6th Regional Conference in Sarajevo, May 17-18 2012.

1. HIV AND HCV PREVALENCE
IN PRISONS IN TUZLA
CANTON
Sana Šabović-Olić
Clinic for Infectious Diseases, University Clinical Center Tuzla,
Bosnia and Herzegovina
SARAJEVO, may 17-18, 2012

2. Prisons in B&H, besides fighting against entry of drugs, cell
phones and other prohibited items, are confronting with one not
so negligible problem, and it is about prisoners infected with
HIV and hepatitis B and C.
The situation with the number of infected prisoners in B&H is
not alarming, but the problem exists, and is not
for underestimation.
Testing in prisons is voluntary, confidential and free of charge in
order to prevent spreading HIV and HCV infection, and to
detect infected prisoners, so their treatment can be started in
optimal time.

3. The aim of this study is to show the
prevalence of HIV, HCV & HBV infection in
inmates of prisons in Tuzla Canton.

4. In period from january 1, 2007 to december 31, 2011, in Tuzla
prison were 483 inmates tested for HIV and HCV. The total number
ff inmates that could be tested was much higher. For inmates under
investigation we needed special permission, so we did not test them,
as well as inmates in an outpost of prison, which was in city of
Orašje.

5. Testing was volontery, with pre-test and post-test counseling, and
with partially filled encrypted questionnaire. The questionnaire
covered all the risky moments by which one person could get HIV
and HCV.
Blood of inmates was tested by ELISA HIV Combo assay, anti HCV
and HBsAb, rapid HIV tests and ORA QUICK tests for HCV.

6. First testing in the prison was made in
1999.
34 prisoners were tested.

7. In years after, we tested prisoners
2 times per year.

8. From 2005, we tested prisoners 4-6
times per year.

9. Among the tested were 2% of
prisoners who were previously
tested, and they were not
included in this study.

10. Table 1. Age ond sex of prisoners in the prison in Tuzla
Age Both sexes Male Female
< 20 years 51 (10,56%) 40 (12,46%) 11 (6,72%)
21-30 years 154 (31,88%) 92 (28,66%) 62 (38,27%)
31-40 years 184 (38,1%) 110 (32.27%) 74 (45,67%)
41-50 years 34 (7,03%) 29 (9.03%) 5 (3,08%)
51-60 years 41 (8,48%) 32 (9,96%) 9 (5.55%)
> 60 years 19 (3.93%) 18 (5,60%) 1 (0,61%)
Total 483 (100%) 321 (64,4%) 162 (35,6%)

11. Table 2. Education of prisoners
TYPE OF EDUCATION NUMBER OF PRISONERS
Without any education 21 (4,34%)
Elementary school 131 (27,12%)
High school 328 (67,95%)
College 3 (0,62)
Total number 483 (100,0%)

12. Table 3. Some characteristics of the tested prisoners
TYPE OF CHARACTERISTIC NUMBER OF PRISONERS
Intravenous drug users 106 (21,9 %)
Users of other drugs 51 (10,55%)
Unprotected sexual contacts 217 (44,92 %)
MSM 11 (2,28 %)
LB 4 (0,82)
SWs 31 (6,41%)
Contact with blood 37 (7,66 %)
Fear 27 (5,59 %)
Curiosity 37 (7,66 %)
Total 483 (100,0 %)

13. Table 4. Test results
TEST Positive
HIV Combo 0
HBsAg 31(6,4%) 0
Anti-HCV 41 (8,49%)
Male Female
21 - 18 idu 20 - idu
3
unknown

14. In Tuzla prison 41 prisoner were positive for HCV, which is
8,49% of total number of 483 inmates. Newly discovered HCV
positive inmates did not have any of symptoms.
In 12 inmates, in consultation with prison doctor, liver tests
were controlled.
After coming out from prison, 5 ex inmates were admitted to
Clinic for Infectious Diseases for starting treatment.

