1
|
Friestad C, Haukvik UK, Johnsen B, Vatnar SK. Prevalence and characteristics of mental and physical disorders among female prisoners: a mixed-methods systematic review. Int J Prison Health 2023; 19:599-627. [PMID: 37158168 DOI: 10.1108/ijph-12-2022-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE This study aims to provide an overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among sentenced female prisoners. DESIGN/METHODOLOGY/APPROACH A mixed-methods systematic literature review. FINDINGS A total of 4 reviews and 39 single studies met the inclusion criteria for the review. Mental disorders were the main area of investigation in the majority of single studies, with substance abuse, particularly drug abuse, as the most consistently gender biased disorder, with higher prevalence among women than men in prison. The review identified a lack of updated systematic evidence on the presence of multi-morbidity. ORIGINALITY/VALUE This study provides an up-to-date overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among female prisoners.
Collapse
Affiliation(s)
- Christine Friestad
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Unn Kristin Haukvik
- Faculty of Medicine, University of Oslo, Oslo, Norway and Department of Mental Health and Addiction, Oslo University Hospital, Asker, Norway
| | - Berit Johnsen
- University College of Norwegian Correctional Service, Lillestrøm, Norway
| | - Solveig Karin Vatnar
- Department of Mental Health and Addiction, Oslo University Hospital, Asker, Norway and Molde University College, Molde, Norway
| |
Collapse
|
2
|
Ahmadi Gharaei H, Fararouei M, Mirzazadeh A, Sharifnia G, Rohani-Rasaf M, Bastam D, Rahimi J, Kouhestani M, Rezaian S, Dianatinasab M. The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:93. [PMID: 34210349 PMCID: PMC8252262 DOI: 10.1186/s40249-021-00876-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/16/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common among individuals with human immune deficiency virus (HIV) infection worldwide. In this study, we did a systematic review and meta-analysis of the published literature to estimate the global and regional prevalence of HCV, HBV and HIV coinfections among HIV-positive prisoners. METHODS We searched PubMed via MEDLINE, Embase, the Cochrane Library, SCOPUS, and Web of science (ISI) to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV. We used an eight-item checklist for critically appraisal studies of prevalence/incidence of a health problem to assess the quality of publications in the included 48 cross-sectional and 4 cohort studies. We used random-effect models and meta-regression for the meta-analysis of the results of the included studies. RESULTS The number of the included studies were 50 for HCV-HIV, and 23 for HBV-HIV co-infections. The pooled prevalence rates of the coinfections were 12% [95% confidence interval (CI) 9.0-16.0] for HBV-HIV and 62% (95% CI 53.0-71.0) for HCV-HIV. Among HIV-positive prisoners who reported drug injection, the prevalence of HBV increased to 15% (95% CI 5.0-23.0), and the HCV prevalence increased to 78% (95% CI 51.0-100). The prevalence of HBV-HIV coinfection among prisoners ranged from 3% in the East Mediterranean region to 27% in the American region. Also, the prevalence of HCV-HIV coinfections among prisoners ranged from 6% in Europe to 98% in the East Mediterranean regions. CONCLUSIONS Our findings suggested that the high prevalence of HBV and HCV co-infection among HIV-positive prisoners, particularly among those with a history of drug injection, varies significantly across the globe. The results of Meta-regression analysis showed a sliding increase in the prevalence of the studied co-infections among prisoners over the past decades, rising a call for better screening and treatment programs targeting this high-risk population. To prevent the above coinfections among prisoners, aimed public health services (e.g. harm reduction via access to clean needles), human rights, equity, and ethics are to be seriously delivered or practiced in prisons. Protocol registration number: CRD42018115707 (in the PROSPERO international).
Collapse
Affiliation(s)
- Hasan Ahmadi Gharaei
- Department of Epidemiology, School of Public Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Health, Faculty of Public Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Public Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Golnaz Sharifnia
- Department of Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Marzieh Rohani-Rasaf
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Dariush Bastam
- Medical School, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Jamileh Rahimi
- Department of Epidemiology and Biostatistics, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mostafa Kouhestani
- Department of Health, Faculty of Public Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Shahab Rezaian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Dianatinasab
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, the Netherlands.
