Risk behaviour and factors associated with HIV prevalence among female prisoners aged 18-65 years at Lusaka Central Prison: Missed opportunities in HIV prevention

Abstract

Studies globally indicate that HIV prevalence in prisons is high (UNODC, 2011) suggesting that prisons are a high risk environment for HIV transmission (UNODC, 2008). HIV and AIDS in Zambian Prisons is high (27.4%), contributing to morbidity and mortality (CSO, 2009). HIV infection among female prisoners has been on the increase from 33.6% in 2010 (HRW) to 43.3% in 2011 (UNODC and UNAIDS). Studies by HRW (2010) and UNODC/UNAIDS (2011) suggested Men having Sex with Men (MSM) as the main driver of HIV infection among male prisoners. Currently, there is no data on risk behaviours associated with HIV sero-positivity among women prisoners. The study explored the risk behaviours and factors associated with HIV sero-positivity among female prisoners in Lusaka Central Prison. The study was a cross-sectional analytical survey, using both quantitative and qualitative approaches. A non-probability, convenience sampling method was used and 118 female prisoners participated in the study. Determine and Uni-Gold Rapid Tests were used for screening and ELISA Test as Gold Standard. Pre and post-test HIV counselling was offered. Quantitative data was analysed using STATA 12 (Stata Corp, USA) while qualitative data NVivo10 was used. Chi-squared tests were used to determine the association. Multivariate Logistic Regression was used to obtain CI and odds ratios. The statistical significance was set at ≤0.05 and 95%CI were calculated. HIV prevalence estimation among female prisoners was high 67/118(56.8%). New sero-convertors accounted for 28/67(41.8%) and among these 17/28(60.7%) declined referral to HIV and AIDS management. A total of (28/39)71.8% were on ART, (11/39)28.2% were on CD4 monitoring, while 53/67(79.1%) had undergone VCT or DCT. Risk behaviours and factors which predicted HIV sero-positive status were: age group 28-37 years (AOR 7.6, 95%CI: 2.97-12.52, P=0.004), one or more years in prison (AOR 4.6, 95%CI: 1.45-10.49, P=0.016), previous incarceration (AOR 8.5,95%CI: 2.53-7.02, P=0.005), substance use (AOR 4.2, 95%CI: 3.17-7.18, P=0.034), commercial sex (AOR 3.1, 95%CI: 1.42-7.72, P=0.042), coerced sex while in lawful custody (AOR 3.3, 95%CI: 1.78-11.61, P=0.041) and multiple sexual partners (AOR 9.6, 95%CI: 2.46-9.78, P=0.019). HIV prevalence has continued to be high among female prisoners despite observed declined in the general population. The possibility of some female prisoners being infected while in prison may not be ruled out. HIV in prisons has implications for HIV outside prison.