to die would differ clinically from prisoners who had attempted suicide. Inmates admitted to the prison unit of a public hospital for treatment of self-inflicted wounds or who had a history of previous self-injury were administered a standardized intake protocol by the first author, which included asking about their intent at the time they injured themselves. Patients were classified as self-mutilators or suicide attempters on the basis of intent. Fifteen patients reported that they had attempted to take their own lives, while 16 reported other reasons for harming themselves. Suicide attempt was associated with adult affective disorder 13/15 versus 2/16 mutilators); self-mutilation with a history of childhood hyperactivity (12/16 versus 1/15 suicide attempters) and a mixed dysthymia/anxiety syndrome that began in childhood or early adolescence (9/16). Prison self-mutilators and suicide attempters had very different clinical presentations and histories. The history of childhood hyperactivity in self-mutilators deserves further study in both correctional and noncorrectional populations.

Adolescent↗
PubMed1998

Mourning in prison: mission impossible?

The author's interest in the issue of mourning in prison is twofold. As an active hospice volunteer, she became involved with bereavement work, which sensitized her to the issues of loss encountered upon joining the staff at the Maine State Prison. More often than not, the inmates with whom she met had unresolved issues of loss. The impetus for a grief support group came from an inmate who had experienced the death of five relatives during his period of incarceration; he commented on how difficult it is to mourn in prison, and he worried about how he would deal with all his losses when confronted with them upon his release. The author raised the possibility of a support group and the inmate offered to help organize it. This article describes the author's experience with such a prison-based support group and what she has learned, through this experience, about mourning in prison.

Grief↗
PubMedDate not supplied

Syphilis and HIV infection among prisoners in Maputo, Mozambique.

A cross-sectional study was carried out among 1284 male and 54 female prisoners to assess the prevalence of and risk factors for sexually transmitted diseases (STD) in 4 correctional institutions of Maputo, Mozambique. Among the men, 32% reported a history of prostitute contact and 41% reported a history of STD. Only 9% reported having ever used condoms. Seventy (5.5%) men reported having had sexual intercourse while in prison, in all but one instance this involved sex with another man. There was no reported intravenous drug use. One hundred and four (7.8%) inmates had positive serological tests for syphilis and 8 (0.6%) had antibodies to HIV. Among men, syphilis was associated with a history of genital ulcer [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.4, 6.4] and uncircumcised status (OR = 1.5, 95% CI = 1.0, 2.5). This study demonstrates that syphilis is common among inmates in Maputo and that risk behaviours for STD transmission exist within Maputo prisons. There is a need for STD screening and treatment programmes within prisons in Mozambique and the introduction of educational interventions, including condom promotion.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Optimality under noise: higher memory strategies for the alternating prisoner's dilemma.

The Alternating Prisoner's Dilemma is a variant of the iterated Prisoner's Dilemma in which the players alternate in the roles of actor and recipient. We searched for strategies which are "optimal" in the Alternating Prisoner's Dilemma with noise (a non-zero probability that a player's decision will be transmitted incorrectly). In order to achieve success against a variety of other strategies, a strategy must be "self-cooperating" (able to achieve mutual cooperation with its clone), "C-exploiting" (able to exploit unconditional cooperators), and "D-unexploitable" (able to resist exploitation by defectors). It must also have high evolutionary "dominance", a general measure of evolutionary performance which considers both resistance to invasion and the ability to invade other strategies. A strategy which meets these optimality criteria can evolve cooperation by invading a population of defectors and establishing a stable cooperative society. Most of the strategies commonly discussed in the Alternating Prisoner's Dilemma literature are low-memory strategies such as Tit For Tat, Pavlov, and Firm But Fair, but none of these strategies can simultaneously meet all of the optimality criteria. However, we discovered a class of higher memory "Firm Pavlov" strategies, which not only meet our stringent optimality criteria, but also achieve remarkable success in round-robin tournaments and evolutionary interactions. These higher memory strategies are friendly enough to cooperate with their clone, pragmatic enough to exploit unconditional cooperators, and wary enough to resist exploitation by defectors: they are truly "optimal under noise" in the Alternating Prisoner's Dilemma.

Algorithms↗
PubMed1995

Compulsory random drug testing of prisoners in England and Wales: design flaws in the system.

