{"id":543676,"date":"2025-03-20T18:29:20","date_gmt":"2025-03-20T21:29:20","guid":{"rendered":"https:\/\/revistapesquisa.fapesp.br\/?p=543676"},"modified":"2025-03-20T18:39:21","modified_gmt":"2025-03-20T21:39:21","slug":"brazilian-prisons-increase-risk-of-illness-and-violent-death","status":"publish","type":"post","link":"https:\/\/revistapesquisa.fapesp.br\/en\/brazilian-prisons-increase-risk-of-illness-and-violent-death\/","title":{"rendered":"Brazilian prisons increase risk of illness and violent death"},"content":{"rendered":"

With one of the highest incarceration rates in the world, Brazil\u2019s prison system has become a cauldron of disease and death. Inmates face a risk of contracting and dying from infectious diseases \u2014 especially tuberculosis \u2014 two to seven times higher than same-aged people outside. They are also two to six times more likely to die in violent altercations or to \u2014 reportedly, at least \u2014 take their own lives, particularly if they are young. These heightened risks don’t end with their release. Even after discharge, former inmates continue to face increased risks of disease and death for years before they finally align with those of the general population, with certain unique patterns. For instance, the rate of deaths due to assault and homicide remains exceptionally high after release, unlike in wealthier nations such as Australia, Sweden, or the US, where former inmates are more likely to die from alcohol poisoning or drug overdoses, according to a study published in The Lancet<\/em> in April.<\/p>\n

This grim reality, while not surprising, has been increasingly elucidated in recent years by multiple studies on the lives and deaths of Brazilian inmates, led by a multidisciplinary team of doctors, nurses, psychologists, anthropologists, historians, and sociologists. Much of what we know today stems from studies initiated over the past decade by teams like those of infectious disease experts Julio Croda, of the Federal University of Mato Grosso do Sul (UFMS) and the Oswaldo Cruz Foundation (FIOCRUZ), and Jason Andrews, of Stanford University, who have extensively documented the frequency and spread of infectious diseases in Brazilian prisons, along with the causes of inmate deaths both inside and outside these institutions. Further insights have come from studies led by public health physician Ligia Kerr of the Federal University of Cear\u00e1 (UFC), who started research on the physical and mental health of female inmates in 2014<\/a>, along with sociologist Maria Cec\u00edlia de Souza Minayo and psychologist Patricia Constantino of the National Public Health School (ENSP) at FIOCRUZ, who recently conducted a study on the living and health conditions of elderly prisoners in Rio de Janeiro\u2019s penitentiaries.<\/p>\n

Their research shows that, much like in other countries, Brazil\u2019s prison system falls short of fulfilling its legal obligations to individuals placed under state custody. Rather than providing suitable facilities for serving sentences, along with access to healthcare and education aimed at \u201cpromoting the social reintegration of those convicted and imprisoned,\u201d as mandated by the 1984 Penal Enforcement Act (Law no. 7,210), Brazil\u2019s correctional facilities instead worsen the health of inmates. \u201cWhile Brazil does not have the death penalty, a prison sentence here can be tantamount to a death sentence,\u201d says C\u00edntia Rangel Assump\u00e7\u00e3o, a federal penal enforcement officer and the general coordinator of civics and penal alternatives at the National Office for Penal Policy (SENAPPEN), an agency under the Ministry of Justice and Public Security. \u201cThis outcome is tied to our societal view that punishment is a form of revenge.\u201d<\/p>\n

See more:<\/strong>
\n– Female prisoners have poorer health than the general population and are often abandoned by their families<\/a>
\n– Elderly population in Brazilian prisons has increased more than ninefold in 18 years<\/a>
\n– Most crimes committed by men over 60 involve sexual assault<\/a><\/div>\n

Some experts argue that the prison system intensifies societal problems by concentrating socially marginalized people with limited access to economic, educational, and healthcare resources. According to SISDEPEN, a data collection tool used by the Brazilian Penitentiary System, and the latest \u201cPenal Information Report,\u201d 642,491 men and women were incarcerated in Brazil during the second half of 2023. Of these, nearly 66% were Black or mixed-race; 60% were between 18 and 34 years old; and 59% had not completed primary education. \u201cGenerally speaking, these are people without professional skills, who had very few opportunities to enter the job market,\u201d Assump\u00e7\u00e3o notes.<\/p>\n

