This cross-sectional study carried out in the jails in Southern Lazio showed a prevalence of HIV/HCV, HBV/HCV and HIV/HBV coinfections of about 4%, 18% and 3% in inmates, respectively. Data regarding these coinfections prevalence, even if remarkable, could however represent a biased estimation of the phenomenon, as screening for these infections are not mandatory for all prisoners. In our study the percentage of prisoners actually subjected to HIV testing was 47.37% of all prisoners. This particular situation could be due to the fact that all of the penitentiaries examined in our study are jails where the prisoners are confined waiting for judgement or condemned to punishments less than 5 years.
As depicted in other international studies, our study showed that HIV, HBV and HCV sero-positivities coinfections are strictly associated with the status of drug addiction, especially intravenous heroin addiction. Moreover, the spread of HIV and viral liver infections is due to needle sharing, the most important risk related factor, confirming the results of similar national [49–51] and international investigations [7, 8, 12, 17, 28, 29, 31, 39, 41, 42, 52–54].
Furthermore, HIV, HBV and HCV sero-positivities are influence by civil status, being a widower or cohabitant is significantly associated with these coinfections.
Finally, it is possible to consider that even if health management of HBV, HCV and HIV sero-positivities in jails appears worrisome, there is paradoxically an opportunity for these patients of receiving good treatment inside the prison environment .
Our study has some limitations. One weakness is information bias. The study was based on the information gathered from the clinical charts, which may not have been complete in defining inmates' health status and diagnostics. Moreover, for some variables, such as educational level, and civil status, gathered data were not complete.
It is not known whether the study population is representative of the whole populations of participating prisons. It is possible that drug addicts were more likely to be given a HIV, HBV and HCV test, in which case an overestimation of the prevalence rates of infections could occur. In this case, if we hypothesize that all prisoners not given a test were seronegative, we would find a prevalence of 2.45%, 10.9% and 11.6%, respectively.
A fundamental role in the control of infection from HIV in prison environments may be found through prevention. As prisoner populations are at high risk for all of these infections, it is necessary for public health and institutions to collaborate to develop HBV, HCV, HIV prevention programs, including immunization, health education and substance abuse treatment. It is worrisome that not all prisoners are submitted to screening of these infections, while in other countries mandatory drug and blood tests exists .
In waiting for a positive evolution in the preparation of a sure and immunological vaccine, the application of direct and indirect prophylaxis measures represents the more convenient way to combat the AIDS problem in prisons.
The second fundamental aspect of the preventive strategy against HIV/AIDS in the prison environment is the thorough observance of hygiene rules either general or specific (i.e., personal use of razors, teeth brush), which are often neglected, even the most elementary ones.
The overcrowding of prisons and the consequent discomfort either among the warders or among the prisoners has become one of the most urgent problems to face. As reported by the WHO guideline to the essentials in prison health, the living conditions in most prisons of the world are unhealthy and rates of infection with HIV and hepatitis are much higher than in the general population . Concerns exist that prisons could serve as a reservoir for the amplification of the transmission of infectious diseases in the wider community after the release of inmates who have became infected while incarcerated .
Of those identified as being infected in prison, 85% of cases were associated with pre-incarceration behaviours [35, 36]. The restrictive nature of the prison environment and the scarcity of clean syringes and condoms probably heighten the hazards associated with high risk activities, thus increasing the risk of transmission from infected to uninfected inmates .
The scientific literature shows a strong connection between infection from HIV, HBV, HCV and the group of drug-addicts in which some risk factors are surely present [38, 39]. As shown in many studies, it is clear that although the jail can reduce the consumers of drugs by parenteral mean, the risk to contract the infections from HIV, HBV, and HCV would increase for people who continue to inject toxic substances [40, 41].
In conclusion, our study points out that within the inmates population a resevoir of infected individuals exists, and that the jails could represent a pivotal target for primary prevention programs (for inmates, for prison guard and for the general population when an inmate leaves the jail), secondary prevention (in order to reduce the clinical risks for progression of liver disease and AIDS, and to reduce costs for management complicated infection) and tertiary prevention (to guarantee prisoners right of health).