| |
Collapse
|
3
|
SAYYAH M, RAHIM F, KAYEDANI GA, SHIRBANDI K, SAKI-MALEHI A. Global View of HIV Prevalence in Prisons: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:217-226. [PMID: 31205875 PMCID: PMC6556176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to estimate the global prevalence of HIV, as well as cross-countries comparison in people who are in prison. METHODS We systematically assessed published studies reporting HIV prevalence among prisoners in the world. We searched international datasets banks, including PubMed, SCOPUS, Cumulative Index to Nursing and ISI web of science along with local databases and included original articles reporting data on the prevalence of HIV from 1980 to 2017. RESULTS We included 72 studies that reported HIV prevalence for 2,275,930 adult male and female prisoners. The pooled estimate of HIV prevalence was 3.4% (95% CI 3.2%-3.6%); however, the prevalence of HIV across individual studies varied considerably (ranging from 0 in Bosnia and Herzegovina to More than 20% in Iran, Zambia, Spain) and statistical heterogeneity was substantial (I2=0.99, Q=121; P<0.0001). The prevalence of HIV among prisoners in the continents Asia, Africa, North America and Europe was estimated as 3.0% (95% CI 3.3%-4.3 %), 6% (95% CI -0.0%-2.0%), 4% (95% CI 3.0%-4.0%), 5.0% (95% CI 0.0%-11%), respectively. CONCLUSION Protecting prisoners' health protects general public health. Successful HIV preventive measures in prisons include provision of HIV education and information; clean needles and syringes; drug treatment; and condoms. Governments have a moral and ethical obligation to prevent the spread of HIV/AIDS in prisons and to provide compassionate care, treatment and support for those infected.
Collapse
Affiliation(s)
- Mehdi SAYYAH
- Education Development Center (EDC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher RAHIM
- Research Center of Thalassemia & Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,Corresponding Author:
| | - Gholam Abbas KAYEDANI
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kiarash SHIRBANDI
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Ahvaz, Iran
| | - Amal SAKI-MALEHI
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
4
|
|
5
|
Iroh PA, Mayo H, Nijhawan AE. The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis. Am J Public Health 2015; 105:e5-16. [PMID: 25973818 DOI: 10.2105/ajph.2015.302635] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.
Collapse
Affiliation(s)
- Princess A Iroh
- Princess A. Iroh and Ank E. Nijhawan are with Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas. Helen Mayo is with Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center
| | | | | |
Collapse
|
6
|
Youmans E, Burch J, Moran R, Smith L, Duffus WA. Epidemiological characteristics of HIV-infected women with and without a history of criminal justice involvement in South Carolina. JOURNAL OF CORRECTIONAL HEALTH CARE 2012; 19:15-26. [PMID: 22935622 DOI: 10.1177/1078345812456376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The circumstances that lead to incarceration may potentiate the HIV/AIDS epidemic and this has become an emerging public health concern. In the United States and in most jurisdictions, HIV prevalence in the correctional setting is higher among female inmates than male inmates. This dichotomy is not fully understood and few studies have focused on women in the South. Using data from the South Carolina (SC) electronic HIV/AID Reporting System, the SC Law Enforcement Criminal History database, and a public access website of the SC Department of Corrections, the authors describe the epidemiological characteristics and correctional history of a population of HIV-infected women in SC diagnosed between January 1, 1996, and December 31, 2005.
Collapse
Affiliation(s)
- Eren Youmans
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | | | | | | | | |
Collapse
|
7
|
Harzke AJ, Goodman KJ, Mullen PD, Baillargeon J. Sources of heterogeneity in hepatitis B virus (HBV) seroprevalence estimates from U.S. adult incarcerated populations: A systematic review and meta-regression analysis. Int J Prison Health 2010; 6:5-17. [PMID: 21556292 PMCID: PMC3089417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
HBV seroprevalence estimates from U.S. incarcerated populations are relatively high. However, the usefulness of these estimates for guiding HBV-related correctional healthcare policy is limited by wide variation in estimates across studies and little understanding of the sources of this variation. The authors systematically reviewed studies indexed from 1975-2005, meeting pre-specified criteria and reporting HBV seroprevalence estimates from U.S. adult incarcerated populations. Using meta-regression techniques, the authors investigated report type, geographical region, serum collection year, facility type, serum source, sampling procedures, sample characteristics, and measurement procedures as potential study-level sources of heterogeneity in prevalence estimates for common HBV seromarkers. In bivariable meta-regression analyses, mean age ≥31 years was strongly associated with increased HBsAg prevalence (POR=2.6), and serum collection year before 1991 was strongly associated with increased prevalence of any positive marker (POR=2.0). Other moderate-to-strong associations were observed, but these were considered less certain because of small numbers of observations, influence of single studies, or potential confounding. Potential sources of heterogeneity should be considered when comparing HBV seroprevalence estimates in adult U.S. incarcerated populations and when developing HBV screening and vaccination protocols in correctional settings.
