The sharing of contaminated needles and syringes among injecting drug users was responsible for the outbreak at Glen-ochil jail in Perthshire, Scotland, with between 20 and 30 inmates sharing a single needle and syringe. Between one-third and a quarter of those who injected drugs in the prison from January to June 1993 became infected.
Several studies have reported that HIV infection is prevalent among prisoners, and sharing injecting equipment is acknowledged as a risk factor, although no evidence has been presented to support this.
According to reports in tomorrow's issue of the British Medical Journal, eight HIV transmissions definitely occurred and a further six probably took place in Glenochil. Scientists who conducted a follow-up study a year after the outbreak believe that another six prisoners who were released or transferred before investigation took place, were also infected.
Dr Sheila Gore, a senior statistician at the Institute of Public Health in Cambridge, and colleagues who carried out the follow-up study also found that a quarter of the 72 inmates who injected drugs said they injected for first time while in Glenochil or another prison.
As some of those infected were unaware of their HIV status, and condom use among those who injected drugs before imprisonment was rare or non-existent, there is potential for spread from the prison population, the reports warn. Public health experts and scientists yesterday called for urgent action throughout the prison system to "safeguard future inmates and the community".
Writing in the BMJ, Dr David Goldberg, a consultant epidemiologist at the Scottish Centre for Infection and Environmental Health at Ruchill Hospital in Glasgow, and co-author of one of the BMJ reports, said that there was "clearly considerable potential for the dissemination of infection into the wider heterosexual population after release".
New measures have been introduced in Scottish jails since the incident, including provision of sterilising tablets to clean needles and syringes, counselling on admission to prison, and "detox" and rehabilitation programmes for drug users.
The outbreak at Glenochil came to light after prisoners became ill with hepatitis B and two inmates developed antibodies to HIV between April and June 1993, alerting doctors to high-risk behaviour in the prison. HIV counselling and tests were offered to all prisoners in July.Reuse content