|Year : 2017 | Volume
| Issue : 1 | Page : 27-31
Human immunodeficiency virus infection among male prison inmates in Birnin Kebbi, Nigeria
James Saa-Aondo Gberindyer1, Ayu Agbecha2, Josiah Shindi3, Nicodemus Useh1
1 Department of Veterinary Pathology and Microbiology, Federal University of Agriculture, Makurdi, Benue State, Nigeria
2 Department of Chemical Pathology, Federal Medical Centre, Makurdi, Benue State, Nigeria
3 Department of Psychology, Benue State University, Makurdi, Benue State, Nigeria
|Date of Submission||26-Dec-2016|
|Date of Acceptance||21-Feb-2017|
|Date of Web Publication||19-Apr-2017|
Department of Chemical Pathology, Federal Medical Centre, Makurdi, Benue State
Source of Support: None, Conflict of Interest: None
Background and Objective: Prisons are penal institutions, where most often human immunodeficiency virus (HIV) testing of inmates is neglected. The prison could serve as a source of HIV spread during reintegration of the inmates back into the society upon release. The study is designed to determine the seroprevalence of HIV infection among male inmates in Birnin Kebbi prison, Nigeria.
Materials and Methods: A total of 290 counseled and consenting inmates aged 15–55 years were enrolled in a “cross-sectional” study. Serum samples prepared from venous whole blood obtained from inmates were screened for HIV infection by a parallel testing algorithm using two commercial HIV-1 and 2 antigen testing kits.
Results and Analyses: The results from the study showed that 8 (2.76%) out of the 290 inmates enrolled in the study had detectable HIV antibodies. The prevalence rate among the age groups was as follows; 15–24 years (2.78%), 25–34 years (2.74%), 35–44 years (5%), and 4–55 years (0.00%). Among the ethnic groups, the prevalence rates recorded were Tiv (14.29%), Nigeriens (7.69%), Igbo (4.55%), Yoruba (2.7%), and Hausa/Fulani (1.92%).
Conclusion: Our study observes a high prevalence rate of HIV, across age grades, and ethnicities among inmates. Considering the non-HIV testing of inmates in prisons, we recommend the establishment of preventive and management measures of HIV in penal institutions throughout the country.
Keywords: Birnin Kebbi, human immunodeficiency virus, inmates, prisons
|How to cite this article:|
Gberindyer JS, Agbecha A, Shindi J, Useh N. Human immunodeficiency virus infection among male prison inmates in Birnin Kebbi, Nigeria. Environ Dis 2017;2:27-31
|How to cite this URL:|
Gberindyer JS, Agbecha A, Shindi J, Useh N. Human immunodeficiency virus infection among male prison inmates in Birnin Kebbi, Nigeria. Environ Dis [serial online] 2017 [cited 2023 Jun 6];2:27-31. Available from: http://www.environmentmed.org/text.asp?2017/2/1/27/204790
| Introduction|| |
Prisons form part of the criminal justice system, and it is estimated that over 9 million people are in penal institutions worldwide. Prisons are in the risky environment for human immunodeficiency virus (HIV) transmission because of the behavioral practices such as the injection of illicit drugs through sharing of needles, risky sexual behavior, and tattooing. Although rape in prisons is rarely reported, the WHO estimates a prevalence of up to 16% in some prison environments. Infection with the virus could lead to acquired immunodeficiency syndrome (AIDS).
In Nigeria, the National AIDS Reproductive Health Survey (NARHS) reported a national HIV prevalence rate of 3.4%. The NARHS estimated about 3,229,757 people living with HIV in Nigeria and about 220,393 new HIV infections occurred in 2013 with 210,031 deaths from AIDS-related cases. The national HIV testing survey of the general population provided HIV estimates at national, zonal [Figure 1], and state [Table 1] levels. It also provides a measure of HIV prevalence for age groups [Figure 2].
|Figure 1: Human immunodeficiency virus prevalence according to zones in Nigeria. Source: National AIDS Reproductive Health Survey 2013|
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|Table 1: Human immunodeficiency virus prevalence in the general population according to top states in Nigeria|
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|Figure 2: Human immunodeficiency virus prevalence by age group in the general Nigerian population. Source: Federal Ministry of Health Nigeria 2013|
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In HIV prevention and control plans, inmates are often neglected and overlooked.,, Prevention programs that have been shown to reduce HIV transmission are rarely available for inmates, and many prisoners with HIV are unable to access life-saving antiretroviral treatment. In many parts around the world, prison conditions are far from satisfactory and HIV positive inmates barely receive the most basic health care and food.
