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PROJECT TOPIC AND MATERIAL ON HIV PREVALENCE AND ASSOCIATED RISK FACTORS AMONGST PRISON INMATES IN KUJE FEDERAL PRISON, FEDERAL CAPITAL TERRITORY, ABUJA, NIGERIA, JANUARY, 2013.

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  • Name: HIV PREVALENCE AND ASSOCIATED RISK FACTORS AMONGST PRISON INMATES IN KUJE FEDERAL PRISON, FEDERAL CAPITAL TERRITORY, ABUJA, NIGERIA, JANUARY, 2013.
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TABLE OF CONTENTS

Attestation ……………………………………………………………………………………………………………………….. ii
Certification ……………………………………………………………………………………………………………………. iii
Dedication ………………………………………………………………………………………………………………………. iv
Acknowledgement …………………………………………………………………………………………………………….. v
Summary ………………………………………………………………………………………………………………………… vi
Table of contents …………………………………………………………………………………………………………….. viii
List of Figures …………………………………………………………………………………………………………………. xi
List of Tables …………………………………………………………………………………………………………………. xii
Acronyms ……………………………………………………………………………………………………………………… xiii

CHAPTER ONE: INTRODUCTION …………………………………………………………………………………… 1
1.1 Background …………………………………………………………………………………………………………. 1
1.1.1 Situation analysis of Nigerian Prisons ………………………………………………………………. 3
1.1.2 Burden of HIV/AIDS ……………………………………………………………………………………… 4
1.2 Problems Statement ……………………………………………………………………………………………… 8
1.3 Rationale/Justification for study …………………………………………………………………………….. 9
1.4 Research Questions: ……………………………………………………………………………………………. 11
1.5 Objectives of study ……………………………………………………………………………………………. 11
1.5.1 General objective …………………………………………………………………………………………. 11
1.5.2 Specific objectives ……………………………………………………………………………………….. 11

CHAPTER TWO: LITERATURE REVIEW……………………………………………………………………. 12
2. 1. Prevalence of HIV in prisons ……………………………………………………………………………….. 12
2.2 Knowledge of prison inmates on HIV …………………………………………………………………… 13
2.3 Attitudes of prison inmates towards HIV……………………………………………………………….. 14
2.4 Behaviours / practices of prison inmates on HIV/AIDS …………………………………………… 14
2.5 Factors associated with HIV/AIDS ……………………………………………………………………….. 15
2.6 Conceptual Framework of HIV transmission in prison …………………………………………….. 19

CHAPTER THREE: MATERIALS AND METHODS ………………………………………………………… 20
3.1 Description of Study Area …………………………………………………………………………………… 20
3.2 Study design ………………………………………………………………………………………………………. 21
3.2.1 Study period ………………………………………………………………………………………………… 21
3.3 Study population ………………………………………………………………………………………………… 21
3.3.1 The inclusion criteria for the study were: …………………………………………………………….. 21
3.3.2 The exclusion criteria for the study were: ……………………………………………………………. 22
3.4 Sample size determination ……………………………………………………………………………………. 22
3.5 Sampling technique ……………………………………………………………………………………………… 24
3.6 Study Instruments ……………………………………………………………………………………………….. 25
3.7 Data collection technique ……………………………………………………………………………………… 25
3.8 Quality assurance ………………………………………………………………………………………………… 29
3.8.1 Pilot Study……………………………………………………………………………………………………….. 29
3.8.2 Training of fieldworkers ……………………………………………………………………………………. 30
3.9 Data Management ……………………………………………………………………………………………….. 30
3.9.1 Data collection and retrieval ………………………………………………………………………………. 30
3.9.2 Measurement of Variables …………………………………………………………………………………. 31
3.9.3 Statistical Analyses …………………………………………………………………………………………… 31
3.9.4 Criteria for scoring and grading of HIV Knowledge, Attitude, and Practice of respondents ………………………………………… 32
3.10 Ethical consideration …………………………………………………………………………………………… 34
3.11 Limitations ………………………………………………………………………………………………………… 35
3.12 Scope of the study ………………………………………………………………………………………………. 36
3.13 Dissemination Plan …………………………………………………………………………………………….. 36

