People recently discharged from correctional facilities

• People who spend time in the care of correctional facilities often live with complex physical and mental health conditions and have had difficulties accessing appropriate care in the community
• Socio-economic and lifestyle factors also influence the burden of disease and lead to worse health outcomes
• In Aotearoa New Zealand, more than 50% of the prison population identify as Māori
• Ara Poutama Aotearoa (Department of Corrections) aims to carry out a health check, including sexual health screening, on all prisoners at admission
• Recent data from correctional facilities in northern Aotearoa New Zealand show that the prevalence of chlamydia and gonorrhoea is twice that of the general community
• For women, syphilis rates are twice those of the general population and trichomoniasis prevalence is over 3 times higher in correctional facilities, with 20% of those tested for trichomoniasis returning a positive test result
• 3% of samples from men in correctional facilities are reactive for syphilis, reflecting a high burden of past or current disease
• Similar to sexually transmitted infections (STIs), prevalence of hepatitis C antibody (6.5%) is much higher in correctional facilities than in the general population (1%); hepatitis B is also prevalent
• Injecting drug use and unsafe tattooing practices can occur in correctional facilities
• There is currently no formal handover system from prison health centres to external general practices

As per sexual health check guideline

• All people should have a risk assessment for sexual health and bloodborne virus infection when attending their first GP appointment after discharge from correctional facilities
• This should include questions on sexual behaviour to determine appropriate testing and management. Men who report sex with other men should have multi-site STI screening
• All women with a history of incarceration should be offered trichomoniasis testing as part of screening

• The GP should contact the prison health centre if medical records are unavailable
• Sexual assault can occur in prison, and may not be reported. Offer referral to local sexual assault services if disclosed

If test results are positive, refer to appropriate STI guideline for management advice

Even if all test results are negative, use the opportunity to:

• Educate about condom use and risk minimisation
• Vaccinate for hepatitis B, if susceptible (unfunded)
• Discuss and activate reminders for regular testing according to risk, especially if behaviours indicate the need for more frequent testing