Collapse
Affiliation(s)
- Amy J Harzke
- Division of Correctional Managed Care and the Department of Preventive Medicine and Community Health at the University of Texas Medical Branch, Galveston, TX, USA
| | | | | | | |
Collapse
|
8
|
Harzke AJ, Goodman KJ, Mullen PD, Baillargeon J. Heterogeneity in hepatitis B virus (HBV) seroprevalence estimates from U.S. adult incarcerated populations. Ann Epidemiol 2009; 19:647-50. [PMID: 19596205 DOI: 10.1016/j.annepidem.2009.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 04/01/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Amy J Harzke
- Division of Epidemiology and Outcomes in Correctional Managed Care, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | | | | | | |
Collapse
|
9
|
|
10
|
González C, Canals J, Ortiz M, Muñoz L, Torres M, García-Saiz A, Del Amo J. Prevalence and determinants of high-risk human papillomavirus (HPV) infection and cervical cytological abnormalities in imprisoned women. Epidemiol Infect 2008; 136:215-21. [PMID: 17445312 PMCID: PMC2870800 DOI: 10.1017/s0950268807008382] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2007] [Indexed: 11/06/2022] Open
Abstract
The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27.4% and prevalence of SIL was 13.3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24.6% vs. 14.3%, P<0.05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0.001) and tobacco use (OR 2.62, 95% CI 1.01-6.73). HPV infection (OR 4.8, 95% CI 1.7-13.8) and HIV infection were associated with SIL (OR 4.8, 95% CI 1.6-14.1). The commonest HPV types were HPV16 (29.4%), HPV18 (17.6%), HPV39 (17.6%) and HPV68 (17.6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.
Collapse
Affiliation(s)
- C González
- Department of Public Health and History of Science, Miguel Hernández University, Alicante, Spain.
| | | | | | | | | | | | | |
Collapse
|
11
|
Strazza L, Massad E, Azevedo RS, Carvalho HB. Estudo de comportamento associado à infecção pelo HIV e HCV em detentas de um presídio de São Paulo, Brasil. CAD SAUDE PUBLICA 2007; 23:197-205. [PMID: 17187118 DOI: 10.1590/s0102-311x2007000100021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Accepted: 05/26/2006] [Indexed: 11/22/2022] Open
Abstract
Observa-se aumento do número de casos de AIDS e hepatite C entre mulheres, incluindo aquelas confinadas no sistema prisional. Este trabalho propôs estudar aspectos relacionados ao comportamento sexual e associados ao risco de transmissão do HIV e da hepatite C em detentas numa penitenciária de São Paulo, Brasil. É um estudo transversal realizado em 2000, aplicando questionários de comportamento e obtendo diagnósticos sorológicos para HIV e HCV. A medida de associação escolhida foi OR para análises bi e multivariada (regressão logística). Participaram do estudo 290 detentas. A prevalência observada para HIV e HCV foi de 13,9% e 16,2%, respectivamente. Associações estatisticamente significantes (p < 0,05) para HIV positivo foram observadas para as variáveis: parceiros com AIDS OR = 6,9 (2,7-35,2); usuários de drogas ingetáveis (UDI) OR = 3,3 (1,6-14,7); parceiro fixo OR=3,7 (1,5-8,3) e para HCV positivo com UDI OR = 13,7 (4,4-42,7); parceiro UDI OR = 4,9 (1,9-12,2); prisão anterior OR = 2,8 (1,2-6,5) ajustadas por: parceiros com AIDS, UDI, parceiro UDI, uso de drogas e prisão anterior. Concluiu-se que o risco parenteral foi associado com infecções pelo HIV e HCV, e o sexual, pelo HIV. Recomendam-se programas de prevenção adequados e continuados no ambiente carcerário.
Collapse
Affiliation(s)
- Leila Strazza
- Departamento de Medicina Legal, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
| | | | | | | |
Collapse
|
12
|
Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029 USA
| | | |
Collapse
|
13
|
Resch S, Altice FL, Paltiel AD. Cost-effectiveness of HIV screening for incarcerated pregnant women. J Acquir Immune Defic Syndr 2005; 38:163-73. [PMID: 15671801 DOI: 10.1097/01.qai.0000146598.40301.e6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antiretroviral therapy (ART) initiated on a prenatal basis in HIV-infected pregnant women is a highly effective method for preventing mother-to-child HIV transmission. We developed a decision analytic model to project the clinical and economic outcomes of alternative HIV screening strategies (voluntary prenatal screening [VPS], routine prenatal screening [RPS], and mandatory newborn screening [MNS]) for a high-risk population of incarcerated pregnant women. Data for the decision model came from the HIV voluntary counseling and testing program at Connecticut's sole correctional facility for women and a comprehensive anonymously linked serosurvey of all inmates who entered the facility during the 2-year period beginning in October 1994. Based on serosurvey results, in the absence of any HIV screening program, 2.5 cases of pediatric HIV infection would be expected per 1000 pregnancies. Multiplied by the discounted lifetime cost per case of $247,000, this translates to a cost of $624 per testing-eligible prison entrant. Entrants were considered eligible if they were pregnant and their HIV status was unknown. MNS would save money, cost $364 per eligible entrant, and simultaneously reduce the rate of infections to 1.1 per 1000 pregnancies. Doing both MNS and RPS is most effective in reducing the rate of new infections (down to 0.2 per 1000 pregnancies). It would, however, increase costs to $430 per eligible entrant. This would result in an incremental cost of $73,603 per additional pediatric HIV case averted when compared with MNS alone. If mandatory newborn testing was not considered a feasible option, RPS would dominate VPS and would be cost-saving compared with no screening. RPS compares favorably with alternative uses of HIV prevention and treatment resources. In correctional facilities where voluntary newborn screening is already in place, our findings show that there remains a small marginal benefit to be realized from switching to RPS. In settings where HIV screening policies are not in place, however, the implementation of RPS can be expected to significantly reduce pediatric HIV cases and net health care expenditures.
