A J Khan¹, S P Luby¹, S Baqi1, A J Ahmed¹, S Fisher-Hoch², JB McCormick¹

¹ Department of Community Health Sciences, AKU ² Department of Pathology, AKU World-wide, prison inmates have high rates of sexually transmitted diseases (STDs). We sought to measure the prevalence of STD symptoms and high-risk behaviors among male Sindh Prisons inmates and to assess the their contact with the general population.

As part of a larger study in July 1994 we visited all 16 jails in Sindh province and administered a detailed sexual history and risk behavior questionnaire to a systematic sample of 40% of all male inmates.

3392 (72%) of 4700 male prisoners approached agreed to answer the questions. 706 prisoners (21%) reported lifetime occurrence of purulent urethral discharge a few days after sexual intercourse, 698 (21%) reported ever having fluid-filled genital vesicles and 411 (12%) reported ever having genital ulcers. One hundred and twenty prisoners (4%) reported lifetime occurrence of sexual intercourse with multiple men; 523 (15%) with multiple men and women; 973 (29%) with multiple women only, and 1086 (32%) with a partner who had multiple sex partners. Compared to low risk prisoners who had zero or a single sexual partner, STDs were significantly more common among inmates reporting multiple male-male sexual contacts (Prevalence Ratio[PR]= 5.2; p<0.001), multiple bisexual contacts (PR= 8.1; p<0.001) and sex with high-risk partner (PR= 5.7; p<0.001). Compared to prisoners who had been imprisoned for 3 months or less, inmates imprisoned for 25 months or longer were more likely to have practiced male-male sex within prison (PR= 9.2; p<0.001); have genital ulcers (PR= 1.5; p= 0.003); and have fluid-filled genital vesicles (PR= 1.5; p<0.001).

Thirty one percent of the inmates have history of prior imprisonment and 27% had been imprisoned for less than 3 months, indicating high in- and out-migration. Significant contact exists between inmates (when inside or outside prison) and the general population through prostitutes (26%), blood donations (22%), therapeutic needle-sticks (82%), heterosexual contacts (60%), male-male sex (27%), and IV drug use (4%).

We demonstrate an epidemic of STDs among prisoners practicing high-risk sexual behaviors who serve as conduits between the high STD-prevalence prison environment and the general population. This has serious connotations for the coming AIDS epidemic. We call for an aggressive STD treatment and prevention program within the Sindh Prisons system.

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