Full length articleHepatitis C antibody prevalence among Mexico City prisoners injecting legal and illegal substances
Introduction
An estimated 185 million people, or 2.6–3.1% of the global population, are hepatitis C virus (HCV) antibody (anti-HCV) positive, indicating infection with HCV at some point in time (Mohd Hanafiah et al., 2013). Around one-quarter of people with acute HCV infection will clear the virus (Nelson et al., 2011). The others will progress to chronic infection, which after a decade or more may lead to hepatic fibrosis, cirrhosis, and hepatocellular carcinoma (Nelson et al., 2011).
HCV is a blood-borne infection, and people who inject drugs (PWID) or have a history of injecting drug use comprise the majority of existing infections; an estimated two-thirds of PWID globally are anti-HCV positive (Nelson et al., 2011). Unsafe injecting practices (e.g., syringe sharing, rushed injecting) and vulnerability to infections among PWID are a result of an array of social, structural, and environmental influences (Rhodes et al., 2006). Previous studies have recognized the potential risk of HCV transmission among people who inject substances other than illicit drugs (McVeigh et al., 2003), such as steroids or vitamins (e.g., anabolic steroids). However, there is limited data about the size of this group’s contribution to HCV transmission.
Prisons are important sites for HCV transmission (Larney et al., 2013). Sharing injection equipment represents the greatest risk of transmission of hepatitis in these settings (UNODC et al., 2006). Thus, in the absence of access to sterile injecting equipment (as in the case of almost all prisons globally) (Harm Reduction International, 2016), hepatitis can be transmitted between prisoners who share contaminated needles and syringes. Recent evidence from a meta-analysis confirms that HCV infection is highly prevalent among prisoners; an estimated one-quarter of all prisoners globally are anti-HCV positive, and among prisoners who inject drugs, anti-HCV prevalence is estimated at 64% (Larney et al., 2013). International reports suggest that a single syringe could be shared by 10 or more people within this PWID-prisoner context (UNODC, 2014).
Anti-HCV prevalence in Mexico has been estimated at 1–2.5% (Burguete-García et al., 2011, Santos-López et al., 2008, Valdespino et al., 2007). This is below 2016 HCV viraemic prevalence estimates for Mexico of 0.4% (The Polaris Observatory HCV Collaborators, 2016). Among prisoners, there is limited evidence regarding to the epidemiology of HCV. One study in a Durango prison in 2001–2002 found anti-HCV prevalence of 10% (Alvarado-Esquivel et al., 2005). More recently, a large study in Mexico City suggested that anti-HCV prevalence in Mexican prisoner populations is somewhat lower than this, although still higher than in the general population (3.3% in men prisoners and 2.7% in women prisoners) (Bautista-Arredondo et al., 2015).
In addition to the commonly understood risk factors of injecting drug use (Smith et al., 2014), blood transfusion, surgery, dental care (Santos-López et al., 2008), and non-sterile tattooing (Carney et al., 2013), in the Mexican prison context, there may be anti-HCV risks associated with injection of vitamins; however, there is a lack of literature on this subject. Vitamin injection may be carried out because of perceived superiority of injected vs oral administration. Although, prior research has documented the prevalence of HCV in some Mexican prisons, to date there has been no exploration of the risks associated with injection of vitamins. This study has two aims: to determine the prevalence of risk behaviors for anti-HCV prevalence, with particular interest on injecting behavior, and to assess factors associated with anti-HCV positivity among prisoners in Mexico City during 2010–2011.
Section snippets
Study setting
We analyzed data from a cross sectional study carried out among prison population from three male and two female prisons in Mexico City during 2010–2011 (North and South prisons, CERESOVA- Men’s Social Rehabilitation Center Santa Martha; Santa Martha Acatitla and Tepepan). The Institutional Review Board at the National Institute of Public Health, Mexico (Protocol ID # 821), approved this study.
This study consisted of two main components, a screening phase that included a general health
Results
After excluding 393 participants due to missing data (9.1%), 3,911 prisoners were included in the analysis (weighted sample = 15,828). Compared to prisoners not included in our analysis, our sample of prisoners were older, had more years of schooling, a lower socio-economic status index, a larger percentage were married and reported to have ever injected vitamins.
Anti-HCV weighted prevalence was 3.3% (n = 103 cases) (95% CI: 2.6, 4.0%), 2.2% of female (95% CI: 0.9, 3.5%) and 3.5% of male prisoners
Discussion
Based on data from the most populous prisons in Mexico City, we found that overall prevalence of anti-HCV was 3.3% (95% CI: 2.6%, 4.0%), being similar by sex: female prisoners (2.2%; 95% CI: 0.9, 4.0%), male prisoners (3.5%, 95% CI: 2.7, 4.2%). This study also showed that anti-HCV is highly prevalent among prisoners with history of injecting behavior (43.1% (95% CI: 33.0%, 53.7%) among ever-injected illegal drugs and 43.8% (95% CI: 30.8%, 57.8%) among ever-injected vitamins). In this sense,
Conclusion
Prison can be a setting for effective public health interventions for HCV infection prevention. Anti-HCV/HIV public health messages do not target the vitamin-injecting population, providing a potential risk population for future transmission. Thus, widening the public health policies focused on injecting behavior should consider substances different from illicit drugs in the potential transmissibility of HCV infection. Designing and implementing these policies should take advantage of strategic
Contributors
OSR, ESM, and SBA: Conceived and design the study. OSR and ESM: Analyzed the data and wrote the first draft of the manuscript. All authors reviewed and contributed to the manuscript writing and approved the final manuscript version.
Role of funding source
This work was supported by the Ministry of Health of Mexico City during 2010 [grant number INSP-2010-340]. The funders did not have any role on the study design, data analysis, decision to publish, or drafting the manuscript. This study was reviewed and approved by the Committees of Research, Biosafety and Ethics of the INSP, Mexico (Protocol ID # 821).
Conflict of interest
No conflict declared.
Acknowledgements
The authors would like to thank Nathalie Grass Allain for her valuable comments on the barriers for implementing HCV programs for prisoners. She is the Subdirector of health care for key population and specific programs of the Centre for HIV/Aids integral care and prevention of Mexico City at Condesa Specialized Clinic. We would also like to thank the study participants and authorities of the penitentiary system from Mexico City for their generous help to carry out this study.
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