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PhD Thesis - Dolan, K

HIV In Australian Prisons: Transmission, risk behaviours and prevention
Dolan K (1997)

Abstract:
The study of HIV transmission, risk behaviours and prevention in the prison setting is a difficult but important task. The difficulties lie in gaining access to inmates, obtaining representative samples and reliable reports of risk behaviour and collecting conclusive evidence of HIV transmission in prison. This area of research is important because the high level of inmate turnover means that HIV transmission in prison threatens HIV control in the community when inmates are released. Research is required to evaluate the effectiveness of HIV prevention measures in prison settings as little such evidence exists.

This thesis examines HIV transmission (Chapter 1), risk behaviours (Chapter 2) and its prevention (Chapter 3) in prison. Four original studies were conducted between 1993 and 1996 in Sydney, New South Wales, Australia. The first study was a `Survey of HIV Risk Behaviour of Current Inmates' in AIDS education courses (Chapter 4). The second study was a telephone `Survey of HIV Risk Behaviour of Recently Released Prisoners' (Chapter 5). The third study was a `Case Control Study of HIV Positive and Negative IDUs' with a history of imprisonment (Chapter 6). The fourth study was an `Investigation of a Network of HIV Transmission in Prison' (Chapter 7). These studies provided data for assessing bleach (Chapter 8) and methadone maintenance programs (Chapter 9) in reducing risk behaviour in prisons.

The research indicated that drug injecting in prison presented greater risk for HIV transmission than tattooing or sexual activity. Moreover, injecting in prison was more prevalent and hazardous but less frequent in comparison with injecting in the community. HIV transmission had occurred primarily as a result of syringe sharing. HIV injecting risk behaviour (and probably transmission) in prisons was reduced by methadone maintenance and bleach programs. The extent of HIV transmission in Australian prisons has been underestimated because of problems of measurement due to the high level of inmate turnover. HIV transmission in prison has important public health implications for control of HIV in the general community. Implications for future research are discussed (Chapter 10).

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