Infectious diseases in the Tuscan detention setting: Data from the Health Agency of Tuscany

The main health care problems in prisons are mental disorders, substance abuse and communicable diseases. The risk of infectious diseases in this setting is related to social and environmental risk factors (e.g. use of intravenous drugs, unprotected sex, poor nutrition, sharing of sharp tools, and tattooing using non-sterilized needles) in addition to specific features of the prison environment (e.g. restricted space, overcrowding and promiscuous behaviour).The general lack of condoms and sterilized needles/syringes within correctional facilities make these unsafe behaviours worse than they are in the community. Moreover, the high turnover of inmates worsens hygienic conditions, and increases the likelihood that infections will spread; new contaminating vectors enter prisons while others spread outside into the community. The most widespread communicable diseases among prisoners are hepatitis C virus (HCV) and hepatitis B virus (HBV), human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and tuberculosis, but there are many more and these are usually more common among prisoners than the general population.3 Many epidemics have been reported in correctional settings.1,4,5 However, the true extent of transmission is difficult to determine, as it is not easy to recognize when an infection was acquired, and overestimation must be avoided due to the risk of further stigmatizing the inmates.1 Prevention of infectious diseases can be organized at population, institutional and individual levels in different ways. Possible actions involve five main domains: counselling and education; limiting harm due to risky behaviours; screening for infections; treatment of cases; and immunization. Effective preventive measures should be taken for four communicable diseases, based on the type of transmission and epidemics reported in the literature: tuberculosis, HIV, viral hepatitis and sexually transmitted diseases (STDs).3,6 As such, the aim of this study was to evaluate the prevalence of infectious diseases among convicts in Tuscany, Italy in order to support policy decisions about prevention and treatment programmes that can be adopted.