Low acceptability of real time HIV counseling and testing among prision inmates in South Brazil
Background: Inmate populations include a large number of individuals at risk of human immunodeficiency virus (HIV) infection due to injection drug use, unsafe sex, body piercing and tattooing. Special strategies to identify and prevent HIV infection in these settings are needed. Objective: To assess acceptability of a real time HIV voluntary counseling and testing strategy (RT-VCT) and to describe sociodemographic and behavioral characteristics of inmates of a regional prison in South Brazil. We also estimated HIV seroprevalence among participants. Methods: We conducted a cross-sectional survey (n=439) at Presídio Industrial de Caxias do Sul in the period of 24 - 27 of February, 2003. Inmates were group counseled and offered RT-VCT (HIV rapid test performed in front of the patient while responding a questionnaire and results given at the same visit). Data on demographics, knowledge of HIV, risk factors for acquisition and their opinion on RT-VCT process was obtained. Testing was conducted preserving confidentiality. After consent, inmates' whole blood was screened for HIV antibodies by InstantScreen Ultra-Rapid HIV-1/2 (GAIFAR GmbH, Germany). Results: Of 439 male inmates, 125 participated (28,5%); (95% CI: 24,3 – 32,9). 102 (81.6%) were white. 68 (54.8%) were single and 54 (43.5%) reported inconsistent use of condoms. The mean age was 28,3 years (SD: 7,5). Mean (median) time of incarceration was 20 (13) months. Mean time for individual counseling and testing: entire group: 28 min, (negatives: 15 min; positives: 39 min). The prevalence of HIV infection was 4,0% (95% CI: 1,3 – 9,1). Conclusion: Prison environment present a special challenge for the implementation of HIV RT-VCT. Correctional institutions need to offer adequate space and trained personnel to increase RT-VCT participation. Voluntary HIV testing in prison should be encouraged, and inmates should receive appropriate counseling and information to allow realistic assessment of risk and care. We speculate low participation due to stigma in this environment.
Motta, L R
L R Motta1, R S De Souza1, C T De Souza1, M Cavagnoli1, M C Bisi1, P B Pasquali1, M Bertelli1, A L A Aver1, C D Mitchell2
1HIV/AIDS Research Laboratory - Universidade de Caxias do Sul, Caxias do Sul, Brazil; 2Department of Pediatrics Division of Infectious Diseases - University of Miami, Miami, United States