[HIV risk behavior in prison and factors associated with reincarceration of injection drug users]

The aim of this study was to estimate the frequency of risk behavior for HIV transmission in prison and to identify the factors associated with reincarceration.

An epidemiologic study was carried out in the penitentiary center of Marseilles between December 1995 and March 1997. Five hundred and seventy-four prisoners answered an anonymous voluntary questionnaire managed by independent interviewers.

Among the 574 prisoners, 133 (23%) reported they had injected drugs (intravenous drug users, IDU) including 71 (53%) who had injected drugs during the three months preceding incarceration. Seven percent of the IDU received opiate substitutes before their imprisonment. Nine prisoners of the 120 who have responded to the question (7.5%: 3.7-14.2 95% CI) stated they had injected drugs during the first three months of incarceration. Multivariate analysis showed that reincarceration was significantly more frequent among men, HIV-infected and unemployed prisoners, and prisoners not receiving opiate substitutes at the time of their imprisonment.

This study show that risk behaviors of HIV and hepatitis virus transmission are frequent among intravenous drug users, including during their incarceration. The relationship between opiate substitution treatment and reincarceration deserves to be studied further on larger samples in order to better evaluate its impact on social rehabilitation of drug addicts. This data also underline the need to strengthen prevention programs in prisons and the importance of social and health policies targeted on drug users especially opiate substitution programs.