The Home Office has recently introduced compulsory testing of prisoners in England and Wales for drug abuse. From 1996 all prisons in the UK will be involved. Urine samples from approximately 10% of the prison population will be collected each month. The method of drug analysis selected by the Home Office is fast and economical but readily prone to interference from common substances giving false results. An elaborate procedure has therefore been evolved including a rigorous personal search of the prisoner to prevent sample adulteration. The definitive test gas chromotography - mass spectrometry (GC-MS), is more expensive but is resistant to sample adulteration, and currently all positive samples are confirmed by this method. In view of the proportion of samples that have tested positive, the extent of the unknown number of false negatives, and the possible rejection of the collection protocol by prisoners, savings could be made if the method of analysis employed in the first instance was GC-MS. This paper illustrates the inaccuracies produced in an assay technique similar to that used by the Home Office when urine is contaminated by simple, commonly available substances.

Journal Article↗
PubMed2002

Eating disturbances in female prisoners: the role of anger.

Women in prison have high levels of impulsive damaging behaviours, including disordered eating. In addition, they display pathological levels of the emotional precursors that have been associated with eating disorders, particularly anger. The present study examines levels of disordered eating behaviours in female prisoners, and whether those behaviours are associated with anger. The sample consisted of 91 sentenced women at a medium-sized prison in the UK. The women completed an interview-based screening tool for eating disorders, alongside a standardised measure of anger. Using the established cut-off on the measure concerned, 25% of the women were at risk for an eating disorder. This prevalence rate is exactly twice that observed in a non-eating-disordered community sample, using the same measure. Furthermore, different facets of anger were associated with different aspects of eating psychopathology. The most plausible explanation for this association appears to be that many women enter prison with high levels of anger-driven impulsivity, and that the constraints of the prison environment result in a focus on eating behaviours. Future research directions are discussed.

Journal Article↗
PubMed2003

Ethical and legal standards for research in prisons.

Biobehavioral research, especially that which is conducted with prisoners, has become much more closely regulated in the last 30 years. State and federal law, as well as professional standards, regulate the conduct of many types of research; in the case of prisoners, this regulation is even more stringent. However, currently no mandatory, uniform, national regulatory or oversight process exists, and many privately funded research endeavors are operating in a regulatory void. In response to this, the National Bioethics Advisory Commission has argued for the creation of a single, national, independent regulatory body to oversee all human participant research, regardless of funding source. As ethicolegal research standards evolve alongside advances in science and technology, an appreciation of the history of prisoner research and an awareness of current standards is critical to conducting ethical prison research.

Behavioral Research↗
PubMed2006

Sexual violence inside prisons: rates of victimization.

People in prison are exposed to and experience sexual violence inside prisons, further exposing them to communicable diseases and trauma. The consequences of sexual violence follow the individual into the community upon release. This paper estimates the prevalence of sexual victimization within a state prison system. A total of 6,964 men and 564 women participated in a survey administered using audio-CASI. Weighted estimates of prevalence were constructed by gender and facility size. Rates of sexual victimization varied significantly by gender, age, perpetrator, question wording, and facility. Rates of inmate-on-inmate sexual victimization in the previous 6 months were highest for female inmates (212 per 1,000), more than four times higher than male rates (43 per 1,000). Abusive sexual conduct was more likely between inmates and between staff and inmates than nonconsensual sexual acts. Sexual violence inside prison is an urgent public health issue needing targeted interventions to prevent and ameliorate its health and social consequences, which spatially concentrate in poor inner-city areas where these individuals ultimately return.

Adolescent↗
PubMed1985

Prisoners in the emergency department.

Eight issues in the care of prisoners in the ED have been examined. Close to one-half million persons are incarcerated at any time in the United States, and the numbers can be expected to increase. When seeing prisoners in the ED, the physician must keep in mind two facts: 1) prisoners have a right to medical care; and 2) incarceration demands that certain considerations be made regarding the correctional environment when evaluating, treating and, most importantly, discharging a prisoner back to the cell.

Emergency Medicine↗
PubMed1995

Medical devices made into weapons by prisoners: an unrecognized risk.

