[Knowledge, beliefs and attitudes of inmates towards AIDS and HIV infection: a survey in a Marseille penitentiary center]. / Connaissances, croyances et attitudes des détenus face au Sida et à l'infection à VIH: une enquête au centre pénitentiaire de Marseille.

BACKGROUND: The objectives of our study were to evaluate knowledge, attitudes and beliefs of inmates toward HIV infection, and to compare them with those reported in the general population and according to injecting drug use. METHODS: Three hundred and seventy persons incarcerated in the prison of Marseille were invited, between December 1995 and March 1997, to answer a voluntary questionnaire offered by an independent staff. Odds ratios were estimated by logistic regression models adjusting for age, sex and type of questionnaire (self-administered for literate, face-to-face for illiterate inmates). The average scores among injecting and non injecting drug users (IDUs) were compared by analysis of variance adjusting for age, sex and type of questionnaire. These scores were also compared with those reported in a national survey (ACSF 1994), after adjustment for age, sex and educational level. RESULTS: The participation rate was 55%. Among the 202 participants, 152 answered a self-administered and 50 a face-to-face questionnaire; 45/202 (22%) were IDUs. The average scores of knowledge and tolerance towards HIV infected people were lower among inmates than in the general population. Furthermore, the scores of uncertainty towards HIV risk and unfavorable opinions about condom were higher than in the general population. While the average scores of knowledge, uncertainty towards HIV risk and unfavorable opinions did not differ between IDUs and non-IDUs, the score of tolerance towards HIV infected people was lower among non-IDUs than IDUs. CONCLUSION: That study shows that in spite of the high prevalence of at risk behaviors among people who are incarcerated, that population is not targeted enough by HIV prevention programs. Furthermore, the low level of tolerance towards HIV infected people among inmates, especially non-IDUs, is very likely an obstacle to health care management in that population with a high HIV prevalence. It is urgent to enhance the equality of access to care and prevention policy inside and outside prison.

HBV and HIV screening, and hepatitis B immunization programme in the prison of Marseille, France.

This study estimated the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) serological markers among inmates and evaluated inmates' compliance with an HBV immunization programme. During the mandatory consultation at the sexually transmitted disease (STD) clinic of the Marseille Prison (HIV counselling, and syphilis/HIV screening), physicians offered serological testing (anti-HBs, anti-HBc, HbsAg, anti-HIV) and Engerix B vaccination to each entrant. The number participating in the survey is 391/411 (89%); 75% were aged 18 to 35 years and 79% were men; 42% reported having had multiple sexual partners during the last 12 months. Report of an intravenous drug user (IDU) sexual partner was more frequent among women than men (22% vs 8%). Injecting drug use over lifetime was reported by 23%; 27% declared having shared their injection equipment during the last 12 months. 124/267 (32%) had an HBV marker: anti-HBs + only (immunized): 2.3%; anti-HBs + and anti-HBc +: 21.7%; anti-HBc + only: 6.4%; HBsAg +: 1.3%. The HIV seroprevalence was 6% (21% among IDUs). This survey underlines the high HBV and HIV seroprevalence among prisoners and the high proportion of inmates at risk for these infections. There is an urgent need for immunization and education programmes in this population. It demonstrates an HBV immunization programme is feasible and accepted by inmates and staff members.

Risk behaviours of inmates in south-eastern France.

This study was set up to compare risk behaviours between IDU and no-IDU inmates and among IDUs and to elicit the differences of preventive and risk behaviours according to sex. It was carried out in the Baumettes Prison, France, from November 16 to December 21, 1992; 295 male and 137 female inmates were interviewed using a self-questionnaire checked by the medical staff. Twenty per cent of participants (85/432) declared to be IDU (heroin); half of them reported needle sharing. After adjustment for age and sex, the number of sexual partners during the last year was significantly higher among IDU inmates (more than two partners: 19% vs 9.5%); similarly, sexual intercourse with an IDU during the last five years was reported more frequently by IDUs (47% vs 5%). After adjustment for the number of sexual partners, the proportion of IDUs who declared using always condoms was higher than that of non-IDUs (30.5% vs 13%). IDUs reported a prior HIV testing more often than no-IDUs (93% vs 49%). Multidimensional analysis showed that IDU female inmates reported having been HIV tested (100% vs 88%), had sexual intercourse with an IDU (73.5% vs 25.5%) and practised needle sharing (62% vs 43%) more often than male IDU inmates. This survey shows that, beyond drug taking which is the main risk factor for HIV infection in the carceral population, sexual behaviours could be an additional risk factor among IDU inmates, especially among women.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV testing, HIV infection and associated risk factors among inmates in south-eastern French prisons.

