2. HIV and HBV Infection, Knowledge and Risk Behaviour in Ghanaian Prisons
Edward Adiibokah1, Emmanuel T. Larbi1, Francis S. Hagbe 3, Stephen A. Addo 2 , Angela EL- Adas1 1Ghana AIDS Commission, Ghana , 2 National AIDS Control Program, 3Ghana,Ghana Prisons Service

3. Background
HIV and HBV infections are more common among prison inmates than the general population-6 to 50 times higher than the general adult population (UNODC, 2007).
Previous studies in Ghanaian prisons have reported HIV prevalence of 19.2% (Adjei et al.,2006 ) and 5.9% (Adjei et al.,2008)
Objectives
Assess the situation of HIV, HBV and other key illnesses among prison inmates in Ghana
Identify factors that contribute to prison inmates being infected with HIV and HBV
Make recommendations to guide the development of HIV/AIDS and health programmes for Ghanaian prisons
Source: National AIDS/STI Control Programme

4. Methods
Cross-sectional Integrated Bio-Behavioural Surveillance Survey conducted from June to August 2012
Behavioural survey - inmates’ knowledge, attitudes, behaviours (before and during imprisonment ) and prison environment factors
Biomedical component : test for - HIV, HBV, Malaria, Diabetes, Hypertension and underweight/overweight
Inclusion criteria
All adult prisoners : on remand, awaiting trial and convicted and sentenced , all forms of prison sentences & categories of prisons
Exclusion criteria
Prisoners considered too great a risk for harm to themselves or interviewers
Not competent (sick or intellectually immature)
Could not speak English or any other Ghanaian language

5. Method- Sampling Procedure
2,443 prisoners were involved in the study, comprising 205 female and 2,238 male inmates
Male Prisoners : first stratified by type of prison, 12 out of 34 eligible prison stations were selected randomly , inmates selected systematically using a list
Female Prisoners : all inmates were involved due to their limited number
Ethical considerations : Noguchi IRB and the Ghana Health Service Ethical Review Committee
Data analysis : Descriptive statistics , bivariate & multiple logistic regression using SPSS version 18.0.
A p-value of 0.05 was used to determine statistical significance

6. Results – socio-demographic s & Prison Environment
Mean age - male inmates 34.1, years (SD =11.8), Females inmates years (SD=13.8)
Over 70% were less than 40 years, with 3% being less than 20 years
About 18% had never been to school
Only 4% of male inmates and 6.8% of females have had tertiary education
Characteristic
Male (%)
Female (%)
Total (%)
Type of sentence 
On Remand
14.3
29.8
15.6
Convicted
85.7
70.2
84.4
Type of Prison 
Maximum Security
2.2
0.0
2.0
Medium security
29.1
48.3
30.7
Central prison
39.6
45.9
40.2
Local prison
14.5
5.9
13.8
Camp prison
13.3
Length of stay in prison
≤1 year
31.1
42.0
32.0
1-5 years
54.1
49.2
53.7
≥6 years
14.8
8.8
Ever Imprisoned
Yes
6.7
6.3 No
93.3
98.0
93.7

7. Results – Knowledge about HIV & AIDS-related risk behaviours
Awareness about HIV/AIDS is almost universal (99%) among Ghanaian prison inmates
Overwhelming majority (96% male vs. 97% females) reports that HIV can be prevented by having only one uninfected sexual partner
About 9 in 10 inmates know that HIV can be prevented by using condoms all the time

8. Results-Common STI symptoms inmates reported as having suffered before incarceration and during prison

9. Results - HIV risk behaviours
Blood-related HIV risk behaviours
Sharing razor blades in prison - 29% of males and 9% females
Ever tattooed before imprisonment - 17% males and 19% females
Ever tattooed within prison -1.4% males and 1.5% females
High-risk sexual behaviour
Casual sex 12 months before imprisonment - 58% males and 30% of female prisoners (more than one partner 49% )
Sex with CSWs- 23% of males and 2.5% of female (inconsistent condom 46% use)
Anal sex with other inmates was 0.4%
Injecting Drug use
Ever used drugs before incarceration - 55% male & 20% female (72% wee; 55% alcohol)
Ever injected drugs in prison - 3 (0.1%)
1% of inmates reported they ever injected drugs prior to imprisonment
No report of sex with IDUs in prison

10. Summary of biomedical test results by sex
Overall (%)
Male (%)
Female (%)
HIV
2.3
1.5
11.8
HBV
12.8
13.3
7.8
Malaria
5.5
5.7
3.4
Diabetes
0.6
0.5
1.0
Blood Pressure (S+D)
26.3
25.5
35.6
Systolic BP
19.2
18.6
25.4
Diastolic BP
19.8
18.9
30.2
Underweight (Low BMI)
3.5
3.6
2.4
Overweight (High BMI)
24.0
21.2
53.7

11. HBV status by behavioural characteristics
Total
% HIV positive
P-value
Access to blades /razors for shaving
Yes
2366
12.8
p =0.939 No 72
12.5
Sharing of blades /razors with other inmates
664
11.6
p =0.267
1761
13.3
Ever been tattooed outside prison
406
13.5
p =0.644
2015
12.7
Ever been tattooed within prison 34
2.9
p =0.115
2389
12.9
Sex with CSW before imprisonment
515
13.4
p =0.623
1923
12.6
Ever had casual sex before imprisonment
1352
p =0.719
1087
13.1
TOTAL
2442

12. Discussions & Recommendations
While HIV prevalence among males was un-expectantly low, that of females was several fold that of the general population
Confirming the vulnerabilities of female prison inmates.
HBV prevalence among both males and females was high.
Risky behaviours (sexual/drug use/sharing implements) appear to be rare in prisons with no statistically significant relationship between these risky behaviour in prison and HIV and HBV positive status.
Given that inmates in prison are less likely to get infected, new entrants should be offered voluntary counseling and testing before admission into the prisons

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