CHAPTER FOUR: RESULTS ………………………………………………………………………………………….. 38
4.1 Socio-Demographic Characteristics of study population …………………………………………… 38
4.2 HIV Prevalence ……………………………………………………………………………………………………… 50
4.3 Knowledge on HIV/AIDS ……………………………………………………………………………………….. 57
4.4 Attitudes about HIV/AIDS ………………………………………………………………………………………. 57
4.5 HIV related behaviours/Practices ……………………………………………………………………………… 60
4.6 Other HIV related diseases and issues ……………………………………………………………………….. 70
4.7 Factors associated with HIV infection amongst inmates ………………………………………………. 77
CHAPTER FIVE: DISCUSSIONS ……………………………………………………………………………………. 86
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS…………………………………………. 96
6.1 Conclusion …………………………………………………………………………………………………………….. 96
6.2 Recommendations …………………………………………………………………………………………………… 97

REFERENCES ………………………………………………………………………………………………………………. 98
APPENDICES ………………………………………………………………………………………………………………. 106
Appendix 1: Informed consent form statement for HIV test …………………………………………….. 106
Appendix 2: Study questionnaire ………………………………………………………………………………….. 107
Appendix 3: Focus Group Discussion Guide ………………………………………………………………….. 124
Appendix 4: Key Informant Interview Guide …………………………………………………………………. 128
Appendix 5: HIV Request and Result Form …………………………………………………………………… 130
Appendix 6: Participant information form ……………………………………………………………………… 131
Appendix 7: Evaluation Work-plan (Gantt Chart) …………………………………………………………… 134
Appendix 8: Permit from the Comptroller General of Nigerian Prison service …………………… 136
Appendix 9: Ethical clearance certificate ………………………………………………………………………. 137

List of Figures
Figure 1: Trend of National HIV prevalence amongst antenatal clinic attendees, National HIV sero-prevalence sentinel survey, 1991-2010 —————————————————————-5

Figure 2: Conceptual Frame Work of HIV transmission in prison with its link to the community-19

Figure 3: Map of Nigeria showing the Federal Capital Territory (Abuja) with prison location in Kuje Area council————-20

Figure 4: Serial testing Algorithm for HIV Rapid Test kits———————————————-28

Figure 5: Parallel testing Algorithm for HIV Rapid Test kits ——————————————-28

Figure 6: Distribution of final respondents that accepted participation in study by prison status——————39

Figure 7: Highest level of school completed by respondents ——————————————-43

Figure 8: Proportion of respondents that ever heard of AIDS or HIV, 1991-2010 ——————-51

Figure 9: Personal risk perception of inmates on contracting HIV————————————–58

Figure 10: Numbers of respondents that experienced selected sexual practices before imprisonment, 1991-2010———————–61

Figure 11: Condom knowledge of inmates and condom accessibility ———————————63

Figure 12: Frequency of alcohol intake of respondents within the last 4weeks ———————-66

Figure 13: Proportion of respondents that have used psychoactive drugs—————————–67

Figure 14: Ever had any sexually transmitted diseases—————————————————71

Figure 15: Numbers of respondents who have knowledge of selected Tuberculosis variable ———————-72

Figure 16: Proportion of respondents who had anybody/organisation or the prison authority discussed HIV with them within the last 12 months——————————————————75

List of Tables
Table 3.1: Selected variables used to grade knowledge, attitude and practice on HIV/AIDS–33

Table 4.1: Age distribution of respondent ————————————————————40

Table 4.2: Marital Status of respondents by state of origin —————————————-41

Table 4.3: Occupation of respondents before incarceration—————————————-44

Table 4.4: Distribution of respondents by state of origin——————————————-45

Table 4.5: HIV test acceptance and HIV prevalence of respondents that accepted HIV test———————50

Table 4.6: Knowledge of selected variables on HIV and AIDS amongst respondents———————-52

Table 4.7: Knowledge of routes of transmission of respondents———————————-53

Table 4.8: Knowledge on HIV prevention methods————————————————–54

Table 4.9: Misconceptions about HIV Transmission ————————————————55

Table 4.10: Attitude towards HIV/AIDS Stigma and Discrimination—————————–57

Table 4.11: Condom usage of respondents ————————————————————64

Table 4.12: Knowledge of STIs amongst respondents ———————————————–70

Table 4.13: Cross tabulation of occupation of respondents and prison status ———————79