15. In B&H there is no new data about the number of HIV and HCV
positive prisoners, so each one of prison institutions has its own
statistic. According to available data, in prisons in B&H there are
2 to 5% HCV positive inmates. There were no HIV positive
inmates.
In Sarajevo prison, according to available data, 49 prisoners were
tested for HIV, HBV and HCV. Among them 13 were positive for
HCV and 12 for HBV. All of them were inravenious drug users.
There were no HIV positive inmates. Total number of prisoners in
Sarajevo prison were 250, so percentage of infected with HCV is
5,2%, which is pointing on a situation were prisoners are sharing
needles and other equipment for drug injecting.

16. According to available data:
- In Zenica prison, prevalence of HCV in inmates is 6%, one
inmate is HIV positive (HIV positive before coming to prison).
- In Banja Luka prison, prevalence of HCV is 5-7 %, no HIV
infected.
- Conclusion is that HCV infection is bigger problem than HIV in
prisons in BiH.
- Similar situation is in many other countries, were HCV
prevalence ranges up to 35%, but there are also countries were
HIV is bigger problem, like USA, Brasil, Spain.

17. Prevalence of viral hepatitis infection among inmates in prisons in
Croatia is much higher than in general population according to
study done by professor Vitomir Burek from Clinic for Infectious
Diseases in Zagreb.
Studies, which lasted for 3 years, were conducted on 4800 from a
total of 10300 prisoners. While HBV prevalence in general
population is 11%, prevalence in prisons is 17%, and among
intravenous drug users even 30%. Among 4800 tested prisoners
hepatitis B was detected in 379.
Data is even more dramatic when it is about HCV prevalence. In
general population HCV prevalence is 1,1 %, among prisoners it is
14,5%, and among intravenous drug users is 50%. 279 prisoners
were detected to be HCV positive.

18. Study coducted in 25 european prisons from 1996 to 1998
(Rotilly& Weilandt,1999.) showed prevalence of HIV to be
5,7%, and highest prevalence was in Portugal (19,7%) and in
Spain (12,9%). Study showed also that HBV and HCV
prevalences were much higher than in general population.

19. Inravenous drug use is still the most important risk factor for
getting HCV infection, and there is an estimation that
intravenous drug use is responsible for more than 90% of new
infections.
If someone has ever shared equipment for intravenous drug
use, even if it was long time ago, and only once – he or she has
a risk to become HCV positive.

20. Although there is some thoughts that the drug use is less frequent in
prisons than in the community, every episode of drug injecting is
much more dangerous in prison because of lack of the sterile
equipment and high frequency of sharing the same equipment.
Inspite efforts done to prevent drugs to come in to prisons, drugs is
somehow in there. Because the smuggling of equipment for injecting
is much more difficult, often just few syrenges and needles are in
use, which enhances possibilities that more inmates use the same
equipment.

21. Some quantity of blood which come in to the syrenges can be
transffered to next user, and in that way make possible
transmission of agents, which are causing blood transmitted
infections. High concentration of HBV and HCV in blood, and
their possibility to survive outside the body, makes them to be
easier and more frequent transmitted than HIV.

22. We wil continue with testing, counceling and education of
prisoners and prison personnel, all in purpose to prevent
transmission of blood transmitted agents, and early detection
of infected.
We have support and help of prison management.

23. References:
Canadian HIV/AIDS Legal Network www.aidslaw.ca/EN/index.htm
How the UN Office on Drugs and Crime (UNODC) deals with HIV
www.unodc.org/unodc/en/hiv-aids/index.html
International Guidelines on HIV/AIDS and Human Rights, 2006 Consolidated Version,
UNAIDS data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf
WHO guidelines on HIV infection and AIDS in prisons
data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf
HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings, WHO and
UNAIDS data.unaids.org/pub/Report/2006/20060701_hiv-aids_prisons_en.pdf
HIV and AIDS, and vulnerability, Eldis HIV and AIDS Resource Guide
www.eldis.org/go/topics/resource-guides/hiv-and-aids/vulnerability
Harm reduction key issues guide, Eldis HIV and AIDS Resource Guide www.eldis.org/
go/topics/resource-guides/hiv-and-aids/key-issues/harm-reduction

25. THANK YOU FOR YOUR
ATTENTION!