Characterisation of a syndemic of STI symptoms, substance use and violence among incarcerated Peruvian women.

Objectives: Despite parallel global trends of increasing incarceration rates and sexually transmitted infections (STIs) among women, STI epidemiological data for this vulnerable at-risk population are limited. The study objective was to characterise patterns of STI symptoms and explore covariates and drivers of indicating STI symptoms using syndemic theory among a population of incarcerated women in Peru.

Methods: In a cross-sectional study, a sample of 249 incarcerated women responded to a questionnaire on substance use, depression, sexual behaviour, STI symptoms and violence, among other variables, between May and July 2015 in Santa Manica Prison (Lima, Peru). Univariate and bivariate analyses informed a latent profile analysis (LPA) and logistic regression.

Results: Most women (93.5%) were Peruvian; 86.6% had prison sentences <5 years; the median age was 37 years (range 18-70 years); 2.6% were pregnant, 7.2% had children residing with them in prison; most women (78.7%) had a high school degree; >1/3 of the sample had ≥2 STI symptoms. The LPA analysis revealed that 39% of the sample had a 'syndemic' profile (co-occurrence of multiple STI symptoms, experiences of violence and substance use). Approximately 87% of women who were characterised by the syndemic profile were <50 years of age. The 'syndemic' profile was associated with double the prevalence of having multiple STI symptoms (≥2 symptoms: Prevalence Ratio (PR)=1.88 (95% CI 1.18, 2.99); ≥3 symptoms: PR=2.55 (95% CI 1.32, 4.93)).

Conclusions: To address this syndemic, younger incarcerated women presenting with co-occurring STI symptoms (>2) can be clinically screened for diagnosis and treatment and assessed for substance use and risk of violence. Further research in this area may help stem and prevent deleterious health outcomes, including STIs, abuse and substance misuse, that can impact the individual and families.