Table 4.14: Cross tabulation of prison status of respondents and HIV status ——————–80

Table 4.15: Cross tabulation of Age of respondents and HIV positive status by Prison status—————————-81

Table 4.16a: Bivariate analysis of selected exposures variables with HIV status as outcome ——————————83

Table 4.16b: Bivariate analysis of selected exposures variables with HIV status as outcome —————————-84

Table 4.17: Multivariate analysis of exposure variables with HIV status as outcome ———————————-85

Acronyms
AAFB: Acid Alcohol Fast Bacillus

AIDS: Acquired Immune Deficiency Syndrome

ANOVA: Analysis of Variance

AOR: Adjusted Odds Ratio

ART: Anti-retroviral therapy

BCC: Behavioural change communication

BMI: Body mass index

FCT: Federal Capital Territory

FMOH: Federal Ministry of Health

FSW: Female sex workers

GUD: Genito -urinary disease

HCT: HIV counselling and testing

HIV: Human Immune Deficiency Virus

IBBSS: Integrated Behavioural and Biologic Survey

IVDU: Intravenous Drug Users

LGA : Local Government Area

MDG: Millennium Development Goal

MSM: Men who have sex with men

NACA : National Agency for the Control of AIDS

NARHS: National HIV/AIDS and Reproductive Health Survey

OR: Odds Ratio

PLHIV: People living with HIV

PMTCT: Prevention of mother-to-child transmission of HIV

RTI: Reproductive tract infections

SFH: Society for Family Health

STI: Sexually transmitted infections

TB: Tuberculosis

TW: Transport workers

UNAIDS:Joint United Nations Programme on HIV/AIDS

UNODC: United Nations Office for Drugs and Crime

WHO: World Health Organisation

 

CHAPTER ONE

INTRODUCTION

1.1 Background
For centuries history, it has been the recognized right of societies to punish crime and today, the way to deal with persons who commit serious crimes is through confinements in prisons. When the British Government assumed the responsibility for the administration of Lagos in 1961, the evolution of an organized prison system began. The Nigerian prison system was modeled after the British system. The deplorable conditions of Nigerian prisons with the concomitant high death rate in most of them led to a setting up of a commission of enquiry in 1920. Post-independence, the increase in the prison population posed a lot of problems due to filthiness, understaffing and poor health related condition1. The prisons represent dynamic communities where at-risk groups congregate in a setting that exacerbates disease and its transmission, including Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS). The sudden emergence of HIV and AIDS in the world, its rapid spread from within and across nations especially in sub-Saharan African and its increasing burden, in the face of limited resources, has posed a serious threat to human existence and the attainment of the desired level of human development. AIDS remains a leading cause of mortality worldwide and the primary cause of death in sub-Saharan Africa, illustrating the tremendous, long-term challenge that lies ahead for provision of treatment services, with the hugely disproportionate impact on sub- Saharan Africa ever more clearer2.
The first reported case of HIV in the world was quite recent in 1981 in the United State of America3. The menace of HIV and AIDS has been increasing in Nigeria since the report of the first case in 19864. Many individuals, families, communities, businesses have felt the devastating effect of the epidemic with about 3 million Nigerians affected as at 2010 5. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and its partners strongly recommended “Universal Access” to prevention, treatment and care for HIV and AIDS6. However, implementation of these strategies in prison settings needs adaptation due to the particular circumstances existing in prisons. It is too often forgotten that prisons can be very different in important ways, and that all prison inmates have their own social and health histories, and come from their own cultures, communities and backgrounds. The prison setting is one of the most challenging for health care, health protection and the prevention of spread of diseases, particularly HIV / AIDS, sexually transmitted infections (STIs) and other diseases such as Tuberculosis (TB) and Malaria. The World Health Organization (WHO) issued the Moscow Declaration in 2003 calling for integration or at least close working relationships between national health and prison health services. Otherwise, health in prisons can remain on the periphery of interest of governments and can be equally marginalized within prisons7. WHO/UNAIDS26,27 advocated for the use of second generation surveillance systems and incorporation of HIV testing into studies/surveys among the general populace and high risk groups to monitor changes and better understand HIV epidemic in each country. Second generation surveillance systems include HIV and STI biological and risk behaviour surveillance, using resulting data to warn of or explain changes in the levels of infection. Population-based survey (either in general population or high risk groups) provide an opportunity to link HIV status with social, behavioural and other biomedical information, thus enabling researchers to analyze the dynamics of the epidemic in more detail. Information from this analysis could lead to better programme design and planning27.

