Seizures of Drugs in prisons

In 2005, a total of 565 inspections in the chains, were seized 6.113 kilograms of narcotic drugs, more than a pound in 2004, when they were made 464 arrests.

Were also seized 1643 individual doses of drugs and 190 grams of substances "inconclusive", most often used to adulterate the drugs.

According to a document DGSP in 2003 were seized 2.5 kilos of drugs in 376 enforcement actions, and in 2004 a little over five pounds, in 464 enforcement actions. On a monthly basis means that, in 2003, there have been 31 seizures of drugs in prisons, which in 2004 increased to 38 and in 2005 totaled 47.

According to the GPSD, "soon will launch a plan aimed at intensifying the control of trafficking and abuse in prison, along with the implementation of new measures relating to prison health, such as the distribution of syringes, the introduction of kits needles for tattoos and piercings and even condoms and lubricants.

The plan for the intensification of control requires a strengthening of technical and human resources to control the entry of drugs, increased raids and reviewed by stripping and better collection and processing systems to allow better planning of control measures.

Syringes only in Lisbon and Pacos de Ferreira

Specific Program Needle Exchange (PETS) started today, but only an experimental, dedicated to training. Chains of Lisbon and Tottenham Hotspurs were chosen. The high proportion of drug addicts and prisoners with infectious diseases were the reasons for choosing these establishments to host the first phase of the project, which does not, as yet, an effective exchange of syringes.

Before starting the program, inmates are first subjected to a clinical evaluation by the prison, where they will be advised of the alternatives available to them, including support for the abandonment of the drug.

Those accepted will receive a kit with two syringes, two alcohol wipes with alcohol, a preservative, an ampoule of distilled water, a filter, two containers and citric acid. Inmates enjoy legal protection and confidentiality of clinical data. After nearly a year since the law was passed in Parliament, the PETS starts before the resistance of the prison guards, who consider the measure counterproductive.

The beginning of needle exchange is planned for mid-October, just in the prisons of Lisbon and Pacos de Ferreira. The program will follow, however, on an experimental basis for a period of 12 months, as decided by the Ministry of Health

Diseases associated with drug use in prisons

The crimes, directly or indirectly related to illicit drugs, are the reason for the arrest of about 72.9% of inmates in prisons, drug addiction and the major risk factor for infection with Human Immunodeficiency Virus (HIV) in arrest triggered by overcrowding, which leads to the inevitable promiscuity. Infection with HIV, Hepatitis B (HBV) and hepatitis C virus (HCV) have to assume as a growing concern in prisons.

In developed countries as sharing needles for drug use and unprotected homosexual relations are the two main risk behaviors for transmission of HIV infection in prisons. The consumption of illicit drugs in prisons is a fact, admitting most of the inmates consume less in prison, however, about 17.8% stated that more time in prison. Prisoners tend to be imported to the prison the pattern of behaviors that were abroad, hence the importance of meeting the recommendation for the performance of screening the entry of the institution, to allow an adequate clinical orientation of all prisoners infected with HIV, HBV or HCV.

The prevalence of infectious diseases in prisons is significantly higher than that existing in the community, mainly due to the behavior of prisoners before and during the period they remain incarcerated. Existing data are global variables and Portugal on this subject has recently been increasing attention of researchers.

The prevalence of infection with HIV in prisons ranges from 2% in Ireland and Quebec (Canada), 6% in France, 17% in the United States of America and 19.4% in Spain. In Portugal the prison population in the prevalence of HIV ranges from 7% in one study and 10.6% indicated by the clinical services of the prisons. Infections by HBV and HCV in prison also have a prevalence higher than that observed in the general population was 9.3% and 0.43% respectively. In the prison population the prevalence varies between 19% and 31% for infection with HBV and 37% to 57.6% for HCV. The present work aims to determine the prevalence of contacts with the prisoners HBV, HCV and HIV to enter the prison and to identify some risk factors.

Material and Methods

To achieve the proposed objectives for this study we chose to study a cross-sectional and, being inexpensive and allow the rapid collection of dados17. The study included a convenience sample consisting of prisoners received at the prison in Leiria in the period between February 1999 and September 2003.

During the period of the study a team comprising a doctor and an experienced medical tests moved to the prison to carry out the screening for infectious diseases. A follow up questionnaire seeking to identify some risk factors associated with transmission of HBV, HCV and HIV in particular the existence of homosexual relations, sex with multiple partners, sex with partners allegedly infected with at least one of the virus, injecting drug use and existence of previous blood transfusion. Was also collected a blood sample to determine the immune status against the same virus.

Sampling of blood was carried out in the first two weeks after entering the establishment. We used the ELISA and Western blot to test for HIV infection. The test of infection for Hepatitis B and C was the ELISA method for determination of anti-HBs, anti-Hbc and anti-HCV and HBsAg. The test results were forwarded on a confidential basis to the prison doctor who subsequently referred the cases that required follow-up.

Results

We collected blood samples in 788 (77.3%) of the nearly 1019 inmates received at the establishment, in the period of the study. The remaining 231 (22.7%) refused to participate. There were 699 males (89%) and 89 females (11%). The mean age was 32.3 years with a minimum of 16 and maximum of 70 years. The age group 20 and 45 comprising 88.6% of inmates (Figure 1).

They had had more than one sexual partner 84% (606), have used injection drugs 40% (294), had sex with infected partner may be 7% (48) and had received a blood transfusion 9.7% (70) found that they had had contact with HBV 40% (312), who had been vaccinated and had only positive AcHbs 15.7% (123) of inmates (Table I). There was no HBV markers in 44% (350). Although not present markers of HBV, 6.2% (49) had positive antibody to HCV.

Were tested for HIV1 and HIV2 780 inmates. Were positive for HIV 1 6% (47) (Table I). There were no cases of infection by HIV2. The average age of those infected with HIV 1 was 30.7 years, with a minimum of 19 and a maximum of 63. HIV1-infected, 43 were males and four females, representing 6.1% and 4.4% of all men and women, respectively. Of the 47 infected with HIV1, 38 (80.8%) had anti-Hbc, 18 (38.2%) anti-HBs, 41 (87.2%) had had contact with HCV and 35 (77%) with HCV, HBV and HIV. Of the inmates who participated in the study 42.0% (326) were infected with HCV (Table I). The injecting drug users accounted for 40% (294) of the sample. Of these, 89.9% (259) had been infected with HCV, 14.5% (42) HIV and 72.9% (212) had positive AcHbc.

It was there a statistically significant association between drug use and infection by HBV and HIV (Table II), as well as between the presence of AcHbc, infection by HCV and HIV and the existence of prior sex with infected partners as appropriate HCV, HBV and HIV. On the contrary there was no association between these infections and sexual relations with more than one partner.

Co-infection with HBV and HCV occurred in 70.0% (206/294) of injecting drug users and co-infection with HBV, HCV and HIV in 11.2% (33 / 294).

Discussion

The sample included all prisoners received at the prison in the period February 1999 to September 2003, a total of 1019. 231 were eliminated for refusing to participate, although they express the wish that the team that made the blood samples. Most of these prisoners were citizens immigrants, predominantly in Eastern Europe. Ignorance of how institutions function in an unknown country can justify a refusal to cooperate. The study shows a prevalence of prisoners with prior contact with HBV 40%, and HCV 42%, into the prison, which is much higher than expected for the general population in a country of the continent's average insidência Europe. It is also higher than the estimate by the trials of prison. The prevalence for HBV was higher than that described in all studies that had access. In the case of HCV only one study showed a higher prevalence.