The Prevalence of Chlamydia Infection in Youth Offenders in HMP/YOI Holloway

June 2003 – June 2005

THERESA BURNS, SEXUAL HEALTH ADVISERWomen’s Health Clinic, HMP/YOI Holloway & Marlborough Clinic, Royal Free Hospital

Methodology

• Health Adviser led session.

• Working with the support of unit officers who often helped with recruitment to the study.

• Evening sessions held on Young Offenders Unit during association time (time for women to take baths, domestic chores and to mix with each other for 11/2 hrs each evening).

• Limited space allowing for privacy. Interviews held in places such as dining room and TV room.

Methodology

• Opportunistic testing – approaching individuals and explaining who I was and why I was there.

• Administered questionnaire.

• Chlamydia urine NATT.

• Total number of patients = 289

Aims of Study

• To determine the prevalence of chlamydia infection and associated lifestyle risk factors in young women from the Young Offenders Unit in HMP Holloway.

• To raise awareness of chlamydia in this vulnerable group.

Age Range

0102030405060708090

32 68 80 81 27

age 17 age 18 age 19 age 20 age 21

0255075

100125150175200225250275300

77.1% 10.4% 5.9% 8.0% 6.6%

white mixed black caribbean black (other) other

Ethnicity

Educational History

0

20

40

60

80

100

120

140

160

3.8% 43.2% 47.7% 5.2%

none <3yrs < 5yrs current

Since age 11, how many years did you spend in full-time education?

Drug Use part I

0

50

100

150

200

250

300

10.4% 85.5% 18.3% 35.0% 45.0%

none tobacco Rx'd alcohol hash

Drug Use Part II

0

20

40

60

80

100

120

140

16.3% 12.5% 17.7% 41.2% 25.3% 17.3%

Ecstasy Amphetamine Cocaine

Crack Heroin (smoked) Heroin (injected)

Current Sexual Partners

0

50

100

150

200

250

90.7% 2.30% 4.70% 2.30%

RMP > RMP RFP other

Age of First Sexual Experience

0

10

20

30

40

50

60

70

80

9 yrs 10 yrs 11 yrs 12 yrs 13 yrs

14 yrs 15 yrs 16 yrs 17 yrs 18 yrs

Commercial Sex Work

53 (18.4%) of the 289 women interviewed admitted at some time being involved in the commercial sex industry.

This was mainly to support their own and their partner’s drug use.

Number of Sexual Partners

THE LAST THREE MONTHS PRIOR TO COMING INTO PRISON

0

20

40

60

80

100

120

140

160

180

0 1 2 3 4 5+ 10+ 20+ 50+ 100+

Condom Use

• 56 (19.8%) of women interviewed reported a condom was used at last intercourse.

• 122 (43%) reported that they never used condoms.

• 122 (43%) reported occasional use.

• 40 (14.1%) reported 100% condom use.

0

20

40

60

80

100

120

140

19.8% 43.0% 43.0% 14.1%

Contraception

0

20

40

60

80

100

120

140

160

180

54.4% 22.3% 15.2% 5.3% 2.8%

none condom pill depo other

Pregnancy

0

10

20

30

40

50

60

13.3% 31.8% 31.2% 23.7%

Pregnant Birth Miscarriage TOP

Previous STI Infection

0

510

1520

25

3035

4045

50

21 47 9 18 3 2 4 1

GC CHLAMYDIA TV HPV STS HEP B HEP C HIV

Chlamydia Results

• Verbal results after one week, hard copy after a fortnight

• Positive results given to women either on the unit or in the clinic. If transferred to another prison, that health care unit contacted and told of the need for treatment. If released, letter sent if address was available.

• Appointment in the Women’s Health Clinic within 48 hours for treatment and an offer of full sexual health screen including HIV, hepatitis B and C if indicated.

Partner Notification

• Difficult due to woman's circumstances:

in prisonlimited contact with the outside worldphone calls listened intoall mail is read by unit officers before posting

• Women often refused to contact partners due to worries over:

Possible violenceConfidentialityEmbarrassment

• Provider referral offered, only possible in a small number of cases

Results

• Prevalence of chlamydia infection was 12.2%.

• All the young women who took part in this research were offered an appointment for a full sexual health screen.

Results

No association with a chlamydia diagnosis

- age

- drug and alcohol use

- sex worker- educational history- social history

Recommendations

• Chlamydia testing offered to all women admitted to the Youth Offender Unit

• Educational session to raise awareness

• Assertiveness training around condom use

• Targeted health promotion programmes

• Multi agency working i.e. drug services