Collapse
Affiliation(s)
- Stephen Resch
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06510-2283, USA
| | | | | |
Collapse
|
14
|
Strazza L, Azevedo RS, Carvalho HB, Massad E. The vulnerability of Brazilian female prisoners to HIV infection. Braz J Med Biol Res 2004; 37:771-6. [PMID: 15107941 DOI: 10.1590/s0100-879x2004000500020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of the present study was to determine the vulnerability of women in prison to HIV infection. The study was carried out from August to October 2000 in a São Paulo State Penitentiary, where 299 female prisoners were serving time. We interviewed and obtained a blood sample from 290 females who agreed to enter the study. Sera were tested for the presence of antibodies to HIV, hepatitis C virus (HCV) and syphilis and the odds ratio (OR) was calculated for variables related to HIV positivity on the basis of a questionnaire. The overall prevalence data were: 13.9% for HIV (37 of 267), 22.8% for syphilis (66 of 290), and 16.2% for HCV (47 of 290). Sexual partnership variables were significantly related to HIV infection. These included HIV-positive partners (OR = 7.36, P = 0.0001), casual partners (OR = 8.96, P = 0.009), injectable drug user partners (OR = 4.7, P = 0.0001), and history of sexually transmitted disease (OR = 2.07, P = 0.05). In addition, a relationship was detected between HIV infection and drug use (OR = 2.48, P = 0.04) and injectable drug use (OR = 4.2, P = 0.002). Even women with only one partner presented a significant OR for HIV infection (OR = 2.57, P = 0.009), reflecting their vulnerability due to their trust in their partner, who did not use a condom. Although the use of injectable substances is associated with HIV infection, our results point to sexual behavior as the most important component of HIV transmission in the female prisoner population.
Collapse
Affiliation(s)
- L Strazza
- Laboratório de Investigação Médica, LIM-01, Hospital das Clínicas, Universidade de São Paulo, Sao Paulo, SP, Brazil.
| | | | | | | |
Collapse
|
15
|
Morrison-Beedy D, Carey MP, Aronowitz T, Mkandawire L, Dyne J. An HIV risk-reduction intervention in an adolescent correctional facility: lessons learned. Appl Nurs Res 2002; 15:97-101. [PMID: 11994826 DOI: 10.1053/apnr.2002.29530] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adolescents are now being described as the generation most at risk for human immunodeficiency virus (HIV) infection. Incarcerated young women remain a group at even greater risk, with markedly higher HIV seroprevalence rates compared with their male counterparts. In preparing for a longitudinal, randomized, controlled trial, our research team conducted a pilot project with incarcerated adolescent women. The purpose of this report is to offer clinicians and researchers interested in working with this population some insights on how to approach young women in detention and the logistics of carrying out a program in a correctional facility.
Collapse
|
16
|
McClelland GM, Teplin LA, Abram KM, Jacobs N. HIV and AIDS risk behaviors among female jail detainees: implications for public health policy. Am J Public Health 2002; 92:818-25. [PMID: 11988453 PMCID: PMC1447167 DOI: 10.2105/ajph.92.5.818] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.