STUDY OBJECTIVE: The alteration of a knee immobilizer into a sharp weapon by a prisoner prompted us to survey neighboring penal institutions to determine the frequency of such events. DESIGN: We mailed a nine-item survey to all detention facilities in Tennessee, Arkansas, and Mississippi. A second survey was sent to nonresponding institutions 6 weeks after the initial mailing. SETTING: The Regional Medical Center at Memphis, the designated facility for evaluation and treatment of prisoners from the county jail and state penitentiary. PARTICIPANTS: Survey respondents included 25 state penitentiaries, 31 county jails, 1 state minimum-security facility, 1 state maximum-security facility, 1 work-release center, 1 county detention center for drunken-driving offenders, and 1 federal penitentiary. RESULTS: Of the 81 institutions surveyed, 77% responded to one of the two mailings. Forty percent responded in the affirmative when asked whether stolen or unauthorized medical equipment from outside their institutions had been discovered among inmates. When respondents were questioned as to whether medical equipment, prescribed or not, had been used or altered in a criminal manner, 34% responded "yes." Medications and medical appliances were listed in the responses. CONCLUSION: A survey of 81 local and neighboring penal institutions in a three-state area revealed that the illicit use of medicine and medical devices by prisoners is a legitimate safety concern of prison personnel and health care workers when medical care for inmates must be sought outside the security of their institutions. The modification of medical equipment into weapons by incarcerated patients, although clearly recognized as a security and safety problem by police authorities, appears to be unappreciated by health care workers providing episodic care to inmates.

Adult↗
PubMed2003

A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system.

OBJECTIVES: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. METHODS: All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. RESULTS: Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. CONCLUSIONS: Consideration should be given to the introduction of prison methadone programs particular where community based programs exist.

Adult↗
PubMed2003

The promise of prison-based treatment for dually diagnosed inmates.

The Stay'n Out therapeutic community was created 25 years ago, the first rigorously evaluated prison program that demonstrated recidivism reduction. Since then, there has been a growing appreciation for the recidivism-reducing benefit of substance abuse treatment and the general understanding has been reached that prison treatment for substance abuse is good for the public interest. A number of replicated outcome studies have led to increases in treatment capacity in most state correctional systems, primarily utilizing the therapeutic community model. In contrast, efforts to introduce treatment for offenders with co-occurring mental illness and substance abuse disorders (COD) are only beginning. This article describes developments in prison substance abuse treatment and reentry programs and offers some guiding observations from prison substance abuse treatment history that could facilitate the development of COD treatment. Lessons learned include that: public safety (i.e., recidivism reduction) is a primary goal; personal accountability as a basic treatment value facilitates cooperation between treatment and correctional staff; self-help approaches foster more ambitious treatment goals than just symptom reduction; and well-run treatment programs often ease the burden of correctional administration.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Implementing residential treatment for prison inmates with mental illness.

There is evidence that mentally ill offenders (MIOs) in prisons commit more infractions, serve longer sentences, and are more likely to be victimized than inmates who are not mentally ill. Humanistic and prison management interests are served if intervention programs minimize symptoms and promote coping and other functional skills. A collaborative agreement was established between Washington State Department of Corrections and a consortium of University of Washington faculty to mutually develop a prison-based program of clinical management and psychoeducation for MIOs. The resulting program is described, along with rationale, planning processes, implementation, and initial evaluation. Most aspects of the planned program are in place. Clinical and behavioral progress by inmates following program participation has been documented. Issues concerning treatment program implementation in prisons are discussed.

Counseling↗
PubMed2005

Prison health in Russia: the larger picture.

Russia, despite recent legal reforms, still has one of the highest rates of imprisonment in the world. There are many reports of the adverse conditions in Russian prisons, often highlighting the consequences for health, in particular, risks of HIV, tuberculosis, and other infectious diseases. However, there are no reviews of the broader health issues in the Russian penal system. This paper reviews the available information on the health of the imprisoned population in Russia and the factors underlying it. It was undertaken by means of a search of Russian and international literature, including unpublished sources, supplemented by in-depth interviews with 27 key informants from the Ministry of Justice, prison administration, and non-governmental organizations. Published and unpublished data from the ministries of health and justice were used to describe the demographic characteristics of the imprisoned population and compare it with the general population. Although convicts are drawn disproportionately from disadvantaged groups in society and are detained in adverse physical conditions, the standardized mortality ratio from all causes is slightly over one-third of that in the overall Russian male population. This is mainly explained by an eight-fold lower mortality from external causes and a more than two-fold lower mortality from cardiovascular disease. These far outweigh the increased mortality from infectious diseases. The chances of survival of young men in Russia may actually be improved by being in prison, highlighting the need for policies that reduce the overall level of violence and other external risks, such as dangerous driving habits, in Russian society. Yet while conditions are improving in Russian prisons, with death rates falling, there are still many avoidable deaths and high levels of mental illness and infectious disease. There is also much that is not known about the health of Russian convicts, with what is available reflecting what is measured rather than what is important.

Government Agencies↗