Aggressive awareness campaigns may not be enough for HIV prevention in prisons-studies in Zambia suggest time for evidence based interventions

Background: More than thirty years into the epidemic and at a time of declining HIV prevalence rates in many affected regions, prisoners continue to receive less protection against HIV infection compared to communities outside. This survey, the third since 1988 was conducted to assess the effectiveness of current programmes in Zambian prisons. Methods: From June 2009-June 2010, 2,244 {184 women (8.2%); 2060 men (91.8%)} prisoners in Zambia participated in a survey of HIV prevalence and risk behaviours. Risk behaviours were elicited using a pretested questionnaire whilst HIV prevalence was determined using two ELISAs and Western Blot. The survey was voluntary, anonymous and confidential. Results: Six hundred and nine (609), (27%), prisoners were found with HIV infection. This was associated with age, highest in those 35-44 years and gender, 47.3% of the women tested were positive for HIV. Other significant associations were found between HIV and tattooing, STIs and TB. Only 35 prisoners agreed to have had male to male sex (MSM) and this was not linked to HIV result. However, indirect questioning suggested much higher figures of MSM in prisons. Overall, prisoners had knowledge about HIV and over 60 % knew their HIV status. Conclusion: The HIV prevalence rate of 27% is nearly double the national average of 14%, suggesting that current interventions in prisons, focused on raising awareness, are not effective. Evidence based programs targeting tattooing and MSM are needed urgently to reduce the risk of HIV infected prisoners spreading infections to their communities after release. © Simooya et al.