The HIV and AIDS epidemics present a major challenge to prison populations across the world. The prevalence of infection with HIV within prison inmates is often far higher than in the general population. These issues are not confined to male prisoners alone but also females, due to the high proportion of injecting drug users within prisons. The number of prisoners living with HIV varies among countries.,,, In West Africa, the median prison population rate is 52/100,000, and often with high prevalence rates of HIV for some sub-Saharan African countries.,, The high prevalence rates have been ascribed to behavioral practices such as homosexuality. Data on the prevalence of HIV infection among inmates are lacking in many African countries. It is difficult for researchers to gain access to prisoners. As a result, only few documented cases of HIV transmission exist regarding prisons.
Although the WHO guidelines for HIV and AIDS in prisons stipulate that all inmates have a right to equitable health care and that national AIDS programs should be applied in jails. This is rare in many African countries. Most inmates eventually get released, and those infected pose a serious risk to their families and communities as they are reservoirs for a further spread in the general population.
The study is aimed at determining the seroprevalence of HIV infection among male prison inmates in Birnin Kebbi, Nigeria.
| Materials and Methods|| |
A “cross-sectional” study was adopted for the purpose of this research. The area of study was Birnin Kebbi, the capital of Kebbi state, Northwestern Nigeria. It is located on latitude 12° 27'13” N and Longitude 4° 12'01” E, Nigeria. Birnin Kebbi has a tropical climate, experiencing warm temperatures most times during the year.
Ethical clearance was sought and obtained from the ethical board of the authorities of Nigerian Prison Service, Birnin Kebbi, to determine the serological HIV status of inmates. Informed consent was sought from the inmates by educating them on the need and relevance to the study. A structured questionnaire was administered to 303 consented inmates out of which a total of 290 aged 15–55 years responded to the questions. The participants were only males of different ethnic groups including Hausa/Fulani, Tiv, Igbo, Yoruba, and Nigerien. Adopting the age categorization as reported by the United Nations Programme on HIV and AIDS (UNAIDS) and Wasley et al., the inmates were grouped into three age groups, namely, 18 years and below (children), 19–49 years (adults), and 50 years and above (elderly)., Participants were enrolled in the study if they consent to join. Venous blood samples were collected from the participants. Each participant was comfortably seated and 4 ml of whole blood aseptically drawn from the cubital fossa vein using a disposable needle and syringe. The blood was dispensed into appropriately labeled plain tubes and centrifuged to separate the serum. The extracted serum was immediately used for the rapid screening of anti-HIV antibody.
The Alere Determine HIV-1/2 test kits “Batch No. 7D2342” obtained from Alere Medicals Japan and Bundi rapid HIV-1/2 test kits “Lot No. LO8-0028” obtained from Bundi International Diagnostics Ltd., Nigeria, were used for testing inmates serum. The two test kits work based on the immunochromatographic principle.
The data obtained were analyzed using frequency percentages and Chi-square with the aid of the IBM Armonk, New York, United States Statistical Package for Social Science, version 17.0. P <0.05 was considered significant.
| Results and Analysis|| |
Eight out of the 290 inmates screened, tested positive for HIV [Table 2]. The overall prevalence of HIV in the incarcerated population stood at 2.76%. Considering HIV prevalence among the age groups [Table 2], inmates belonging to the age group 35–44 years had the highest prevalence (5%) of HIV. Inmates in the age group of 15–24 and 25–34 years recorded, respectively, 2.78% and 2.74% prevalence, with no inmate belonging to the age group of 45–55 years testing positive for HIV. The ethno-zonal distributions of HIV prevalence among inmates [Figure 3] in a decreasing order of percentages were as follows: Tiv-Northcentral (14.29%), Nigeriens-Foreign (7.69%), Igbo-Southeast (4.55%), Yoruba-Southwest (2.7%), and Hausa/Fulani-North (1.92%). Inmates of other ethnic descents such as Kanuri-Northeast, Ishan-South–South, Ekwere-South–South, Angas-Northcentral, and Berum-Northcentral tested negative for HIV.
