Gender differences in HIV prevalence and perception of harm reduction among adult inmates in Taiwan

Background and Purpose: Taiwan's HIV sero-incidence has drastically increased in the aftermath of the Severe Acute Respiratory Syndrome (SARS) pandemic in 2003, particularly among injection drug users (IDUs) and prisoners. A harm reduction effort, which included needle exchange and methadone maintenance treatment, has been operative since 2005. Our major purpose was to explore how men and women adult inmates differ in HIV prevalence and in their perception of the harm reduction efforts. Methods: Survey data was collected from all male prisoners (n=13,428) in seven representative prisons in 2006 and a census survey (n=2,486) for female inmates in 2007, separately. Both surveys used a self-administered anonymous questionnaire in group supervised settings. Participants' HIV status was determined using records of the mandatory HIV blood test upon incarceration according to the law. Results: Among participants, 72.5% males and 68.9% females disclosed that they used illicit drugs prior to this imprisonment. Among drug-using participants, 4,365 males (52.3%) and 1,322 females (81.0%) were IDUs. Significant gender differences in HIV prevalence emerged for analyses with all participants (4.0% vs. 5.6%, p <.001) and with only IDU participants (11.6% vs. 9.4%, p <.001). Roughly 43.5% male and 12.2% female drug-using participants were aware that harm reduction efforts had been implemented (p <.001). Conclusions: Significant gender differences were found in HIV prevalence and in awareness of the harm reduction efforts. Gender sensitive approach in tailoring of HIV and substance abuse health education should be enhanced.