Assessment of the Risk of Zoonotic Infections in Prisons in French Guiana

The French Guiana Correctional Facility The French Guiana Correctional Facility (CPG) comprises a pretrial detention center characterized by a high turnover of inmates, a detention center, as well as a women's wing, a juvenile wing, and a day-release wing. The prison's theoretical capacity is 616 inmates, but chronic overcrowding is a serious problem, with the number of inmates reaching 1,050 in 2023-170% of its capacity. In 2023, the CPG recorded 1,750 inmates, including 121 women (11.5%)-more than the national average (around 4%). In total, 65% of the inmates were first-time offenders; the average age was 34, and more than half were French nationals. Approximately one-third of the inmates were serving sentences of less than 3 months.

Health care for inmates is part of a health care system that addresses all health issues, whether physical or psychiatric. The reform of the prison healthcare system entrusted the public hospital system with the responsibility for all such care. This care is governed by a methodological guide.

The CPG's Outpatient Consultation and Care Unit (UCSA) is responsible for addressing somatic issues, while the Incarceration Psychiatry Functional Unit (UFPI) handles psychological and psychiatric care. All incarcerated patients receive a routine initial medical examination (VME) within 48 hours of admission to custody, which includes a physical and psychological evaluation. One of the objectives of the VME is to detect any contagious or progressive conditions and to implement appropriate health measures. The inmate is evaluated both physically and psychologically. A clinical examination is performed. Following the consultation, specific treatment is recommended. An STI screening and a frontal chest X-ray are routinely offered, though they are not mandatory. The screening includes serology for syphilis, HIV, hepatitis B, hepatitis C, and HTLV, as well as urinary PCR tests for chlamydia and gonorrhea. The care pathway for detainees is well-structured, and they may also receive medical or paramedical consultations throughout their detention, with the wait time for a consultation depending on the level of urgency. In case of an emergency, the detainee may be transferred to the emergency medical department at the Cayenne Hospital Center. A routine annual checkup is offered.

The inmate population at the CPG is a vulnerable group facing a multitude of risk factors. Half of the prison population is French citizens originally from French Guiana. Furthermore, French Guiana is one of the French regions most affected by poverty; according to the national institute for statistics, 50% of the population lived below the poverty line in 2017. Compounding the issue of precarious living conditions are difficulties in accessing rights and healthcare. Nearly 30% of patients were undocumented prior to incarceration and were not entitled to outpatient care. Little data is available regarding educational attainment, but in 2020, 80.9% of inmates were referred by the prison administration to undergo an illiteracy assessment conducted by teachers. Precarious living conditions, low socioeconomic status, low educational attainment, and difficulties accessing healthcare and rights are recognized factors contributing to poor health. In addition to these pre-incarceration vulnerabilities, there are difficult conditions of detention, such as overcrowding exacerbated by prison overcrowding.

In terms of health and infectious disease risks, there is a high prevalence of people living with HIV (PLHIV), at 3.8% in 2021, representing approximately 3% of PLHIV under care in French Guiana in 2021. Following an analysis of tuberculosis-related risk, it was found that nearly 10% of people who reported having active tuberculosis between 2008 and 2020 in French Guiana had been incarcerated at least once.