Government of Swaziland
His Majesty's Correctional Services
A Situational Assessment on TB, HIV,
Syphilis, Hepatitis C, and Hepatitis B
Infections and Associated Risk Behaviour
in Correctional Institutions in Swaziland
Supported by
Ms. Phindile Dlamini
Assistant Commissioner
His Majesty Correctional Services
ICASA , 2011
Background
Objective was to determine:
– prevalence of HIV, Syphilis, TB and HBV & HBC
among prisoners and officers;
– knowledge, attitudes, behaviour and practices in
relation to drug abuse and communicable
diseases;
– gaps in Health Care Service provision in prison
Survey Methodology
• Semi-structured questionnaire adapted from the UNODC
HIV Assessment Toolkit( used to capture KAP & risk
behaviour):
• Sampled using Probability Proportional to Size (PPS).
– 473 inmates (out of population of 2800)
– 243 correctional officers (out of a total of 1400)
• Samples (same coding with questionnaire):
– Blood for testing HIV, Hepatitis (B &C), Syphilis and
– Sputum for TB tests
• Data processing
– Testing for blood borne disease done on Abbot
Architecture
– TB testing : microscopy & Culture (for HIV+ participants)
• Data entered & analyzed using SPSS V.14 and Stata V. 11.
Results : Disease prevalence
• HIV
– prevalence was 34.9% among inmates
– HIV prevalence was 26.9% among officers
• Hepatitis B
– Among officers: 8.1 %
– Among inmates : 10.8 %
• Hepatitis C
– Among officers: 0.4 %
– Among inmates: 0.2 %
• Syphilis
– Among officers: 17.1 %
– Among inmates: 11.8 %
• TB
– Among officers: 4 cases (1900/100,000 )
– Among inmates : 15 cases (3570/100,000 )
Prevalence among inmates-Gender
Results (cont)
• More inmates tested positive for: HIV, TB & HBV
• a larger proportion of officers tested positive for
– Syphilis (17.1% of staff compared to 11.8% of
inmates).
• Only one inmate and one officer tested positive for
hepatitis C
• The measured incidence of TB : Higher than
national:
– Among inmates was 3570/100,000;
– among staff was 1900/100,000
Disease prevalence and incidence among inmates according to Age
Prevalence among Inmates in Correctional Institution
Prevalence among Officers in Correctional Institution
Questionnaire : Health services availability in
Correctional Institution
• Among inmates :
– 76.3% know their HIV Status
– 65.4% had access to ART.
– 50.9% had access to TB treatment in their prison and
– 59.8% had access to STI treatment.
• Among Staff :
– Only 37.9% know their HIV status
– Only 7.9% had been tested for TB in the last year
– 4.6% had been tested for either hepatitis B or C.
– 35.4% had undergone a routine health check-up in the
past year.
Questionnaire: Violence in Correctional
Institution
• Physical Violence
– Most inmates (83.7%) had witnessed physical violence in
prison
– 70.29% of staff noted physical violence exist in the
prison;
• Psychological Violence
– 88.2% had witnessed psychological violence (gangs)
• Sexual Violence
– 44.1% of inmates had witnessed sexual violence in
prison.
– 5.1% of inmates had been forced into sex before.
– only 1.6% of inmates stated that they had been involved
in consensual sex with another inmate
Prisoner experiences with violence, according to prison
Staff exposure to blood borne diseases
Limitations of the study
• Population :
– Of 473 inmates, only 35 were women. The
relatively small sample size of women meant
that we were less able to find significant
differences in disease prevalence, risk
behaviours
• Pilot Study
– Pilot Site had inmates between 15 - 20 years
old. Since study participants were over 20 yrs
old , this may have caused unforeseen
problems, especially with regard to disease
prevalence and risk behaviour including drug
use.
Recommendations for HIV
1.
2.
3.
4.
Intensify HTC on admission
improved HIV education,
Improved rollout of ART
improved access to post-exposure
prophylaxis,
5. improved social support, including provision
of SRH for women inmates (including
PMTCT)
6. Discourage tattooing and sharing of sharps/
razors
7. Encourage officers to know their status
Recommendation for TB
• offer HTC & culture tests for TB
• Set up a TB surveillance system for correctional
officers and prisoners
• Screen new prisoners for TB on entry into prisons
• Sensitise inmates & officers about TB control
• Isolate TB suspect cases
• Improve ventilation of the cells
• Create isolation cells
• Train officers on TB / MDR-TB & provide TB
masks ( N95)
• Intensify DOT
Acknowledgement
Prisoners
Prison Officers
UNODC
Ministry of Health (TB program)
National Emergency Response Council on
HIV and AIDS (NERCHA)
• Ms. Maria Sunderan – data Analysis
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Thank you Very Much !!!!