A review and meta-analysis of more than 200 studies shows a “persistently high” prevalence of bacterial sexually transmitted infections (STIs) in prisons, particularly among incarcerated adolescents and women, researchers reported yesterday in The Lancet Public Health.
For the study, a team led by researchers from McGill University analyzed data from 206 studies examining the prevalence of chlamydia, gonorrhea, and syphilis among adolescents aged 10 to 19 and adults older than 19 who were incarcerated.
The studies included 1.4 million incarcerated individuals in 43 countries, with most conducted in North America (47.1%) and South and Central America (22.3%) and in high-income (64.6%) and middle-income (34.5%) countries.
The study authors note that the World Health Organization (WHO) has identified people in prison and other closed settings as one of the key populations in the global response to sexually transmitted and bloodborne infections (STBBIs). But previous studies of bacterial STIs among the incarcerated have had limited generalizability.
“Bacterial STIs remain understudied despite their disproportionate burden on people who are incarcerated,” they wrote. “Given the high burden of bacterial STI in prisons and other closed settings, understanding their prevalence is critical for refining global estimates and informing testing and treatment practices, to ultimately advance bacterial STI elimination efforts both within and beyond carceral settings.”
Risky sexual behaviors, poor access to testing
Among female adults, the pooled prevalence of chlamydia, gonorrhea, and syphilis was 6.5%, 1.5%, and 5.9%, respectively; among male adults, the corresponding estimates were 4.7%, 0.4%, and 3.7%. Among female adolescents, the pooled prevalence of chlamydia, gonorrhea, and syphilis was 16.8%, 6.0%, and 1.9%, respectively; among male adolescents, the corresponding estimates were 7.4%, 2.0%, and 1.9%.
The authors say the findings potentially reflect both sexual behaviors that increase the risk of STIs and poor access to bacterial STI testing and treatment in carceral and community settings.
“Investment is needed to improve sexual health services in the community and reach populations who experience incarceration,” they concluded. “In addition, offering opt-out testing and treatment to all people in prison and other closed settings is likely required to achieve the 2030 STBBI elimination goals set by WHO.”