Overcrowded and poorly ventilated cells, poor diets, and limited access to medical care all contribute to making prisons what Croda, Andrews, and epidemiologist Yiran Liu \u2014 who has researched the health impacts of incarceration during her doctoral studies at Stanford \u2014 described in a February article in the Journal of Infectious Diseases<\/em> as \u201cinstitutional amplifiers\u201d of pathogen spread. \u201cOutbreaks of tuberculosis, cholera, measles, mumps, varicella, influenza and SARS-CoV-2 spread with devastating speed through prisons, jails, and immigration detention facilities,\u201d the researchers wrote.<\/p>\n

\u201cPrisons are not adequately equipped for healthcare,\u201d says Dr. Drauzio Varella, a pioneer in treating HIV patients within the prison system. Since 1989, he has volunteered to treat inmates in S\u00e3o Paulo\u2019s prisons, and from his experience, he says that little has changed. \u201cThe health conditions I encounter today are often the same as 30 years ago in S\u00e3o Paulo\u2019s penitentiaries,\u201d says the physician, who now works at the Ch\u00e1cara Bel\u00e9m Temporary Detention Center in Belenzinho, S\u00e3o Paulo. \u201cConditions tend to be worse in men\u2019s prisons. Cells often have 5 to 10 more inmates than beds, leaving some to sleep on the floor. In detention centers, there are no on-site medical teams. The state may open positions, but doctors rarely apply. Salaries are low, and the environment is tense.\u201d<\/p>\n

Croda and Andrews have conducted seminal research on the prevalence of major infections affecting Brazilian inmates. In the early 2010s, they and their collaborators started systematically tracking serious communicable diseases in prisons in Mato Grosso do Sul, one of the states with the highest incarceration rates in the country \u2014 around 650 prisoners per 100,000 people, double the national average (320 per 100,000).<\/p>\n

\"\"Aline van Langendonck<\/span><\/p>\n

The researchers analyzed blood samples collected between March 2013 and March 2014 from 3,600 inmates (85% men and 15% women) in 12 prisons across Mato Grosso do Sul. They found that, on average, 1.6% of inmates had contracted HIV \u2014 the virus that causes AIDS, an infection linked to risky behaviors such as unprotected sex, unsafe tattoo practices, or needle sharing \u2014 either before or during incarceration. This rate, reported in a 2015 article in PLOS ONE<\/em>, is roughly four times higher than that of the general population in Brazil. Earlier national studies had identified higher rates, but these were usually limited to a single prison and conducted in the previous decade.<\/p>\n

Another virus more prevalent among inmates than the never incarcerated population is hepatitis C (HCV), according to a 2017 study also published in PLOS ONE<\/em>. Transmitted through contact with infected blood \u2014 via shared needles, personal items, surgeries, and blood transfusions \u2014 HCV causes silent inflammation in the liver, which can progress to cirrhosis or cancer. In the group monitored by Croda and his team across the 12 prisons, 2.4% had HCV, nearly double the rate found in the general population.<\/p>\n

Syphilis was also more common among inmates, according to 2017 data published in The American Journal of Tropical Medicine and Hygiene<\/em>. This sexually transmitted disease, caused by the bacterium Treponema pallidum<\/em>, infected 9% of male and 17% of female inmates at some point in their lives, with 2% of men and 9% of women testing positive for the active form of the disease during the study.<\/p>\n

The most alarming data pertained to tuberculosis, the deadliest infectious disease worldwide, claiming 1.5 million lives annually. In three rounds of testing conducted between 2017 and 2021, Croda and Andrews\u2019s teams found tuberculosis prevalence rates that, in extreme cases \u2014 such as those reported in February this year in Clinical Infectious Diseases <\/em>\u2014 reached 4,034 per 100,000 inmates, or 4%. This figure is 100 times higher than the prevalence of 40 per 100,000 found in the non-incarcerated population.<\/p>\n

Throughout their extensive study on tuberculosis (TB), the researchers found that a small proportion of inmates (less than 10%) were already infected with TB upon admission, often asymptomatically. They also observed that after one year of incarceration, one in four people who had never contracted TB tested positive for the bacillus.<\/p>\n<\/div>

\n \n \n \n <\/picture>Alexandre Affonso \/ Revista Pesquisa FAPESP<\/span><\/div>
\n

