Prevalence and correlates of hepatitis A among adult drug users: The significance of incarceration and race/ethnicity

This report examines associations between hepatitis A virus (HAV) infection prevalence and a history of incarceration in jail or a correctional facility among a population of drug users in Baltimore stratified by African American and white racial/ethnic status. The study sample consisted of 509 non-injection and injection drug users recruited from inner-city neighborhoods of the Baltimore metropolitan region. The baseline prevalence of HAV infection was 36.9% (N = 188). One-fourth (25.5%) of the sample reported no lifetime history of incarceration, 44.6% reported incarceration in a local jail in their lifetime, and 29.9% reported incarceration in a correctional facility in their lifetime. In the multivariate logistic analysis, HAV infection prevalence was higher for whites (44.3%) [adjusted odds ratio (AOR) = 2.3, 95% CI = 1.5-3.5] when compared to African Americans (30.5%) adjusting for gender, age, and education. In the analysis stratified by race/ethnicity, as anticipated, jail incarceration and correctional facility incarceration were each independently associated with elevated HAV prevalence among white drug users. African American drug users with a high school diploma had significantly lower HAV infection prevalence when compared to African American drug users who did not graduate from high school. Heightened HAV prevalence among white drug users compared to African American drug users is noteworthy given the opposite association of HAV infection prevalence and these two racial/ethnic groups in the general population. Since millions of incarcerated drug users in the US return to society each year, the results suggest that incorporating systematic HAV screening, prevention, and treatment programs within correctional systems represents a vital yet underutilized strategy to reduce HAV transmission in society as a whole.