2. Hepatitis C and HIV associated risk factors among people in prison in Latvia, Lithuania, Portugal, Spain: informing interventions to prevent communicable diseases in prison setting

Compared with general population, prevalence of substance use and infectious diseases is higher among prison population. People in prisons (PiP) are at higher risk of exposure to infections considering penitentiary and drug use risk factors. The European Questionnaire on Drug use among people living in Prison (EQDP) has been used in several European countries to provide a comparable cross-countries picture.

Latvia, Lithuania, Portugal and Spain have conducted repeated cross sectional surveys on substance use among PiP between 2014 and 2018, using EQDP. Multivariable logistic regression was used to identify risk factors independently associated with HIV and hepatitis C (HCV) infection among the prison population by using IBM SPSS 24.0 software.

HCV prevalence ranged from 15.7% in Spain to 26.3% in Latvia, while HIV from 5.9% in Lithuania to 7.6% in Latvia. Odds of having HCV were higher for repeatedly incarcerated with OR (95% CI) ranging from 3.2(2.6–3.9) in Latvia to 5.7(2.6–12.7) in Lithuania, while the odds of having HIV was 2-fold higher as compared to those without repeated incarcerations in Latvia, Portugal and Spain.

First injection in prison was positively associated with HCV with aOR (95% CI) ranging from 2.6(1.7-4.1) in Latvia to 8.4(4.5 – 15.6) in Lithuania and similarly for HIV. Tattooing in prison increasing the odds of having HCV (aOR(95% CI): 2.1(1.6–2.6) in Latvia and 4.3(2.6–7.1) in Lithuania). Injection during imprisonment was positively associated with HIV in Latvia and Lithuania (aOR(95%CI): 4.4(95%CI 2.3 – 8.4) and 6.7(95%1.3 – 33.5), respectively).

Incarceration recidivism and first injection during imprisonment were factors strongly associated with HIV and HCV prevalence. Tattooing in prison increased the odds of HCV. Injection during imprisonment rather than only before prison increased the odds of HIV. Identification of risk factors specific to penitentiary system provides valuable information for HIV and HCV prevention strategies.