Analyzing TB progression from 2007 to 2013 across Mato Grosso do Sul\u2019s prison population, Dr. Tarub Mabud from the Stanford team found that the rate of newly reported cases among recently incarcerated individuals was 111 per 100,000 people. Among those incarcerated for 5.2 years, the rate was nearly 12 times higher. Projections published by the group in 2019 in PLOS Medicine<\/em> suggest that the rate remains significantly elevated among these individuals even long after their release from prison. \u201cIt takes seven years for the rate of new TB cases among former inmates to match that of the general population,\u201d says Everton Lemos, a nursing professor at the State University of Mato Grosso do Sul (UEMS) and a coauthor of the study.<\/p>\n

The researchers were already aware that the high TB rates in prisons pose a threat not just to inmates but to the wider community. In 2013, pharmaceutical engineer Fl\u00e1via Patussi Sacchi compared the genetic characteristics of bacilli isolated from 240 TB cases (60 in inmates or former inmates and 180 in community members) recorded between 2009 and 2013 in Dourados, Mato Grosso do Sul. In 54% of cases, the M. tuberculosis<\/em> strains found in those who had never been incarcerated were genetically similar to those of inmates and former inmates, as reported in her article published in Emerging Infectious Diseases<\/em>.<\/p>\n

More recently, Katharine Walter, an epidemiologist with the Stanford team, genome-sequenced 935 M. tuberculosis<\/em> isolates from cases that occurred between 2014 and 2019 in the cities of Dourados and Campo Grande, the state capital of Mato Grosso do Sul. Half of these samples were obtained from inmates, 16% from former inmates, and 34% from people with no history of incarceration. Once again, the genetic similarity between the strains was high, indicating recent transmission, according to a 2022 article in The Lancet Global Health \u2013 Americas<\/em>. By intersecting genome data with prisoner movement records, the researchers identified 18 likely episodes of transmission from prisons to the broader community.<\/p>\n

\u201cInmate transfers between prisons, reentry into society, and interactions with family members and prison staff facilitate the spread of tuberculosis to the broader community,\u201d explains Croda. \u201cWe will never solve the tuberculosis problem in this country \u2014 one of the world\u2019s hardest-hit \u2014 without providing adequate care to the incarcerated population.\u201d<\/p>\n

Over the past two decades, tuberculosis prevalence has doubled in South American prisons. Doctors and other experts primarily attribute this increase to the rise in incarceration and subsequent overcrowding. Since 2000, Brazil\u2019s prison population has nearly quadrupled, making it the third largest in the world. As of the end of 2023, the prison population had reached nearly 844,000 individuals, with approximately 200,000 under house arrest (with or without electronic monitoring) and just over 642,000 held in 1,388 prisons with a capacity for only 480,000.<\/p>\n

Andrews identifies two potential approaches to address Brazil\u2019s dire situation: one biomedical and the other judicial. On the biomedical side, he underscores the need for greater investment in resources for diagnostics, prevention, and treatment services, as well as measures to reduce the risk of infectious diseases, such as improving natural ventilation, increasing sun exposure, or employing ultraviolet radiation for sanitation. Judicially, the solution lies in seeking alternatives to incarceration for nonviolent crimes. \u201cIn Brazil, prisons often serve as major recruitment grounds for organized crime. Increasing incarceration in this context doesn\u2019t enhance security and only worsens health conditions due to overcrowding.\u201d<\/p>\n

In researching the frequency and patterns of infectious diseases in prisons, Croda and Andrews found that the causes of death among inmates differ starkly from those in the general population. With support from the state government, they obtained data on 114,700 individuals who were incarcerated at some point between 2009 and 2018 in Mato Grosso do Sul. During this period, 3,127 deaths were recorded, 705 of which occurred during incarceration and 2,422 after release. By analyzing this data and intersecting it with information on inmates\u2019 gender, age, and incarceration dates, researcher Yiran Liu found a disproportionate number of deaths due to violence and suicide, in addition to deaths from infectious diseases.<\/p>\n

Incarceration increases the risk of death from any cause by 30%. But the likelihood of dying from assault or suicide is twice as high as in the general population \u2014 these causes accounted for up to 33% and 8% of male deaths in prison, respectively. This risk is even higher among younger individuals: in juvenile detention centers, it is 19 times higher than in the general population. \u201cIf prisons were effectively secure, we would expect to see lower rates of violent deaths during incarceration and after release,\u201d says Liu, the lead author of a 2022 PLOS Medicine<\/em> article presenting these findings. This research served as the basis for the Lancet<\/em> study mentioned earlier in this article. \u201cWe believe that the findings in Mato Grosso do Sul reflect what is happening across the rest of the country,\u201d reports Croda.<\/p>\n

