The Prevalence of Chlamydia Infection in Youth Offenders in HMP/YOI Holloway June 2003 – June 2005 THERESA BURNS, SEXUAL HEALTH ADVISER Women’s Health Clinic, HMP/YOI Holloway & Marlborough Clinic, Royal Free Hospital

Methodology Health Adviser led session. Working with the support of unit officers who often helped with recruitment to the study. Evening sessions held on Young Offenders Unit during association time (time for women to take baths, domestic chores and to mix with each other for 1 1 / 2 hrs each evening). Limited space allowing for privacy. Interviews held in places such as dining room and TV room.

Methodology Opportunistic testing – approaching individuals and explaining who I was and why I was there. Administered questionnaire. Chlamydia urine NATT. Total number of patients = 289

Aims of Study To determine the prevalence of chlamydia infection and associated lifestyle risk factors in young women from the Young Offenders Unit in HMP Holloway. To raise awareness of chlamydia in this vulnerable group.

Age Range

Ethnicity

Educational History Since age 11, how many years did you spend in full-time education?

Drug Use part I

Drug Use Part II

Current Sexual Partners

Age of First Sexual Experience

Commercial Sex Work 53 (18.4%) of the 289 women interviewed admitted at some time being involved in the commercial sex industry. This was mainly to support their own and their partner’s drug use.

Number of Sexual Partners THE LAST THREE MONTHS PRIOR TO COMING INTO PRISON

Condom Use 56 (19.8%) of women interviewed reported a condom was used at last intercourse. 122 (43%) reported that they never used condoms. 122 (43%) reported occasional use. 40 (14.1%) reported 100% condom use.

Contraception

Pregnancy

Previous STI Infection

Chlamydia Results Verbal results after one week, hard copy after a fortnight Positive results given to women either on the unit or in the clinic. If transferred to another prison, that health care unit contacted and told of the need for treatment. If released, letter sent if address was available. Appointment in the Women’s Health Clinic within 48 hours for treatment and an offer of full sexual health screen including HIV, hepatitis B and C if indicated.

Partner Notification Difficult due to woman's circumstances: in prison limited contact with the outside world phone calls listened into all mail is read by unit officers before posting Women often refused to contact partners due to worries over: Possible violence Confidentiality Embarrassment Provider referral offered, only possible in a small number of cases

Results Prevalence of chlamydia infection was 12.2%. All the young women who took part in this research were offered an appointment for a full sexual health screen.

Results No association with a chlamydia diagnosis - age - drug and alcohol use - sex worker - educational history - social history

Recommendations Chlamydia testing offered to all women admitted to the Youth Offender Unit Educational session to raise awareness Assertiveness training around condom use Targeted health promotion programmes Multi agency working i.e. drug services