Collapse
Affiliation(s)
- Gary Michael McClelland
- Psycho-Legal Studies Program, Northwestern University Medical School, Chicago, Ill 60611-3078, USA.
| | | | | | | |
Collapse
|
17
|
Lopes F, Latorre MR, Campos Pignatari AC, Buchalla CM. [HIV, HPV, and syphilis prevalence in a women's penitentiary in the city of São Paulo, 1997-1998]. CAD SAUDE PUBLICA 2001; 17:1473-80. [PMID: 11784908 DOI: 10.1590/s0102-311x2001000600018] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Incarcerated women as a group are particularly vulnerable to infections. The lack of public programs for prevention, early diagnosis, and treatment contribute to the increase in the incidence and prevalence of diseases in general and especially sexually transmitted diseases. This article aims to estimate the prevalence of infection by the human immunodeficiency virus (HIV), human papillomavirus (HPV), and syphilis among inmates at the Women's Penitentiary in the State capital of São Paulo, Brazil. All inmates were invited to participate in the study, which was divided into two stages: 1. STD/AIDS preventive workshops including interviews and 2. laboratory tests. The interview covered knowledge of STD/AIDS, risk behavior, and individual reproductive health history. A total of 262 women, with a mean age of 32.4 years and limited schooling, participated in more than one stage of the study. Prevalence rates were 14.5% for HIV, 16.3% for high-oncogenic-risk HPV probes, 4.8% for low-oncogenic-risk HPV probes, and 5.7% for syphilis. The authors conclude that STD/HIV constitute a serious health problem in the prison system, requiring urgent preventive measures.
Collapse
Affiliation(s)
- F Lopes
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, 01246-904, Brasil
| | | | | | | |
Collapse
|
18
|
Wu ZH, Baillargeon J, Grady JJ, Black SA, Dunn K. HIV Seroprevalence among newly incarcerated inmates in the Texas correctional system. Ann Epidemiol 2001; 11:342-6. [PMID: 11399449 DOI: 10.1016/s1047-2797(01)00210-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The seroprevalence of HIV infection was examined among a sample of incoming inmates in the Texas Department of Criminal Justice prison system. Rates were compared across sociodemographic factors and three types of prison facilities: substance abuse felony punishment units (SAFPs), state jails, and prisons. METHODS The study sample consisted of 4386 incoming inmates incarcerated for any duration, dating from November 1, 1998, to May 31, 1999. RESULTS Among males, inmates entering state jails had a higher HIV infection rate (3.7%) than either inmates entering prisons (1.9%) or those entering SAFPs (0.5%). Among females, inmates entering prisons had a higher rate of infection (9.3%) than those entering state jails (2.5%) or SAFPs (4.5%). CONCLUSIONS Although a number of blinded HIV seroprevalence studies have been conducted in U.S. prison systems, scarce information is currently available on HIV infection rates in alternative correctional facilities. The present study shows that HIV seropositivity varied substantially according to race, gender, and prison facility type. Given the shorter incarceration periods for inmates held in alternative facilities, understanding how infection rates vary according to type of incarceration facility holds particular public health relevance.
Collapse
Affiliation(s)
- Z H Wu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | | | | |
Collapse
|
19
|
Abstract
The purpose of this study was to examine low birthweight (LBW) and fetal death rates for women incarcerated in a large county jail during their pregnancy. Additionally, medical and support services available to these inmates were reviewed. Jail records showed this population to be both medically and socially high risk. Analysis indicated that their LBW rate was statistically higher (p < 0.05) than that of the county or state, but comparable to a matched group residing in high-risk areas of the city in which many of these women resided. During the course of the study, numerous jail policies were identified which had the potential to negatively impact the health of these women and their pregnancy outcomes.
Collapse
Affiliation(s)
- D J Mertens
- Northern Illinois University, School of Nursing, DeKalb, Illinois 60115-2894, USA.
| |
Collapse
|
20
|
|
21
|
Mertens DJ. Pregnancy Outcomes of Inmates in a Large County Jail System: Issues Affecting Quality of Care. JOURNAL OF CORRECTIONAL HEALTH CARE 2000. [DOI: 10.1177/107834580000700105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Diana J. Mertens
- School of Nursing at Northern Illinois University in DeKalb, Illinois
| |
Collapse
|
22
|
Abstract
BACKGROUND Among persons with a sexually transmitted disease (STD), the proportion who are also infected with HIV is a major factor influencing the public health impact of that STD on HIV transmission. GOAL To assess HIV infection in persons with syphilis in the United States. STUDY DESIGN A systematic literature review was conducted of U.S. studies with HIV seroprevalence data in patients with syphilis. RESULTS Thirty studies were identified and analyzed. The median HIV seroprevalence in men and women infected with syphilis was 15.7% (interquartile range [IQR]: 13.6-21.8%), among men was 27.5% (23.1-29.6%), and among women was 12.4% (8.3-20.5%). Median odds ratios for men and women, men only, and women only were 4.5, 8.5, and 3.3, respectively. Seroprevalences among men who have sex with men (MSM) and injecting drug users (IDU) ranged from 64.3-90.0% and 22.5-70.6%, respectively. CONCLUSIONS Despite substantial variability, HIV seroprevalence is high among patients with syphilis in the United States, identifying them as a critical target group for HIV prevention efforts.