OBJECTIVES: To estimate HIV seroprevalence in the two main remand and short-stay prisons of south-eastern France and to gather linked anonymous risk-factor information. SETTING: Baumettes prison, Marseille, France between 16 November and 21 December 1992. PARTICIPANTS: Using a self-administered questionnaire about HIV testing and risk factors for HIV infection, 295 male and 137 female inmates were interviewed. The response rate was 96% (100 and 90% for men and women, respectively). At the same time, 279 of a total of 432 (65%) inmates were serologically tested for HIV; 153 (35%) declined to provide a blood sample. DESIGN: Anonymous cross-sectional and surveillance survey. RESULTS: Twenty per cent of participants (84 our of 432) were intravenous drug (heroin) users (IVDU), 51% of whom reported needle-sharing prior to incarceration; 23% reported more than two sexual partners during the last year, and 13% sexual intercourse with an IVDU during the last 5 years. HIV status was available for 356 inmates (82%; 65% from blood samples and 17% from the questionnaire); 39 were HIV-infected (10.9%; 95% confidence interval, 7.7-14.2). The inmates not tested for HIV reported proportionally less risky behaviours than non-HIV-infected inmates. HIV seroprevalence was significantly higher among recidivist inmates (19.9 versus 4.4%; P < 0.0001). The rate of HIV infection was particularly high among IVDU (34 out of 84; 40%). More female non-IVDU were HIV-infected than male non-IVDU (4.1 versus 0.6%; P = 0.04). CONCLUSIONS: This study demonstrates the high prevalence of HIV infection in south-eastern French prisons, especially among IVDU. The rates may be related to the high prevalence of risky drug practices and to delays in the development of HIV prevention programmes for IVDU in France. The higher seroprevalence rate among recidivist inmates might be the result of risk behaviours during imprisonment. Another hypothesis is that recidivist inmates are at greater risk of HIV infection because of higher levels of drug use.

Lumbar bone mineral density in anorexia nervosa.

We studied lumbar bone mineral densities (BMD) using a dual photon absorptiometer in 18 women with anorexia nervosa (AN). Results were compared with data from a control group of 36 healthy women. We found significantly reduced mean bone densities as compared with control group (0.814 +/- 0.072 g/cm2 hydroxy-apatite equivalent vs 1.011 +/- 0.023; p < 0.01). Only one patient developed vertebral compression fracture. BMD was negatively correlated with duration of amenorrhoea (r = -0.68; p < 0.01) but not significantly with duration of AN. We found no correlation between BMD and estradiol blood levels, age of onset, body mass index and daily calorie intake. The correlation between BMD and duration of amenorrhoea may indicate that long standing estrogen deficiency is a major factor in the osteoporosis (OP) observed in AN.

Plasma fibronectin: a study of 340 assays.

The authors report the results of 322 assays of plasma fibronectin. The object of this study was to specify its diagnostic contribution. The assays have been effected from February 1987 to October 1988 by the laser nephelometric method in all the hospitalized patients without exclusion. We have defined two populations on clinical diagnostic criteria into 193 control cases and 129 patients suffering from inflammatory rheumatisms or bone neoplasias. The statistical processing has been effected in the Department of Medical Computer Science. The results are as follows: The rate of plasma fibronectin is inclined to increase with age (p = 1 X 10(-4) a little higher among men than among women (p = 0.05). With regard to the other biological markers of inflammation, there was no obvious correlation with the rate of fibrin, the sedimentation rate at the first hour, or the presence of C-reactive protein. This study does not confirm the specificity of this assay in the inflammatory rheumatisms although our two populations are strictly comparable with respect to age and sex, and the clinical and biological parameters (sedimentation rate and fibrin) would allow us to discern the difference, if any, between the two populations. Plasma fibronectin assay has no diagnostic or discriminating value on a large scale.