|Table 2: Age distribution of human immunodeficiency virus infection among Birnin Kebbi prison inmates|
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|Figure 3: Ethno-zonal distribution of human immunodeficiency virus infection among inmates in Birnin Kebbi prison, Nigeria|
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| Discussion|| |
Results from the study agree with the findings by previous researchers Dada et al., Joshua and Ogboi, Abba et al., and Muhammed et al., who reported varied prevalence rates of HIV among inmates in Nigeria prisons.,,, Although the prevalence rate obtained in this study was lower than the 6.7%, 7%, and 12% reported by Dada et al., Abba et al., and Joshua and Ogboi.,, However, it is similar to the 2.4% reported by Muhammed et al. The finding of this study that the highest prevalence occurred among the age group 35–44 also agrees with the report of Joshua and Ogboi.
The findings of this study are also consistent with reports of UNAIDS. In Ireland, of the 1600 people infected with HIV, 300–500 have been shown to have passed through the prison system. Similarly, the prevalence in French prisons has been shown to be 10 times that of the general population. In a Southeastern French study, 12.7% of prisoners tested positive in a 1994–1995 survey. In Santa Fe Province, Argentina, 11.3% and 14% of prisoners tested positive for HIV in 1995. In the United States “1994” 5.2 cases of AIDS per 1000 prisoners amounting to 6 times, the rate of the general population was reported. In Italy 1995, approximately 13% of the prison population was shown to be HIV positive. In Porto prison, Portugal, over 15% was shown to be HIV positive in 1995. Poulin et al. observed a prevalence of 2.3% HIV infection among the prison inmates studied. Calzavara et al. also found a prevalence of 2.1% HIV infection among prison inmates. The high prevalence rate of HIV in the prison population has been ascribed to certain behavioral practices among prison inmates. These practices have been shown to be homosexuality, sharing of sharp objects, drug abuse, and tattooing., UNAIDS has shown that prisoners are frequently denied the means to protect themselves from high-risk behaviors. Lack of access to information, education, and reasonable medical care led to the high prevalence rate of HIV. Nevertheless, HIV prevalence rates among prisoners in Western Europe have been shown to be <1%.
Results from the study show a high prevalence of HIV in the young inmates of Birnin kebbi prison. This finding agrees with the study in Russia with a higher prevalence of HIV in young prison inmates. In the general population of the nation, FMHN 2013 reported a high prevalence of HIV in the young age group [Figure 2]. The high prevalence could be due to greater physical activity exerted by young individuals been the likely factor instilling certain negative behavioral attitudes peculiar to the young. However, Hallet et al., showed no variation in HIV prevalence between age groups.,
Furthermore, the highest prevalence (14.29%) of HIV recorded among the Tiv ethnic group may be attributed to the high endemicity of the infection in the Northcentral zone of the nation, where the inmate may have been infected before checking into the prison. HIV prevalence in prison inmates may not be necessarily influenced by their ethno-zonal origin since the zonal distribution of HIV in the general population [Figure 1] showed no similarity with the ethno-zonal distribution of HIV prevalence in prison inmates [Figure 3].
During the study, it was observed that the inmates were housed in partitioned rooms which were poorly ventilated, dirty, overcrowded, and unhygienic. The prison had a small clinic with some basic facilities, a recreation (football pitch) and worship centers as well as a skill acquisition center for the inmates. The inmates were also fed twice a day. From the questionnaires administered to the inmates, it was discovered that majority shared materials such as razor blades, needles, and other sharp objects which they use for cutting their nails and tattooing. These practices in addition to the poor environmental health and hygiene may predispose the inmates to HIV infection and other diseases such as tuberculosis as well as aiding the spread of these diseases among the inmates.
| Conclusion|| |
This is the first study investigating the prevalence of HIV infection in Birnin Kebbi Prison, Nigeria. The findings of this study have shown that like other prisons (Lagos, Jos, Kaduna, and Ogun states) across Nigeria, HIV infection was prevalent among inmates at the Birnin Kebbi prison, Nigeria. It is not known whether the infection was contracted by inmates before or within confinement since HIV testing is not conducted on arrival of would be inmates. There is an overall risk of transmission of HIV to other inmates. Consequently, we recommend the establishment of counseling and testing centers throughout penal institutions in the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]