Table 1 and Table 2 described the details of participants and CHs visited.
Prevalence of substance use among inmates in Central (CCH) and District Correctional Homes (DCH) details:
Based on the substances used by the inmates, they were categorised into two groups - habit disorder (Bidi, Guthka, khaini, Zarda, Sadapata, paan) and addiction disorder (Cigarettes, Chullu, Opium, Heroin, beer, wine, sleeping pills, gabapentin, codeine, nitrazepam).
The proportion of inmates smoking cigarettes in DCH is 89%, that is higher compared to CCH (82%). Chullu, a local alcoholic beverage was consumed by inmates in both central and district correctional homes as reported. Opium use among prison inmates in CCH was reported to be 0.7%. (Figure 1) Heroin is in use in DCH (0.24%). (Figure 2) Use of substances like beer, wine, sleeping pills, gabapentin, codeine, and nitrazepam was reportedly in CHs. (Figure 1 & 2) There is a significant difference between central and district correctional homes for addiction disorders among prison inmates as the P-value is exponential (0.001).
Tobacco smoking in the form of bidi was highly prevalent among inmates in CCH (61.9%) (Figure 3) than in DCH (38.75%). (Figure 4) Other narcotic substanceslike guthka, khaini, zarda, sadapata, paan etc. were used by inmates. There is a significant difference between CCH & DCH for habit disorder among inmates (P value – 0.001) and DCH has shown higher in habit disorders compared to CCH.
Opioid substitution therapy among inmates
All CHs provide Opioid Substitution Therapy to inmates to tackle their substance addiction and dependency disorders. For the OST management in inmates, all CHs follow National guidelines and reported providing medical diet to the inmates, methadone therapy and electroconvulsive therapy when required.
Among the inmates, 7.66% of males and 0.50% of females were availing OST. The OST services were mainly used by alcohol addicts (5.83%) compared to heroin-addicted inmates (1.83%).
The reported treatment completion rate among those initiated OST inside CHs was 96.53%, and the re-addiction rate after being released from prison was reported as 98.1%.
Sexual practices of inmates in CHs
In CCHs, 0.35% of inmates were reportedly active in homosexual practices and 0.06% were identified as sexaholics. The DCHs reported homosexual activities of 0.01% of inmates in the past three months. In male prison inmates, 0.39% were gays and 0.007% were sexaholics, as reported.
All the 15 key informants have mentioned that sexual practices were under-reported by inmates as many of the victims are either newcomers or from neighbouring Bangladesh who fear isolation and stigma on reporting such sexual exploitation to authorities.
The respondents from nine out of ten CHs mentioned one or more than one partners of those same-sex inmates.
All 15 participants from CHs reported that homosexual inmates did not practise safe sex as the correctional service authority has stopped condom provision to inmates, and an isolation model is being used to prevent such sexual activities.
Prevalence of STIs among prison inmates, presence of screening and management by CHs
Among male inmates, 1.23% had herpes simplex, 0.45% had gonorrhoea, and 0.47% had genital ulcer diseases in the past three months, whereas 0.16% of female inmates had herpes simplex infection.
There might be an underestimation of the STI prevalence among inmates, as STI screening (Clinical diagnosis) has been conducted only in 4 out of 9 male CHs, and 2 out of 7 female CHs. All 10 CHs provided medicines to STI infected inmates, 9 CHs supplied bathing soaps to maintain body cleanliness, and 8CHs provided health education to STI infected inmates.
Prevalence of hygiene-related diseases by CHs and gender
The information collected from CCHs has shown that the inmates were suffered from hygiene-related infections such as contact dermatitis (41.79%), scabies (7.25%), and urinary tract infections (3.86%) in the past three months. Among the inmates in DCHs, 7.69% had contact dermatitis, 1.96% scabies, and 1.44% had UTIs in the last three months.
Personal Hygiene related infections like contact dermatitis (46.30%), scabies (7.90%), and UTI (3.47%) among male inmates and 9.75%, 4.91% and 12.12% among female inmates were reported in the last three months, respectively. This shows a higher prevalence of UTIs among female inmates.
Five out of 10 correctional homes provided clean and adequate water to inmates, and only one CH had provided adequate space and separate blankets to the inmates. All the 15 key informants cited inadequate infrastructure facilities available to inmates, low budget allocation, and overcrowding in correctional homes.
Prevalence, treatment, and management of HIV among prison inmates in CHs
HIV prevalence among male and female inmates was 0.51% and 1.01%, respectively. Among PLHIV inmates, 80% were already availing ART, and the remaining 20% had to be linked to ART to initiate treatment. Out of 10, only 4 CHs reported uninterrupted provision of ART for prison inmates. All 10 CHs gave medical diets to inmates under any medical condition. Three CHs were providing separate cells for PLHIV inmates out of 10 CHs. The existing systems in CHs were found to be inadequate for partner notification and to ensure treatment adherence of PLHIV inmates after release.
Hepatitis B screening, prevalence and management by CHs
Nine CHs have reported the screening for Hepatitis B to its inmates. Hepatitis B prevalence among male and female inmates were 0.20% and 0.08%, respectively. All CHs lacked the provision for Hepatitis treatment, though a medical diet was offeredto HBV positive inmates in all 10 CHs.
Co-morbidities among prison inmates and its management in CHs
The prevalence of HIV-TB among inmates was 0.08%, and HIV-Hep B was 0.01%, respectively. All key informants reported that the CHs provided preventive measures such as masks, medical diet, and isolation for HIV-TB infected inmates. All CHs provide regular medication of DOTS and ART for TB-HIV inmates. Since these CHs do not have the provision for treatment of Hep B, only ART was given to the inmates having HIV-Hep B co-morbidity.
Needle Exchange Program
The needle exchange programme was reportedly inactive in all CHs, although injecting drug use among inmates were reported.