Alun Richards

Trends in prevalence of HIV infection, hepatitis B and hepatitis C among Australian prisoners - 2004, 2007, 2010

Objective: To report the prevalence of markers for HIV infection, hepatitis B and hepatitis C among Australian prison entrants.

Consensual Sex Between Men and Sexual Violence in Australian Prisons

Estimates of the incidence of sexual coercion in men’s prisons are notoriously variable and fraught with conceptual and methodological problems. In 2006–2007, we conducted a computer-assisted telephone survey of a random sample of 2,018 male prisoners in New South Wales and Queensland. Of 2,626 eligible and available inmates, 76.8% consented and provided full responses. We asked about time in prison, sexual experience, attraction and (homo/bi/heterosexual) identity, attitudes, sexual contact with other inmates, reasons for having sex and practices engaged in, and about sexual coercion, including location and number of perpetrators. Most men (95.1%) identified as heterosexual. Of the total sample, 13.5% reported sexual contact with males in their lifetime: 7.8% only outside prison, 2.8% both inside and outside, and 2.7% only inside prison. Later in the interview, 144 men (7.1% of total sample) reported sexual contact with inmates in prison; the majority had few partners and no anal intercourse. Most did so for pleasure, but some for protection, i.e., to avoid assault by someone else. Before incarceration, 32.9% feared sexual assault in prison; 6.9% had been sexually threatened in prison and 2.6% had been sexually coerced (“forced or frightened into doing something sexually that [they] did not want”). Some of those coerced reported no same-sex contact. The majority of prisoners were intolerant of male-to-male sexual activity. The study achieved a high response rate and asked detailed questions to elicit reports of coercion and sex separately. Both consensual sex and sexual assault are less common than is generally believed.

Penile Implants among Prisoners—A Cause for Concern?

Background We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison. Methods Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, “Have you ever inserted or implanted an object under the skin of your penis?” If they responded Yes: “Have you ever done so while you were in prison?” Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants. Results A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05). Conclusions Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.

Sexual coercion prior to imprisonment: prevalence, demographic and behavioural correlates

Little is known about experiences of sexual coercion among prisoners prior to incarceration. Prisoner populations are routinely excluded from national surveys of sexual health which also tend to under-represent marginalized groups. We surveyed 2351 randomly selected men and women, aged 18–64 years, in New South Wales and Queensland prisons who participated in a computer-assisted telephone interview. Around 60% of women and 14% of men self-reported having been sexually coerced prior to incarceration, with 60% of these experiences occurring before the age of 16 years. Factors independently associated with a self-reported history of sexual coercion were: homosexual and bisexual identity, being unable to work, separated marital status, higher level of education (among women), having been paid for sex, a past sexually transmissible infection (among men), drug use (among women) and a history of mental health problems. Prior sexual coercion was associated with unwanted sexual contact and physical assault while in prison. The high prevalence of sexual coercion reported by prisoners and its association with a range of factors indicates a need for a greater acknowledgement of the potential consequences of this within the criminal justice system. This could entail providing counselling and support services within the correctional setting.

Use of multiple data sources to estimate hepatitis C seroprevalence among prisoners: A retrospective cohort study

Hepatitis C is a major cause of preventable morbidity and mortality. Prisoners are a key population for hepatitis C control programs, and with the advent of highly effective therapies, prisons are increasingly important sites for hepatitis C diagnosis and treatment. Accurate estimates of hepatitis C prevalence among prisoners are needed in order to plan and resource service provision, however many prevalence estimates are based on surveys compromised by limited and potentially biased participation. We aimed to compare estimates derived from three different data sources, and to assess whether the use of self-report as a supplementary data source may help researchers assess the risk of selection bias. We used three data sources to estimate the prevalence of hepatitis C antibodies in a large cohort of Australian prisoners–prison medical records, self-reported status during a face-to-face interview prior to release from prison, and data from a statewide notifiable conditions surveillance system. Of 1,315 participants, 33.8% had at least one indicator of hepatitis C seropositivity, however less than one third of these (9.5% of the entire cohort) were identified by all three data sources. Among participants of known status, self-report had a sensitivity of 80.1% and a positive predictive value of 97.8%. Any one data source used in isolation would have under-estimated the prevalence of hepatitis C in this cohort. Using multiple data sources in studies of hepatitis C seroprevalence among prisoners may improve case detection and help researchers assess the risk of selection bias due to non-participation in serological testing.

Attitudes towards Sex: A Comparison of Prisoners and the General Community

BACKGROUND National population surveys of attitudes towards sexual issues typically exclude prisoners and little is known about their attitudes compared with the community. METHODS Using computer-assisted telephone interviews, we compared a representative sample of 2289 prisoners (men=1960, women=329), aged 18-59 years, from two Australian states against a national community sample of 6755 participants (men=3333, women=3421). RESULTS Overall, prisoners were slightly more conservative in their attitudes towards sex than the community. They were more likely than the community to agree with the statement that abortion is wrong (men: adjusted odds ratio (AOR)=3.3, 95% confidence interval (CI): 2.8-3.9; women: AOR=1.7, 95% CI: 1.2-2.4) and that male homosexuality is wrong (men: AOR=2.6, 95% CI: 2.2-3.1; women: AOR=1.7, 95% CI: 1.2-2.3); these differences were more pronounced for men than women. The attitudes of prisoners and the community varied with age. Attitudinal differences between prisoners and the community tended to be larger than the differences between women and men (agree that abortion is wrong: prisoners, AOR=0.5, 95% CI: 0.4-0.7; community, AOR=0.8, 95% CI: 0.7-0.9; agree that male homosexuality is wrong: prisoners, AOR=0.4, 95% CI: 0.3-0.5; community, AOR=0.6, 95% CI: 0.5-0.7). CONCLUSION Prisoners have either similar or less accepting attitudes towards sex than the general population. These attitudes contrast with the higher engagement in risk behaviours reported by prisoners.