Prevalence of HIV-1 / 2 , HTLV-I / II , hepatitis B virus ( HBV ) , hepatitis C virus ( HCV ) , Treponema pallidum and Trypanosoma cruzi among prison inmates at Manhuaçu , Minas Gerais State , Brazil Prevalência do HIV-1 / 2 , do HTLV-I / II , do vírus da hepatite B ( HBV ) e C ( HCV ) , do Treponem

The purpose of this study was to determine the seroprevalence of human immunodeficiency virus (HIV-1/2), human T-cell lymphotropic virus (HTLV-I/II), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among 63 male prisoners in Manhuaçu, Minas Gerais, Brazil and to compare this with data from eligible blood donors. The positive results were as follows: 11/63 (17.5%) for HBV, 5/63 (7.4%) for syphilis, 4/63 (6.3%) for HCV, 3/63 (4.8%) for Chagas’ disease, 2/63 (3.2%) for HIV-1/2 and 1/63 (1.6%) for HTLV-I/II. The seroprevalence in prisoners was higher than among blood donors, mainly for antibodies to HIV-1/2, HCV and HBV. This is probably due to low social economic level, illiteracy, higher proportion with a prior history of intravenous drug use and/or unsafe sexual behavior. Therefore, these prisoners constitute a high risk group and routine screening and counseling are recommended. Key-words: AIDS. HIV-1/2. HTLV-I/II. HCV. HBV. Syphilis. Chagas’ disease. Resumo O objetivo deste estudo foi determinar a soroprevalência do vírus da imunodeficiência humana (HIV-1/2), do vírus linfotrópico humano (HTLV-I/II), da hepatite B (HBV), da hepatitis C (HCV), do Treponema pallidum e do Trypanosoma cruzi em 63 presidiários do sexo masculino em Manhuaçu, Minas Gerais, Brasil e comparar com resultados de doadores de sangue. Os resultados positivos foram: 11/63 (17,5%) para HBV, 5/63 (7,4%) para sífilis, 4/63 (6,3%) para HCV, 3/63 (4,8%) para doença de Chagas, 2/63 (3,2%) para HIV-1/2 e 1/63 (1,6%) para HTLV-I/ II. A soroprevalência em prisioneiros foi mais alta que entre doadores de sangue, principalmente para anticorpos anti-HIV-1/2, HCV e HBV. Isso se deve provavelmente ao baixo nível socioeconômico e de escolaridade, proporção elevada de história pregressa de uso de drogas endovenosas e/ou comportamento sexual de risco. Concluímos que prisioneiros constituem um grupo de alto risco para essas doenças e testes de triagem e aconselhamento são recomendados como rotina no ambiente carcerário. Palavras-chaves: AIDS. HIV-1/2. HTLV-I/II. HCV. HBV. Sífilis. Doença de Chagas. 1. Fundação Hemominas, Manhuaçu, MG e 2. Fundação Hemominas, Belo Horizonte, MG. Financial support: Fundação Hemominas Address to: Dra Bernadette Corrêa Catalan-Soares. Alameda Ezequiel Dias 321, 30130-110 Belo Horizonte, MG, Brazil Tel: 55 31 273-3377; Fax: 55 31 226-2002 Recebido para publicação em 7/8/98.

Blood and sexually transmittable diseases are important public health problems in Brazilian prisons 8 .Most prisoners have high-risk behavior for these diseases.Besides drug use, unsafe sex and homosexuality 9 , they frequently tattoo their skins in the prison environment, sharing needles and ink 1 2 9 .As a rule, there is inadequate medical staff and access to appropriate care is very difficult for the inmates.
Comparison of data from prisoners and those from eligible healthy donors living in the same geographic area is an important means to provide clues which may lead to action and changes in public health policy, education and clinical practice 4 5 .
In this paper we present the results of a seroprevalence study conducted in a public prison, in which we carried out a brief medical examination and tested the sera of 63 male inmates for the presence of antibodies to human immunodeficiency virus (HIV-1/2), human T-cell lymphotropic virus (HTLV-I/II), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi.

MATERIAL AND METHODS
Study population.Subjects for this study were male inmates incarcerated in Manhuaçu, a city with 80,000 habitants, in Minas Gerais State, Brazil.After explanation of the purpose of the study all prisoners (n = 64) were invited to participate.They were informed that the study was confidential and that the information provided would not affect their incarceration status.Sixty-three individuals joined in the research.Written informed consent was obtained from each participant and information regarding the protocol and informed consent was presented at the appropriate literacy level.The study was conducted in a confidential manner and numbers were used to identify the participants.
Data collection procedures and serological tests.All 63 inmates answered a questionnaire which included demographic information and risk factors for STDs and blood borne diseases.Physical examination was performed to evaluate general health condition of each prisoner.
Statistical analysis.The Fisher's test was used to check for a statistically significant association between the serological results (inmates compared with donors).To measure the strength of the associations OR was calculated and the 95% confidence interval (CI) tested to ascertain whether the results were statistically significant.

RESULTS
All 63 subjects were males, their mean age was 30.2 years and the majority was in the range of 21-40 (51/63).Of the inmates 75% were cigarettes smokers and alcohol consumption was reported by 71%.Marijuana use was reported by 33% (21/63), cocaine (inhaled and/or intravenous) by 12% (8/63) and multiple substances by 10% (6/63) of the inmates.Homosexuality was reported by 11% (7/63) of the subjects; two of these reported initiation of this behavior in prison environment.Fourteen (22%) inmates had their skins tattooed in prison, using shared needles and ink.Physical examination revealed only minor health problems, e.g., superficial fungal and bacterial infections, scabies and light arterial hypertension.
Positive results for HBV were obtained in 11/ 63 (17.46%), for syphilis in 5/63 (7.40%), for HCV in 4/63 (6.34%), for Chagas' disease in 3/63 (4.76%), for HIV-1/2 in 2/63 (13.17%) and for HTLV-I/II in one inmate (1.58%) (Table 1).All positive results were found in different individuals, except for one inmate, who was seropositive for HIV-1/ 2, HBV and HCV.These results were compared with data of eligible blood donors (n = 3,309) of the same geographic area and year.This control group had a comparable mean age and 80% were males.The seroprevalence for all infections was significantly higher in prisoners than among blood donors, except for HTLV-I/II, which, although higher in inmates, had p value above 0.05.

Table 1 -
Prevalence and relation of positive serological results among inmates and eligible blood donors.Manhuaçu,