1.1.1 Situation analysis of Nigerian Prisons Presently, there are a total of 234 prisons (137 convict prisons, 84 satellite prisons camps, 12 prison farms, and one open prison camp). Of the convict prisons two are maximum security while 18 are medium security8,9. According to the Nigerian Prisons Service, the conventional convict prisons are designed as remand for both the convicted and awaiting trial prison inmates. There are two major types of convict prisons operational in Nigeria today namely: The maximum and the medium security prisons. The maximum and medium security prisons cater for all classes of prison inmates including condemned convicts; lifers, long term prison inmates et cetera. The currently installed capacity in the prisons is usually far exceeded. The total installed prison capacity in Nigeria as at end of 2011 was for 47,284 inmates. By 1976, the average daily prison population was 26,000, a 25 per cent increase from 1975. In 2007, Nigeria had a prison population of about 40, 444 according to International Centre for Prison Studies, King‟s College, London10. The population rose to 41, 404 (40,567 males and 817 females) as at May 2009 and as at July 31, 2010, the total prison inmates‟ population was 47, 628 out of which 13,000 (23%) were convicted persons while 34,328 (77%) are awaiting trial. As of May 2012, the total population of prison inmates was 50, 920 (convicted-14, 041; awaiting trial-36, 879; males-49,944 and females-976)8,11. There is usually disproportionate representation of prison inmates‟ population in each prison. Ikoyi prison had an original capacity for 800 persons, today, the population is 1,900. Out of this number, only 24 prison inmates are convicts. Port Harcourt prison has an installed capacity for 804 persons currently locks up 2, 924 persons out of which only 117 persons are convicts. Awka prison with an installed capacity for 238 persons presently accommodates 486 prison inmates out of which only 21 are convicts9. The Nigerian Prison system was supposed to exist with the full complement of legal, vocational, educational, religious, health and other social services but the situation has remained poor.

1.1.2 Burden of HIV/AIDS
Worldwide, as at the end of 2009, UNAIDS estimated that there were 33.3 million [31.4 million–35.3 million] people living with HIV (PLHIV) with an estimated 2.6 million newly infected. The number of children living with HIV increased to 2.5 million [1.7 million–3.4 million] with 370, 000 newly infected and 14 million children orphaned. The number of annual AIDS-related deaths worldwide was 1.8 million. Sub-Saharan Africa accounted for 22.5 million of PLHIV which represented 68% of the global total with about 1.3 million people dying of HIV related illnesses in sub-Saharan Africa which represented 72% of the global figure12. According to the 2008 report, almost 60 million people have been infected with HIV and 25 million people have died of HIV-related causes since the beginning of the epidemic2. Amongst countries with the largest epidemics in sub-Saharan Africa are Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe2.
HIV is a serious health threat for the 10 million people in prison across the world. In most countries, levels of HIV among prison population are far higher than in the population outside prisons. It is estimated that the prevalence may be up to a hundred times higher than in the community. High rates of HIV in prisons are often accompanied by high rates of tuberculosis, sexually transmitted infections, drug dependence and mental health problems13. In West and Central Africa, according to recent publications and surveys carried out by UNODC, UNAIDS, WHO and the World Bank 28,29,30,31, available data on HIV among prison inmates indicate that the several countries are particularly affected by high HIV rate in prison settings. Regarding HIV, the prevalence among prison inmates in West Africa varies from double to nine times higher than what is observed among general population. It was estimated that the HIV prevalence among prison inmates in Nigeria was 9% in 2004, with Ghana having 19% in 2006, and Togo 7.6% in 200832.

