Penile implants and other high risk practices in French Guiana's correctional facility: A cause for concern

Methods, practices, and complications related to the use of artificial penile nodules within the French Guiana penitentiary

Background

Artificial penile nodules (APNs) are small, handmade objects inserted under the penile skin, a practice deeply rooted in the prison environment of French Guiana, raising significant concerns related to sexual health, including complications and an increased risk of sexually transmitted infections (STIs).

Aim

The primary objective of the current study was to investigate APN practices, methods, and complications in prison and to identify risk factors for complications among APN users and their sexual partners.

Methods

This cross-sectional study was conducted among adult male detainees in June 2023 at the French Guiana Penitentiary (FGP). Eligible participants completed an anonymous 47-question survey addressing sociodemographic data, APN practices, and sexual health. Facilitators played a critical role in distributing and collecting the questionnaires, which were available in five languages to accommodate the prison's population ethnogeographic diversity. Data analysis was conducted using logistic regression to identify risk factors associated with complications.

Outcomes

Outcomes included the prevalence of APN use among detainees, the proportion of individuals experiencing complications, the association between APN characteristics (number and placement) and partner-related complications, as well as the rates of condom breakage and self-reported STI history.

Results

Among 779 eligible detainees, 132 participated (17%). The majority were under 35 years old (67%), and 69% reported having APNs, with a median of 5.2 nodules per user (range: 1-22). The main motivation for APN use was enhancing partner satisfaction (60%), while 5% cited intent to harm. Complications were reported by 25%, including pain (52%), bleeding (41%), and infections (35%). Partner-related complications (pain or bleeding) were significantly associated with having five or more APNs and placement in the foreskin of the penis.

Clinical Implications

Given the high prevalence of APNs in the prison setting and their associated health risks, targeted health education and harm reduction strategies are essential to mitigate complications and promote informed decision-making among detainees.

Strengths and Limitations

The main limitation of this study was its reliance on self-reported questionnaires completed in cells, which may have affected confidentiality, response accuracy, and participation due to prison dynamics and literacy barriers. However, the approach provided valuable insight into a stigmatized topic, and collaboration with facilitators and staff helped achieve meaningful participation.

Conclusion

APNs are deeply rooted in prison culture in French Guiana but pose significant health risks. Findings underscore the need for targeted health education to address these risks, particularly focusing on reducing partner-related complications and promoting informed decision-making about APN practices.

Highlights

Despite their widespread use, APNs pose significant health risks, including pain, infections, and complications for sexual partners, with nearly half of users reporting partner-related issues.This study underscores the need for targeted health education interventions to address these risks and promote safer practices within the penitentiary system.Nearly 70% of detainees reported having artificial penile nodules, with a median of 5.2 nodules per user, highlighting the prevalence of this practice in French Guiana's prisons.A significant link was found between having five or more nodules and partner complications, such as pain or bleeding, emphasizing the impact on sexual health.

Involving hard-to-reach populations is pivotal for the tailoring and implementation of an epidemiological study in cross-border communities of French Guiana and Suriname

Background

Hard-to-reach, vulnerable and cross-border populations are often disproportionately affected by communicable diseases. Epidemiological data on viral hepatitis in French Guiana and Suriname are available for urban areas, but not for remote communities. The Maroni River, which separates FG and Suriname, is home to Tribal and Indigenous communities. Reaching these populations is challenging due to logistical constraints, cultural and language barriers, and mistrust of outsiders.

Objectives

We aimed to conduct an epidemiological study of viral hepatitis [Maroni Hepatites Virales (MaHeVi)] in this remote and complex area. Here, we describe the operational hurdles and solutions required to achieve this.

Methods

We undertook a preliminary assessment of the area with local community leaders and health workers to gain approval of MaHeVi, acceptance of blood sampling, and suggestions for adapting the study to cultural and logistical constraints. Anthropological assessments were conducted through focus groups and interviews with key individuals to assess knowledge, beliefs and risk factors for VH.

Results

MaHeVi was well received by the local communities. The approval of the community leaders was crucial for the implementation and acceptance of the study. The main adaptations were hiring community health mediators to overcome cultural and language differences, using blotting paper instead of venipuncture for logistical and acceptability reasons, and adapting communication materials.

Conclusion

Careful preparation and tailoring of the communication materials and research protocol have enabled the successful implementation of the study. This process could be replicated in this area and transferred to other complex contexts combining borders, logistical hurdles and populations requiring cultural adaptations.

Effect of a board game on imprisoned women's knowledge about sexually transmitted infections: a quasi-experimental study

INTRODUCTION

Board games can be used as a playful educational practice in the teaching and learning process, as they constitute an educational technology that can be a source of health knowledge and an aid in decision-making. The objective of this research was to assess the effect of a board game on imprisoned women's knowledge about STIs.

METHODS

A quasi-experimental study was conducted in 2022 with 64 imprisoned women who were students at a school located in a prison unit from the city of Recife, state of Pernambuco, Brazil. A 32-item instrument was used to assess knowledge about sexually transmitted infections before, immediately after the intervention and at 15 days. The intervention consisted in applying the Previna board game in a classroom. All the analyses were performed in the Stata software, version 16.0, with a 5% significance level.

RESULTS

The knowledge mean in the pre-test was 23.62 (± 3.23) points, whereas it rose to 27.93 (± 2,28) in the immediate post-test, dropping to 27.34 (± 2.37) (p < 0.001) in post-test 2, which was performed 15 days after the intervention. There was a statistically significant difference in the means obtained between the pre-test and the immediate post-test (p < 0.001), with a difference of 4.241 points, as well as between the pre-test and post-test 2 (p < 0.001), a difference of 3.846 spots.

CONCLUSIONS

The Previna board game significantly increased its players' knowledge about STIs, and such increase in knowledge remained significant during the follow-up period.

[Overview of infectious and non-infectious diseases in French Guiana in 2022]

Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.