HIV and Hepatitis in an Indonesian Prison

March 2011—HIV and hepatitis C are often more prevalent in prison settings than in the general population due to the over-representation of people who inject drugs.¹ Improved access to voluntary counseling and testing (VCT) during the prison intake process may vastly improve identification of infected inmates, improve access to HIV treatment, and facilitate prevention after release. While HIV prevention, care, and treatment programs are generally limited in prisons in Southeast Asia, Indonesia has made significant progress in addressing HIV in prisons. To understand the behavioral correlates of HIV and other blood-borne infections among Indonesian prisoners and to explore the impact of prison-based VCT, a cross-sectional study was conducted in the West Javan city of Bandung in Banceuy prison, one of two in the region for drug-related offenses.

Among the 639 incoming prisoners who agreed to be tested, the prevalence of HIV was 7.2 percent, 5.8 percent for hepatitis B, and 18.6 percent for hepatitis C.² A history of injection drug use was strongly associated with HIV and hepatitis C infection. Hepatitis B and C were more common among prisoners with tattoos. Current prisoners with self-reported risk behavior or signs and symptoms related to HIV infection were also offered testing. Of the 57 inmates who were tested, 29.8 percent had HIV and 37.7 percent had hepatitis C. All who were diagnosed with HIV received further CD4 count testing and ART according to national guidelines.

VCT for incoming prisoners is an important but often missed opportunity to provide timely diagnosis and treatment of HIV. It may also provide an opportunity to inform and educate inmates who are engaging in high-risk practices. The researchers emphasized the importance of supportive prison policies, collaboration between the prison and healthcare facilities, and the involvement of staff and prisoners to successfully implement a comprehensive testing and treatment program.

 ¹ Dolan, K, et al. HIV in prison in low-income and middle-income countries. Lancet Infectious Diseases. 2007; 7: 32-41.

² Nelwan, EJ, et al. Human immunodeficiency virus, hepatitis B and hepatitis C in an Indonesian prison: Prevalence, risk factors and implications of HIV screening. Tropical Medicine and International Health. 2010; 15 (12): 1491-98.