The Changing Landscape: Geospatial, Epidemiologic Characteristics and Infectious Diseases of Inmates Living in a Region with a High Number of Prisons, Brazil
Authors: do Nascimento Charlene Troiani , Pena Danilo Zangirolami , Giuffrida Rogério , Bandeira Monteiro Fernanda Nobre , da Silva Francisco Assis , Flores Edilson Ferreira , Prestes Carneiro Luiz Euribel 
Published: January 2020

ABSTRACTObjectiveWe determined the geospatial and epidemiologic characteristics and prevalence of HIV, tuberculosis, viral hepatitis, syphilis, and co-infections in inmates in 28 prisons.DesignThis is a regional, observational, retrospective, and descriptive study conducted from November 2017 to October 2018.SettingPrisons are located in the western and northwestern regions of São Paulo state, Brazil.MethodsData were obtained through a standard questionnaire from inmates with a diagnosis of infectious diseases and co-infections (HIV, hepatitis B virus, hepatitis C virus, syphilis, and tuberculosis), treatment, and time of incarceration. Locations of prisons and highways were obtained from shape file databases. Data on inhabitants, population growth, and Human Development Index were obtained from public agencies. Maps were constructed using geographic information system.ResultsA total of 37,497 individuals were enrolled in the study and 741 (1.97%) were diagnosed. HIV was the most prevalent disease (0.68%), followed by tuberculosis (0.66%), syphilis (0.2%), HCV (0.2%), and HBV (0.04%). HIV-syphilis was the most prevalent co-infection (odds ratio, 63.7; 95% confidence interval: 41.4, 96.7). There was a statistical significance (P<0.001) for those with HIV acquiring co-infections. In 21 units, there was no relationship between the number of prisoners and the prevalence of infectious diseases.Mean age was 35.82 years (SD, 10.41 years) and 57.9% had been in prison previously. Strategically, most prisons were constructed beside radial highways. A higher than expected population growth was observed in 17 municipalities in which prisons were constructed (47.2%).ConclusionsThis is one of the biggest studies in Brazil, and the prevalence of infectious diseases among inmates was lower than countrywide. Therefore, improvements in health care are necessary, mainly in screening for infectious diseases. Construction of large prisons beside the radial highways changed the landscape and prevented migration of people from small to large cities.Strengths and limitations of this studyThe western and northwestern regions of São Paulo state have the highest number of prisons in Brazil and the risk of infectious diseases in prisoners is higher than that in the general population.Few studies have addressed this issue countrywide and for this reason, we determined the prevalence of HIV, HBV, HCV, syphilis, tuberculosis and co-infections as well as epidemiologic characteristics in 37,497 inmates of 28 prisons.The data were obtained through a questionnaire sent to each prison health care unit. Due to lack of commitment to complete the questionaire and as a retrospective study, some important data cannot be measured and therefore are limitations of this study.We used geospatial analytic techniques to understand the geographic strategy used for the location and construction of the prisons.Most prisons were constructed in small-sized cities. We used the number of inhabitants, population growth and human developing index to analyze their impact on preventing migration and development in the municipalities in which prisons were constructed.