1.1.2.1 Burden and impact of HIV and AIDS in Nigeria
HIV and AIDS constitute major public health problems in Nigeria; the burden of this disease spectrum is further compounded by the impact on other diseases, human output and economy. HIV and AIDS affect millions of people in Nigeria and stretch the already challenged infrastructure of the health sector. HIV weakens the immune system and fuel the burden of other diseases and opportunistic infections such as Tuberculosis (TB) and Pneumocystis jiroveci (carinii) pneumonia (PCP). Nigeria has been in a state of generalized epidemic. The trend of HIV prevalence amongst antenatal clinic attendees in Nigeria went up from 1.8% in 1991 to 5.8% in 2001 then declined to 4.4% in 2005. It rose again to 4.6% in 2008 and in 2010 it was 4.1%5. Figure 1: Trend of National HIV prevalence amongst antenatal clinic attendees, National HIV sero-prevalence sentinel survey, 1991-2010.  These figures are been used as proxy for the national prevalence. The 2007 National population based survey gave a figure of 3.6% for age range 15-49 years14. A national HIV survey conducted amongst the high risk groups in Nigeria in 2010 showed a prevalence of 27.4% amongst brothel-based female sex workers (FSW), 4.2% among injecting drug users (IDU) and 17.2% amongst Men who have sex with men (MSM)15. Based on the 2010 antenatal clinic survey prevalence of 4.1%, and further analysis with WHO‟s Estimation and Projection package (EPP 2009) and spectrum, about 3.15 million people were estimated to be living with HIV in Nigeria in 2011, with about 2.2 million orphans and vulnerable children, and about 200,000 deaths annually5. The majority of people living with HIV in Nigeria are between the ages of 15 and 49 in the prime of their working lives5,14. There is no national figure for HIV prevalence in Nigerian prisons but various studies found values ranging from 6% – 9%16,17,18 and also the HIV/AIDS burden in the prison is not adequately known. HIV is associated with increased morbidity, health care utilization, public health facility use, lost work time and increased time devoted to care-giving by relatives, causing neglect or abandonment of agricultural work /reduced labor force / time 19, 20. A similar situation has been found in other countries like Malawi, Mozambique, Botswana, Namibia and Zimbabwe where the agricultural workforce has been reduced by between 14-20%21. This may also be the situation with Nigeria if drastic and decisive measures are not taken.
In 2008, 394.664 million USD was expended on HIV program with Government contributing about 7.6%12. With support from Global fund, United States President‟s Emergency Plan for AIDS Relief, United Kingdom‟s Department for International Development, World Bank and other donor agencies, Nigeria‟s National Agency for the control of AIDS (NACA) also estimated that in 2007 and 2008, the total spending for HIV and AIDS tracked by funding sources was 299,246,295.00 USD and 394,963,881.00 USD, respectively22. In prisons, the high prevalence of HIV infection and its associated illnesses, presence of injecting drug users (IDUs) combined with other risk behaviors, overcrowding and poor nutrition create crucial issues of public-health importance for correctional institutions and at a broader level, the communities in which they are situated. Findings from the Integrated Biological and Behavioural Surveillance Survey conducted by the Federal Ministry of Health (FMOH), Nigeria in 2007 and 2010 showed that high risk groups generally have HIV prevalence usually higher than that of the general population15,23. The Millennium Development Goal‟s (MDG) target „6‟ is that by 2015 HIV spread / new infection should have halted and the trend should be reversing24. To achieve this, all groups at high risk of HIV and AIDS must be clearly understood so that interventions can be developed to reduce the prevalence and incidence amongst them. Also, to reduce the spread of HIV, relationship between it and other sexually transmitted infections (STIs) must be understood as they also add to the burden. STIs may cause ulcers that may lead to easier and more efficient transmission of HIV from one infected sexual partner to another. Also, the presence of HIV increases vulnerability to STIs. As a result of the presence of other untreated STIs and some endogenous RTIs, an HIV-infected person is more likely to transmit HIV in subsequent unprotected sexual contact. Prevention and management of STIs, therefore, have become a critical strategy for minimizing the impact of the HIV/AIDS pandemic25.

