Incarceration is a major risk factor for blood-borne infection among intravenous drug users

Background: There is a strong association between hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection which are mainly transmitted by contamination with blood via intravenous drug abuse (IVDU) or sexual contact. Objectives: To determine the prevalence of these infections and the risk factors associated with them among prisoner and non-prisoner IVDUs in Tehran, Iran. Patients and Methods: This cross-sectional study was performed in two jails and three drug rehabilita- tion centers between 2001 and 2002 in Tehran. HBsAg and HBcAb were checked using highly specific third generation enzyme immunoassays (DIA.PRO, Italy, specificity >99%, and Radim, Italy, specificity 99.7%, respectively). HCVAb was detected using ELISA (DIA.PRO, Italy) with both sensitivity and specifi - city >98%. HIVAb test (DRG Diagnostics kit, Germany) was performed for 459 of the 468 IDU subjects. Results: 392 prisoners and 135 individual attending drug rehabilitation centers were approached. Of the 518 subjects studied, 464 (89.5%) were male, 386 (74.5%) were prisoners and 132 (25.5%) were non- prisoners. In this study, HBsAg, HCVAb and HIVAb were positive in 19 (3.7%), 359 (69.5%) and 70 (15.5%) of subjects, respectively. These tests were positive in 17 (4.5%), 311 (80.5%) and 63 (17%) among prisoners and 2 (1.5%), 48 (36.5%) and 7 (7.8%) in non-prisoners, respectively. Multiple logistic regression analysis revealed that independent factors related to co-infection of HCV and HIV infection were imprison- ment (p<0.001. OR: 7.5) and using common syringe (p=0.03, OR: 4.5). Conclusions: Our findings strongly suggest that drug injection inside prison carries is a risk for HIV in - fection and that HIV infection among IDUs is likely to be bridged to the broader population through sexual contact without using effective prevention programs. Implication for Health policy/practice/research/medical education: Past history of being in a prison is discussed as one of the risk factors of acquiring Hepatitis B infection especially among IV drug abusers. Family physicians, health policy makers, authorized person in the health system of prisons should read this important article. Besides, this should be more considered for NGO's which are active for improvement of health conditions in the public places like prisons.