Women at the center of attention in prison health care. As of January 31, 2021, they represented 4.2% of the prison population, for a total of 2,250 units. A minority component, but growing and especially with a higher number of men in terms of pathologies. This is what emerges from a study still in progress, the first results of which were presented at the Prison Agora 2021, XXII National Congress of SIMSPe – Italian Society of Medicine and Prison Health. The penitentiary system is extremely complex, each year more than 100,000 people pass through it; recently it was severely tested by Covid, which however, despite initial fears, did not cause significant damage. For this reason, it is now necessary to draw attention to other pathologies, including mental and infectious ones.
Women in prison, the figures of hepatitis C
The study conducted by ROSE – Rete d’Onne SimspE tackled HIV and Hepatitis C infections among female prisoners in different Italian prisons. ROSE is a SIMSPe gender network on the health of women in prison, born on the occasion of the 2016 Prison Agora.
The responsible coordinator is Dr. Elena Rastrelli, UOC Protected Medicine-Infectious Diseases, Belcolle Viterbo Hospital. The Network studies the spread of HIV and HCV among female prisoners, but does not limit itself to infectious diseases. On this occasion, the study examined 5 prisons from 4 different regions, which represented 10% of the female prison population. The data is still preliminary, but it is the most significant ever produced at the level of the female population in prison.
“With regard to hepatitis C, data from the Ministry of Health already show that incarcerated women were twice as likely to contract the infection as men and 14 times compared to the general population – underlines Elena Rastrelli. – Women represent a complex population to reach, dispersed throughout the territory and often linked to stories of drug addiction and prostitution. Since November 2020, 156 inmates have been enrolled in the study. Among them, 89 (57%) were Italian: the average age was 41; 28 of them (17.9%) used intravenous drugs. Out of 134 were screened with the innovative saliva test for HCV, while for the others it was done intravenously. We found compelling data: the serum prevalence of HCV was 20.5%, a figure slightly higher than the prevalence reported in the most recent international literature, as well as twice as high as 10.4% in males. Moreover, the women had an active infection in more than 50% of the cases”.
“Most of the patients who tested positive were taken by surprise: this highlights the need for an intervention targeted at the female prison population, especially since there are currently therapies for hepatitis C that can to definitively eradicate the virus in a few weeks and without support. – adds infectious disease specialist Vito Fiore, medical director of the complex infectious and tropical diseases unit of Sassari. – Another interesting fact concerns co-infected patients. Of 84 male prisoners treated under the HCV micro-eradication project, only 3 were also HIV-positive. Of the women treated in this project, however, 25% were also positive for the virus that causes AIDS. Moreover, if in men there were no cases of hepatitis B, in women no less than 5, so 21%, were also carriers of this virus. We can deduce that in prison women are more exposed than men to co-infections”.
“The limited number of female prisoners should encourage greater attention, additional services, proactive health management – emphasizes Prof. Sergio Babudieri, scientific director of SIMSPe – In some prisons, women are a few dozen people: in these situations, it is possible to improve the prison health care We cannot wait for the prisoner to ask for help or even worse for him to commit an act of self-harm; we have to understand the needs of individuals.”
The difference between mental diagnosis and psychiatric pathologies
Another particularly important trend in health care in prisons is that of psychiatric pathologies, which represent a serious and sometimes underestimated problem. “Mental illness is an identifiable pathology according to a standardized coding throughout the world – underlines Luciano Lucanìa, president of SIMSPe – Many people are affected by it. However, the pathological part must be distinguished from those who show mental distress on arrival in prison as a sign of response to the limited adaptation to new living conditions: among these there are those who had previous disorders, drug addicts, people placed in a difficult and totally new context. They too must be cared for and protected, but a distinction must be made between what is illness and what is discomfort. The clinical aspect indeed concerns mental illnesses such as schizophrenia or paranoia, pathologies for which a patient must go to the psychiatrist and undergo specific therapy. Mental distress is the response of a person with basic problems (depression, drug addiction, etc.) to deprivation of liberty, which remains a very serious stress. The latter are the ones that make the most news, because they have greater aggressiveness, less tolerance for frustration, rules, forced cohabitation, but the categories must be treated in their respective ways, without creating confusion “.