1.2 Problems Statement
A high concentration for HIV has been documented in prisons in many parts of the world13, 28,29,30,31,42,44,45. Inmates once free, mix with general population hence may act as a bridge for HIV transmission, i.e may serve as a source of infection to the general population. Considerable gaps remain in the quantity and quality of information available in Nigeria on HIV/AIDS in prisons and the underlying dynamics of the HIV epidemic and its likely future course. In particular, data that provide insights into the dynamics of transmission and the following questions on HIV in prisons are lacking: What are the determinants of new HIV infections in prison inmates? Are there factors that influence transmission or influence the response? How well is the current response addressing new HIV infections in prisons? Is the coverage adequate? Has the response had an impact over time in prisons, in terms of behavioural change and HIV biological markers?
There is lack of adequate data, national figure for HIV prevalence and burden in prisons; also there is inadequate literature on HIV risk factors in Nigerian prisons. The details of these factors in Kuje Federal prison are also not known. There are no specific health interventions regarding HIV for prison inmates. Even the decisions on interventions on HIV are based on data from the general populace in the communities. Another challenge being faced now in the population and high risk group is the issues of TB/HIV co-infection in Nigeria, despite this, the strategic framework and policy documents put in place by FMOH to guide implementation of HIV and even TB/HIV co-infection in Nigeria has no specifications for prison settings partly due to unavailability of comprehensive prison specific and national data on knowledge, behaviors, attitude, practices and risk factors that drive HIV in prisons33,34.

1.3 Rationale/Justification for study
The rationale for this study is pivoted on the fact that the prevalence of HIV/AIDS in prison settings is a growing concern and information on HIV/AIDS in prison communities in Africa indicates that prisons concentrate great numbers of HIV-infected and at-risk populations28. The study will determine and quantify the magnitude of HIV and its dynamics in Kuje prisons because more information is necessary to formulate evidenced based interventions in prisons to reduce HIV transmission. It will fill information gaps on what Kuje prison inmates know about HIV/AIDS, their feelings (and preconceived ideas) and determine the HIV prevalence amongst them. As one of the earliest studies in this prison, it will serve as baseline and guide for other studies including conduct of similar studies nationwide and thus provide basis for effective and evidence-based interventions that will promote well-being, reduction in morbidity and mortality due to HIV and AIDS in Kuje prisons which can be extended to other prisons in Nigeria. Such interventions will include promoting and provision of universal access to HIV prevention, treatment and care which is in line with the declaration of the international community that prisoners retain all rights that are not taken away due to incarceration. Loss of liberty alone is the punishment, not the deprivation of fundamental human rights. Like all persons, therefore, prisoners have a right to enjoy the highest attainable standard of health and in context of HIV/AIDS, this includes a right to HIV/AIDS prevention tools13.
Sequel to the above, there is a need to collect serologic data and behavioural data to assess knowledge, behaviors, attitude, practices, mode of transmission and other determinants and associations that drive HIV amongst prison inmates. Series of studies have shown that with high prevalence of HIV there is a corresponding high incidence of TB and other diseases35, 36, .37,38. In absence of intervention, when a PLHIV develops TB, it gives only 40% smear positive and 50% lifetime breakdown39. Due to the lack of adequate information for planning and inavailability of anti-retroviral drugs, six prison inmates of a Federal Prisons reportedly died of HIV/AIDS in 2011, while 12 others were confirmed to be infected9. These have further shown the impact of HIV and the need for this study in prison such as Kuje Federal prison. The first step to the development of adequate HIV prevention, treatment, care and support programmes in prisons is to build better knowledge of the situation, better knowledge of the extent of the problem, and needs. The study will give information on prevalence and factors associated with HIV transmission in Kuje prisons which will aid formulation of preventive interventions for reducing transmission. It will also be a baseline for other studies and conduct of similar studies nationwide.

1.4 Research Questions:
• What is the prevalence of HIV amongst Kuje prison inmates?
• What are the knowledge, attitudes, practices and risk behaviours of Kuje prison inmates on HIV/AIDS and STI?

1.5 Objectives of study

1.5.1 General objective
The general objective of the study is to determine HIV Prevalence and its associated risk factors amongst prison inmates in Kuje Federal Prison, Federal Capital Territory, Abuja, Nigeria.

1.5.2 Specific objectives
The specific objectives of the study are:
1. To determine HIV prevalence amongst prison inmates in Kuje prison with provision of opportunities for HIV counseling and testing (HCT) with appropriate referral.
2. To assess knowledge on HIV/AIDS & STI transmission and prevention amongst prison inmates in Kuje prison.
3. To assess attitude towards HIV infection and AIDS amongst prison inmates in Kuje prison.
4. To assess behaviours and practices on HIV infection amongst prison inmates in Kuje prison.
5. To determine risk factors associated with HIV infection amongst prison inmates in Kuje prison.

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