Collapse
Affiliation(s)
- M E Blocker
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | |
Collapse
|
23
|
Altice FL, Mostashari F, Selwyn PA, Checko PJ, Singh R, Tanguay S, Blanchette EA. Predictors of HIV infection among newly sentenced male prisoners. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1998; 18:444-53. [PMID: 9715840 DOI: 10.1097/00042560-199808150-00005] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of individuals with or at risk for HIV infection in prisons and jails is severalfold higher than age-adjusted rates in surrounding communities. This HIV serosurvey of 975 newly sentenced male prisoners employed a new methodology that anonymously linked individual information to HIV serologic data. The HIV prevalence was 6.1%; multivariate regression analysis indicated injection drug use (OR = 18.9), black race (OR = 5.5), Hispanic ethnicity (OR = 3.4), psychiatric illness (OR = 3.1) and a history of having had a sexually transmitted disease (OR = 2.2) were independent predictors of HIV infection. Laboratory markers such as hypoalbuminemia, an elevated aspartate aminotransferase (AST) level, leukopenia, anemia, and thrombocytopenia suggest increased risk for HIV among prisoners, particularly in settings where HIV testing resources are scarce. This study, unlike those reported in other geographic regions, indicated that the majority (71%) of HIV-seropositive persons self-reported their HIV status. This finding may suggest that HIV-infected individuals will self-report their status if HIV care is comprehensive and consistent. The large number of HIV-infected individuals within prisons makes prisons important sites for the introduction of comprehensive HIV-related care. This is particularly relevant in that development of new guidelines issued for the management of HIV infection in which potent combination antiretroviral therapy has been demonstrated to decrease morbidity and mortality. The high prevalence of HIV-seronegative inmates with self-reported high-risk behaviors also suggests the importance of prisons as sites for the introduction of appropriate risk-reduction interventions.
Collapse
Affiliation(s)
- F L Altice
- Yale University AIDS Program, New Haven, Connecticut 06510-2283, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
Martín V, Caylà JA, Morís ML, Alonso LE, Pérez R. Predictive factors of HIV-infection in injecting drug users upon incarceration. Eur J Epidemiol 1998; 14:327-31. [PMID: 9690748 DOI: 10.1023/a:1007461608434] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify predictors of HIV-infection in injecting drug users upon incarceration. PATIENTS AND METHODS We studied 639 IDU or ex-IDU prisoners admitted to a provincial prison of Northwestern Spain between 1 January 1991 and 31 December 1995. Each was interviewed by health personnel and tested for HIV-infection (ELISA followed by immunoblot confirmation in positive cases). Statistical analysis was based on logistic regression. RESULTS The prevalence of HIV-infection was 46.9% (95% CI: 43.1%-50.8%). No decreasing tendency in annual prevalence of HIV-infection was observed (p = 0.88); however, for those incarcerated for the first time prevalence fell from 38% in 1991 to 19% in 1995 (p = 0.20). Gypsies (OR: 0.43; 95% CI: 0.23-0.80) and prisoners who were older upon first incarceration (OR: 0.94; 95% CI: 0.90-0.99) were associated with lesser risk of HIV-infection. Women (OR: 2.17; 95% CI: 1.29-3.65), older prisoners (OR: 1.06; 95% CI: 1.02-1.11), those with multiple incarceration histories (OR: 1.06; 95% CI: 1.01-1.11) and long-term prisoners (OR: 1.01; 95% CI: 1.00-1.02) were associated with higher risk. CONCLUSIONS The high prevalence of HIV-infection, especially in women, younger prisoners, repeat offenders and long-term prisoners, suggests that prevention measures directed toward the most marginal IDU have not been very effective. Harm-reduction programs must be made to reach the IDU population, both in and outside prison walls.
Collapse
Affiliation(s)
- V Martín
- Centro Penitenciario, León, Spain.
| | | | | | | | | |
Collapse
|
25
|
Rich JD, Dickinson BP, Spaulding A, Lafazia L, Flanigan TP. Interpretation of indeterminate HIV serology results in an incarcerated population. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1998; 17:376-9. [PMID: 9525440 DOI: 10.1097/00042560-199804010-00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The objective of this study was to evaluate the significance of indeterminate HIV test results in the prison setting. No specific information or guidelines are currently available to direct counseling of incarcerated persons with an indeterminate HIV test. A medical chart review was conducted on all incarcerated inmates at the Rhode Island State Prison who received indeterminate HIV test results between the inception of mandatory testing in 1990 and October 1996. Thirty-five inmates had an indeterminate HIV Western blot (WB) result, and 31 had follow-up HIV testing. Twenty-three of 31 (74%) of the prisoners with follow-up HIV tests seroconverted (95% confidence interval, 55%-88%). Drug/alcohol use, including crack cocaine and injection drug use, was strongly associated with seroconversion (p < 0.01, odds ratio [OR] = 11.8, relative risk [RR] = 2.04). Injection drug use was also significantly associated with seroconversion (p = 0.03, OR = 9.3, RR = 1.56). This is the highest rate of seroconversion ever reported for persons with indeterminate WB test results. Indeterminate test results need to be interpreted differently in the prison setting than in the community. Prison inmates with indeterminate HIV serology should be counseled that in all likelihood they are HIV-infected, and confirmatory viral load testing should be conducted immediately.
