Vulnerabilities of the prison population in Ceará to sexually transmitted infections

Teles, Davi Oliveira; Oliveira, Raquel Alves de; Ribeiro, Samila Gomes; Soares, Paula Renata Amorim Lessa; Menezes, Purdenciana Ribeiro de; Pinheiro, Ana Karina Bezerra

doi:10.37689/acta-ape/2026AO0000791

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Original Article • Acta Paul Enferm 39 • 2026 • https://doi.org/10.37689/acta-ape/2026AO0000791i linkcopy

Vulnerabilities of the prison population in Ceará to sexually transmitted infections

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective To analyze the individual, social, and programmatic vulnerabilities and their associations with the history of Sexually Transmitted Infections (STIs) and/or HIV in the Prison Population in Ceará.

Methods This cross-sectional study was performed in May-September 2022 in Ceará prison units (20,666 prisoners). Data were collected using a questionnaire with sociodemographic, prison, and health history information. The predictor variables were categorized according to the theoretical framework of vulnerabilities. The diagnosis of any STI/HIV during or after entry into the prison system was the outcome variable. For continuous variables, measures of position, dispersion, and normality analysis were calculated and for the association between vulnerability marker variables and STI history, binary logistic regression was performed.

Results The prevalence of STIs was 445 (2.2%), and Syphilis and HIV were the most prevalent diseases. Most diagnoses (54.4%) were made on admission. The markers of greater vulnerability to STIs were as follows: be 30 years of age or older, have a psychiatric condition or previous chronic illness, low income, have been arrested for a drug crime, have relationships with other prisoners, work in the system, and prison time of up to one year. The markers of lowest vulnerability were the following: having a religion, previous formal employment, having a disability, being LGBTQIA+, receiving condoms in prison, reporting violence by police officers, receiving a visit from a partner, and having been transferred from one unit to another.

Conclusion The prison population of Ceará presented individual, social, and programmatic vulnerabilities to STIs/HIV, which were active before and during imprisonment. The high admission prevalence reinforces the importance of understanding such vulnerabilities to promote health and life quality actions, considering the pre- and intra-prison context.

Keywords:
Sexually transmitted diseases; Prisoners; Prisons; Health vulnerability; Vulnerability study

STI	Diagnoses on admission	Diagnoses after arrest	Total by STI	Prevalence n=20666
STI	n(%)	n(%)	n(%)	(%)
Syphilis	153(63.2)	137(67.5)	290(65.1)	2.4
HIV	41(16.9)	26(12.8)	67(15)	0.3
Gonorrhea	17(7)	44(21.7)	61(13.7)	0.3
HPV	22(9.1)	2(1)	23(5.2)	0.1
Chlamydia	3(1,2)	19(9.4)	22(4.9)	0.1
Hepatitis B or C	4(1.7)	8(3,9)	12(2.7)	0.06
Herpes	10(4.1)	0(0)	10(2.2)	0.05
Total per moment	242(54.4)	203(45.6)	445(100)	2.2

Vulnerability markers	Reference categories	p-values	OR	95% CI
Vulnerability markers	Reference categories	p-values	OR	Lower	Superior
Individual vulnerabilities
Age	≥30 years (sample median)	0.004	1.49	1.13	1.97
Religion	With religion	0.022	0.66	0.46	0.94
Previous marital status	Married or in a stable relationship	0.102	0.79	0.59	1.05
Race and/or ethnicity	Non-white	0.978	1.00	0.72	1.4
Have children	Yes	0.72	0.94	0.7	1.27
Diagnosis of previous mental disorder	Yes	0.029	1.48	1.04	2.09
Chronic disease	Yes	0.01	1.49	1.10	2.02
Person with disabilities	Yes	0.003	0.48	0.29	0.78
Are you LGBTQ+?	Yes	<0.001	0.04	0.02	0.13
Social vulnerabilities
Arrest of family member	Yes	0.792	0.96	0.75	1.25
Low family income	Yes	0.026	1.33	1.03	1.71
Arrested for drug crime	Yes	<0.001	1.69	1.31	2.18
I lived on the streets	Yes	0.185	1.82	0.74	4.48
Programmatic vulnerabilities
Education	Complete elementary school	0.132	1.22	0.94	1.58
Formal work	Yes	<0.001	0.52	0.39	0.7

Vulnerability markers	Reference categories	p-values	OR	95% CI
Vulnerability markers	Reference categories	p-values	OR	Lower	Higher
Individual vulnerabilities
Prison time	≤1 year	0.022	1.53	1.06	2.21
STI diagnosis on admission	Yes	<0.001	0.12	0.05	0.27
Social vulnerabilities
Use of legal substances in prison	Yes	0.473	1.58	0.45	5.47
Use of illicit substances in prison	Yes	0.089	2.09	0.89	4.88
Affective and/or sexual relationship with other inmates	Yes	0.012	1.72	1.12	2.63
Receives visits from a previous partner	Yes	<0.001	0.18	0.07	0.47
Programmatic vulnerabilities
Access to prison health service	Satisfactory	0.608	0.9	0.6	1.34
Received guidance on STIs/HIV	It received	<0.001	1.89	1.29	2.75
Receives condoms in prison	Yes	<0.041	0.398	0.164	0.964
Report of violence by prison officers	Yes	<0.001	0.34	0.23	0.51
Report of violence by other inmates	Yes	0.064	1.92	0.96	3.81
Number of people per cell	≤ 8	<0.001	0.54	0.38	0.75
Studies in prison	Yes	0.165	1.28	0.9	1.84
Transferred from unit	Yes	<0.001	0.21	0.14	0.33

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[TFN1001] STIs: Sexually Transmitted Infections.

[2] Source: Prepared by the authors