Aamir J Khan1, S P Luby1, S Baqi1, O Pasha1, A JAhmed1, J B McCormick1, S Fisher-Hoch2

1Department of Community Health Sciences, AKU 2Department of Pathology, AKU

Prison inmates are at increased risk of HIV infection and have higher prevalence rates than the general population. Ignorance of AIDS, HIV transmission routes and the protective role of condoms increases likelihood of exposure to HIV infection. To assess this risk we measured knowledge of AIDS-related topics that could influence the risk of exposure to HIV among inmates of Sindh Prisons.

As part of a larger study in July 1994 we visited all 16 jails in Sindh province and administered a detailed questionnaire on AIDS, condom awareness and risk behaviors to a systematic sample of 40% of all inmates.

Of 4700 male prisoners approached, 3392 (72%) agreed to answer the questions. 2295 (68%) inmates had never heard of AIDS. Prisoners who had heard of AIDS reported their source of information to be newspapers (59%), TV (32%), radio (21%) and fellow prisoners (22%). 1539 prisoners (45%) did not know what a condom was. Only 243 prisoners (7%) had ever used a condom 345 thought (10%) that condoms can protect from the AIDS virus. One hundred and twenty prisoners (4%) reported having sexual intercourse with multiple men; 523 (15%) with multiple men and women; 973 (29%) with multiple women only, 1086 (32%) with high-risk partner. Among high-risk groups, prisoners reporting multiple male-male sex had lowest AIDS awareness (25%) and condom awareness (56%) and were most likely to think that condoms do not protect from AIDS (37%).

We found that the group of prisoners who reported never having heard of AIDS (when compared to the group of prisoners aware of the routes of AIDS virus transmission) were less likely to be practicing IV drug (PR= 0.52; p<0.001) or multiple heterosexual contacts (PR= 0.54; p<0.001) or sex with high-risk partner (PR= 0.61;p<0.001). 66% of prisoners who were aware of the routes of transmission of the AIDS virus were from prisons in Karachi and Hyderabad.

Sindh Prisons inmates are ignorant concerning their risk for AIDS and the protective role of condoms. Prisoners reporting awareness of AIDS and its transmission routes also paradoxically reported significantly higher IV drug use, multiple homosexual contacts and sex with high-risk sex partner. Hence, intervention programs should not rely upon increasing AIDS awareness to influence risk behaviors. Increasing accessibility to condoms and demonstrating their proper use may prove to limit the exposure of prisoners to HIV.

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