Collapse
Affiliation(s)
- J D Rich
- The Miriam Hospital and Brown University, Providence, Rhode Island 02906, USA
| | | | | | | | | |
Collapse
|
26
|
Inciardi JA. HIV risk reduction and service delivery strategies in criminal justice settings. J Subst Abuse Treat 1996; 13:421-8; discussion 439. [PMID: 9142672 DOI: 10.1016/s0740-5472(96)00117-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Because of the HIV risk behaviors of substance abusers, particularly injection drug users and those who exchange sex for drugs, and the large numbers who are already infected with HIV or showing symptoms of AIDS, significant service delivery issues are associated with their criminal justice processing. Many strategies have been implemented in correctional settings in an effort to prevent and control the transmission of HIV. A number of these are for the purpose of lowering transmission risk in institutions, whereas others have been structured for the sake of offering prevention/intervention to inmates before they return to the free community. As such, prisons and jails represent opportune settings for HIV prevention and education. The most common HIV control/prevention/education strategies include mandatory testing of inmates for HIV, segregating infected inmates from the general prison population, establishing special health care units for HIV positive and AIDS symptomatic inmates, offering HIV prevention and risk reduction programs, and granting medical parole for the terminally ill. Because drug abuse treatment results in substantial declines in the use of heroin, cocaine, and other drugs, treatment per se can play a significant role in reducing the spread of HIV and AIDS among those coming to the attention of the criminal justice system. Most promising are continuous and integrated treatment services that are tied to the stages of correctional supervision: primary treatment while incarcerated; secondary treatment while on work release, halfway house or community supervision; and, tertiary treatment in ongoing aftercare.
Collapse
Affiliation(s)
- J A Inciardi
- Center for Drug and Alcohol Studies, University of Delaware, Newark 19716-2582, USA
| |
Collapse
|
27
|
STEVENS JESSICA, ZIERLER SALLY, CRAM VIRGINIA, DEAN DIANE, MAYER KENNETHH, DE GROOT ANNES. Risks for HIV Infection in Incarcerated Women. J Womens Health (Larchmt) 1995. [DOI: 10.1089/jwh.1995.4.569] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Fogel CI. Pregnant Prisoners: Impact of Incarceration on Health and Health Care. JOURNAL OF CORRECTIONAL HEALTH CARE 1995. [DOI: 10.1177/107834589500200205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
29
|
Abstract
Since the 1960s, the cycle of violence and drug use has mounted and an increasing number of people are being incarcerated. Coincident with this phenomena, we have experienced rising rates of morbidity and mortality among the incarcerated, many of whom suffer from infectious diseases. In fact, the spread of diseases like tuberculosis has been facilitated by the congregate nature of the penal system. As the number of people behind bars has risen, we have seen a disproportionate increase in the number of women incarcerated, most of whom are in their childbearing years. The number of pregnant women in jails and prisons has, in turn, been escalating. Certain prenatal interventions are described and evaluated in the literature, which we review in this article. Experience with the prenatal program in the New York City jail system is described. In general, the authors' position is that as society chooses a social policy of incarceration to address the problems of violence and drug use, there is solid public health reason to design and implement comprehensive prenatal programs in correctional facilities with connections to community-based health services.
Collapse
Affiliation(s)
- S M Safyer
- Henry and Lucy Moses Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | | |
Collapse
|
30
|
|
31
|
Hankins CA, Gendron S, Handley MA, Richard C, Tung MT, O'Shaughnessy M. HIV infection among women in prison: an assessment of risk factors using a nonnominal methodology. Am J Public Health 1994; 84:1637-40. [PMID: 7943484 PMCID: PMC1615080 DOI: 10.2105/ajph.84.10.1637] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The relative contributions of needle use practices and sexual behaviors to human immunodeficiency virus (HIV) antibody seropositivity among 394 women incarcerated in Quebec were determined by risk factor assessment and serology with a nonnominal methodology. HIV positivity was found in 6.9% (95% confidence interval [CI] = 4.6, 9.9) of all participants and in 13% (95% CI = 8.6, 18.6) of women with a history of injection drug use. HIV seropositivity among women with a history of injection drug use was predicted by sexual or needle contact with a seropositive person, self-reported genital herpes, and having had a regular sexual partner who injected drugs, but it was not predicted by prostitution. Nonnominal testing is an ethical alternative to mandatory and anonymous unlinked testing among correctional populations.
