High-risk drug-use practices among a large sample of Australian prisoners.
BACKGROUND
Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia.


METHODS
Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination.


RESULTS
We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR=3.07, 95% CI 1.83-5.12), being unemployed prior to incarceration (ARR=1.34, 95% CI 1.01-1.76), use of three or more drug types prior to incarceration (ARR=1.80, 95% CI 1.40-2.31), a history of needle/syringe sharing (ARR=5.00, 95% CI 3.06-8.16), receiving a tattoo during the current prison sentence (ARR=2.19, 95% CI 1.67-2.86) and HCV exposure (ARR=1.47, 95% CI 1.08-2.02). Older age was protective (ARR=0.90 per 5 years older, 95% CI 0.83-0.99).


CONCLUSIONS
Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings.
Centre for Population Health, Burnet Institute, Australia. kinner@burnet.edu.au
Stuart A
SA
Kinner
Rebecca
R
Jenkinson
Maelenn
M
Gouillou
M-J
MJ
Milloy
D000328:Adult; D001315:Australia / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D003710:Demography; D062787:Drug Overdose; D005260:Female; D006304:Health Status; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D008297:Male; D008603:Mental Health; D016485:Needle Sharing; D016017:Odds Ratio; D011329:Prisoners / Q000523:psychology*; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012309:Risk-Taking; D016728:Self-Injurious Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D047568:Unsafe Sex