HIV risk behaviours amongst Greek inmates: a theoretical perspective

Abstract

This is a report of a study on drug use and sexual behaviours of inmates, conducted in Greek prisons. Initially, the study took place at a national level and used a representative sample of 861 inmates from ten correctional institutions. The study recorded drug use and sexual behaviour of inmates and identified the correlates of these behaviours. 290 inmates (33.6%) reported injecting drugs, of whom 174 (60%) had injected while in prison, and 146 (50.3%) had shared injecting equipment sometime while in prison. Injectors were predominately aged 25 to 34 years; they were incarcerated mostly due to drug offences and offences against property; they were characterised by a multiplicity of previous sentences and a long duration of total time in prison. Most of the injectors had been convicted for drug offences in the past. Regarding their sexual behaviour one year prior to imprisonment, injectors were more likely to have multiple casual female sexual partners. Logistic regression analysis suggested that total time in prison, previous drug conviction, being a convict and having multiple female sexual partners one year before incarceration were significant HIV risk behaviour correlates. Then, a sample of 242 inmates from the biggest institution of Greece was investigated. Questionnaires comprised knowledge, attitudes and perceived risk/concern scales, as well as measures from the Health Belief Model, Health Locus of Control theory, Health Value and the Theory of Planned Behaviour. Inmates were highly knowledgeable on the basic facts of HIV transmission and prevention, but also had significant gaps. They generally held liberal attitudes towards AIDS-related issues. They worried about general health and AIDS and perceived themselves as at risk for getting AIDS. Inmates had engaged in high risk sexual and drug use behaviours and adopted prevention measures of limited effectiveness prior to incarceration and expected to do the same when released. The most significant predictors of inmates' intentions to practice safe sexual behaviour and drug use behaviour when released was their behaviour prior to incarceration and social cognition beliefs, mostly derived from the HBM. Susceptibility to AIDS and intentions to avoid injecting in prison were the most significant factors predicting drug injection while in prison. Results of this study were discussed theoretically in relation to previous research on drug use in prisons. Specific suggestions are made for drug use policy in Greek prisons, in light of the results and conclusions of this study.