High-risk drug-use practices among a large sample of Australian prisoners
Introduction
Incarceration is a common experience among individuals who inject drugs (IDU); as a corollary, a substantial proportion of prisoners report a history of injection drug use (Abiona et al., 2009, Butler et al., 2003, Miller et al., 2008). In Australia, 55% of adult prison receptions report having injected drugs at some point and 34% report having done so in the month prior to incarceration (Butler and Papanastasiou, 2008).
Internationally, sharing of injecting equipment is a key driver of blood-borne viral (BBV) infections including HIV (Jürgens et al., 2009) and hepatitis C (HCV; Vescio et al., 2008). It is therefore not surprising that the prevalence of these infections is elevated among prisoners, particularly those with a history of IDU (Dolan et al., 2007, Macalino et al., 2004).
Despite intensive and costly efforts to restrict the flow of drugs into prison settings (Black et al., 2004), a substantial proportion of IDU continue to inject drugs in prison (Dolan et al., 1996, Dolan et al., 2010, Hellard et al., 2004, Milloy et al., 2008). Estimates of the prevalence of in-prison injecting drug use (P-IDU) vary widely from as low as 3% (Calzavara et al., 2003) to as high as 53% (Hellard et al., 2004), with most estimates based on small and/or convenience samples (Carpentier et al., 2012). Although most studies find that the frequency of injection is lower in prison than in the community (Shewan et al., 1982), sharing of injecting equipment among prisoners remains common (Dolan et al., 1996, Dolan et al., 2010); a recent Canadian study found that rates of injection with used needles remained the same prior to and in prison (Calzavara et al., 2003).
Therefore, although imprisonment is associated with a reduction in both the prevalence and frequency of IDU, the risks associated with P-IDU remain high, due to the substantial baseline prevalence of BBV infection and, in many contexts including Australia, the unavailability of sterile injecting equipment (Ryan et al., 2010). Consistent with this, there is emerging Australian evidence that P-IDU is an independent risk factor for HCV transmission (Hellard et al., 2004, Miller et al., 2008).
The aims of this study were to (a) estimate the prevalence of lifetime IDU, lifetime P-IDU and recent (during current sentence) P-IDU among adult prisoners in Queensland, Australia, and (b) among those with a lifetime history of IDU, identify health-related correlates of recent P-IDU.
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Participants and methods
Data were collected via face-to-face administration of a structured questionnaire in confidential interviews conducted by trained researchers in seven adult correctional centers in Queensland, Australia, between August 2008 and July 2010. The questionnaire provided baseline data for a randomized controlled trial of a re-entry intervention (Kinner et al., 2009); randomization occurred after baseline interview.
Potentially eligible participants were identified from prison records and included
Prevalence of injecting
The sample consisted of 1,322 participants, of whom 737 (55.7%) reported a lifetime history of IDU, 286 (21.6%) reported a lifetime history of P-IDU, and 163 (12.3%) reported P-IDU during their current prison sentence. Correcting for the oversampling of women, the estimated population prevalence of lifetime IDU was 55.1% (95%CI 52.3–57.9%), of lifetime P-IDU 23.0% (95%CI 20.7–25.4%) and of recent P-IDU 13.2% (95%CI 11.3–15.1%). Among those reporting recent P-IDU, 87.1% reported using a needle
Discussion
Among adult prisoners in Queensland, Australia we robustly estimated that more than half (55.1%) have a history of injection drug use, that almost one in four (23.0%) has injected drugs in prison and that more than one in eight (13.2%) has injected drugs during their current prison sentence. Among these, the vast majority reported receptive sharing of needles and other injecting equipment. These findings are consistent with those of previous studies in Australia and internationally, and add
Conclusions
A growing number of studies have documented drug injection among prisoners, in the context of intensive efforts to prevent the flow of drugs into prisons. In this study around 13% of participants, and 22% of those with a lifetime history of IDU, injected during their current prison sentence. Those injecting were typically young, disadvantaged males who had engaged in a range of risk behaviors both in the community and in prison. Not surprisingly, injection in prison was independently associated
Role of funding source
The Passports study is funded by the Australian National Health and Medical Research Council (NHMRC Strategic Award #409966). Stuart Kinner is supported by a Career Development Fellowship from the NHMRC (#1004765). Rebecca Jenkinson is supported by the NHMRC-funded Centre for Research Excellence into Injecting Drug use (#1001144). M.-J. Milloy is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research.
Contributors
Authors Kinner and Jenkinson designed the study. Author Gouillou undertook the statistical analyses. Author Kinner wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
No conflict declared.
Acknowledgements
The Passports project is funded by National Health and Medical Research Council (NHMRC) grant #409966. Stuart Kinner is supported by NHMRC Career Development Fellowship #1004765. Rebecca Jenkinson is supported by the NHMRC-funded Centre for Research Excellence into Injecting Drug Use (#1001144). M.-J. Milloy is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. The authors wish to thank Passports participants for
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