Collapse
Affiliation(s)
- C A Hankins
- Centre for AIDS Studies, Montréal-Centre Regional Public Health Team, Québec, Canada
| | | | | | | | | | | |
Collapse
|
32
|
Gellert GA, Maxwell RM, Higgins KV, Pendergast T, Wilker N. HIV infection in the Women's Jail, Orange County, California, 1985 through 1991. Am J Public Health 1993; 83:1454-6. [PMID: 8214238 PMCID: PMC1694852 DOI: 10.2105/ajph.83.10.1454] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The incidence and prevalence of human immunodeficiency virus (HIV) infection among injection drug users, prostitutes, and other women seeking confidential testing in the Orange County Women's Jail were assessed from 1985 to 1991. A total of 4616 voluntary tests were completed on 3051 women, and 865 women were tested repeatedly. Eighty-two women tested positively, a ratio of 1.8 positives per 100 tests or 2.7% of all persons tested. Cumulative HIV prevalence increased from 2.5% to 2.7% between 1985 and 1991, increased by age, and showed racial differences. Of women with multiple tests, 29 seroconverted. Incidence declined from 5.7 to 1.4 cases per 100 person-years of observation between 1985 and 1991. The overall rate of seroconversion was 1.6 per 100 person-years of observation.
Collapse
Affiliation(s)
- G A Gellert
- Orange County Health Care Agency, Santa Ana, Calif
| | | | | | | | | |
Collapse
|
33
|
Thurn JR. HIV worldwide. What has happened? What has changed? Postgrad Med 1992; 91:99-100, 103-4, 107 passim. [PMID: 1603765 DOI: 10.1080/00325481.1992.11701367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The human immunodeficiency virus (HIV) has resulted in a worldwide pandemic of infection. By 1991 more than 350,000 AIDS cases had been reported to the World Health Organization, but it is estimated that there are now more than 10 million people infected worldwide. HIV can rapidly spread in new populations: The pandemic is composed of multiple smaller epidemics. In the United States, it is estimated that over a million people are infected with HIV. Methods of estimating this number include extrapolation from the number of reported cases of AIDS, use of mathematical modeling and back-calculation, and seroprevalence surveys. Minorities continue to be overrepresented among those infected, and the prevalence of HIV in women is increasing. In serosurveys, it has been found that as HIV prevalence rates rise, the ratio of infected males to infected females approaches 1:1, suggesting an increased proportion of hetero-sexual transmission. HIV is now variably present but widespread across the United States. The epidemiology of HIV-related illnesses is also changing, as can be seen with current patterns of tuberculosis. HIV continues to be an increasingly complex and dangerous global burden.
Collapse
Affiliation(s)
- J R Thurn
- Department of Infectious Diseases, Minneapolis Veterans Affairs Medical Center, MN 55417
| |
Collapse
|
34
|
Abstract
The results of the Newborn HIV Seroprevalence Study in New York State for 1988 were used to estimate the number of human immunodeficiency virus (HIV)-infected women of childbearing age in 1988. The estimate was accomplished for each of 80 age, racial/ethnic, and geographic strata by dividing the number of seropositive newborns by the 1988 estimated fertility rate. Summing across strata yielded a total of 23,430 infected women age 15 to 44 years in 1988. From this estimate a tree model was used to estimate the number of women infected during 1981-88. Back calculation was used to distribute these infections over time, and the selected incubation distribution was used to estimate future AIDS cases for this population: 8,295 cases by 1993.
Collapse
|
35
|
Abstract
Seroprevalence determinations of human immunodeficiency virus are essential for design and implementation of preventive strategies. By demonstrating the severity of HIV infections within communities, New York State surveys have spurred preventive interventions, including information to the public and health care providers and increased counseling and testing of women of reproductive age. In high-prevalence areas the community health workers have been employed in preventive activities. Specific information has been provided to county health departments on zip code areas with high HIV seroprevalence rates. Serosurveys revealed that the magnitude of HIV infection in adolescents is much larger than indicated by case reports. Various seroprevalence studies confirmed higher rates of infection with increasing age and minority status and a strong association with intravenous drug use. Combining data provided by seroprevalence studies in a given community enables planners to assess the extent of infection in that community and in groups important to transmission of the virus.
Collapse
|