title: Healthcare resources are inadequate to address the burden of illness among HIV-infected male prisoners in Malaysia.
abstract: Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ μL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.
authors.affiliation: Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.|Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.|California Medical Facility, California Correctional Health Care Services, Vacaville, California, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bick
authors.affiliation: Department of Health Systems Science, University of Illinois at Chicago , College of Nursing, Chicago, Illinois, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Culbert
authors.affiliation: Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.|Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.|Centre for International Health, Department of Preventive and Social Medicine, University of Otago , Dunedin, New Zealand.
authors.forename: Haider A
authors.initials: HA
authors.lastname: Al-Darraji
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.
authors.forename: Clayton
authors.initials: C
authors.lastname: Koh
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.
authors.forename: Veena
authors.initials: V
authors.lastname: Pillai
authors.affiliation: Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.|Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.affiliation: Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.|Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.|Department of Internal Medicine, Yale University School of Medicine , Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA.|Division of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven, Connecticut, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Altice
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006526:Hepatitis C / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology / Q000628:therapy; D014376:Tuberculosis / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
keywords: HIV/AIDS; Hepatitis C; Malaysia; Prisoners; Substance abuse; Tuberculosis