In 2023, professors Maira Machado of the Funda\u00e7\u00e3o Getulio Vargas (FGV) law program in S\u00e3o Paulo and Nat\u00e1lia Vasconcelos of INSPER assembled a research team to investigate the causes of death among Brazilian inmates. They analyzed 1,168 cases from all Brazilian states that had been closed between 2017 and 2021 due to the death of the convict. Of these, 10% occurred during incarceration, while the remainder occurred on average 1.5 years after release.<\/p>\n

These deaths were classified into three broad categories: natural, accidental, and violent. However, upon reviewing the cases, the researchers noticed that these distinctions were not always clear-cut, and often there was little effort to thoroughly investigate the cause. \u201cThis classification of deaths obscures boundaries. Some natural deaths are, to some extent, caused by the system itself, while many violent deaths are normalized, as if conflicts between criminal factions and the failures of the prison system were inevitable or beyond prevention,\u201d says Rafael Godoi, a professor of sociology at the State University of Maranh\u00e3o (UEMA), one of the study\u2019s authors. The study was reported in an article titled \u201cLetalidade prisional, uma quest\u00e3o de justi\u00e7a e de sa\u00fade p\u00fablica\u201d (Prison lethality: A matter of justice and public health).<\/p>\n

The story above was published with the title “Surviving in prison<\/strong>” in issue 342 of august\/2024.<\/p>\n

Project
\n<\/strong>Flow of the chains:<\/em> Prisons in S\u00e3o Paulo over time<\/em> (n\u00ba 11\/09590-0<\/a>); Grant Mechanism<\/strong> Doctoral (PhD) Fellowship; Supervisor<\/strong> Vera da Silva Telles (USP); Beneficiary<\/strong> Rafael Godoi; Investment<\/strong> R$151,996.94.<\/p>\n

Scientific articles<\/strong>
\nBORSCHMANN, R. et al<\/em>. Rates and causes of death after release from incarceration among 1 471 526 people in eight high-income and middle-income countries: An individual participant data meta-analysis<\/a>. The<\/strong> Lancet<\/strong>. May 4, 2024.
\nANDREWS, J. R. et al<\/em>. Enduring injustice: Infectious disease outbreaks in carceral settings<\/a>. Journal of Infectious Diseases. <\/strong>Feb. 15, 2024.
\nSGARBI. R. V. E. et al<\/em>. A cross-sectional survey of HIV testing and prevalence in twelve Brazilian correctional facilities<\/a>. PLOS ONE<\/strong>. Oct. 14, 2015.
\nPUGA, M. A. M. et al<\/em>. Prevalence and incidence of HCV infection among prisoners in Central Brazil<\/a>. PLOS ONE<\/strong>. Jan. 6, 2017.
\nCORREA, M. E. et al<\/em>. High prevalence of\u00a0Treponema pallidum<\/em>\u00a0infection in Brazilian prisoners<\/a>. The American Journal of Tropical Medicine and Hygiene<\/strong>. Oct. 2017.
\nPIVETTA DE ARA\u00daJO, R. et al<\/em>. Serial mass screening for tuberculosis among incarcerated persons in Brazil<\/a>. Clinical Infectious Diseases<\/strong>. Feb. 7, 2024.
\nMABUD, T. et al<\/em>. Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil<\/a>. PLOS Medicine<\/strong>. Jan. 24, 2019.
\nSACCHI, F. P. et al<\/em>. Prisons as reservoir for community transmission of tuberculosis, Brazil<\/a>. Emerging Infectious Diseases<\/strong>. Mar. 2015.
\nWALTER, K. et al<\/em>. The role of prisons in disseminating tuberculosis in Brazil: A genomic epidemiology study<\/a>. The Lancet Regional Health – Americas<\/strong>. May 2022.
\nLIU, Y. et al<\/em>. All-cause and cause-specific mortality during and following incarceration in Brazil: A retrospective cohort study<\/a>. PLOS Medicine<\/strong>. Sept. 17, 2021.<\/p>\n","protected":false},"excerpt":{"rendered":"Prisoners are two to seven times more likely to contract infectious diseases than the general population and two to six times more likely to lose their lives to violence","protected":false},"author":16,"featured_media":543678,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[156,165,159],"tags":[260,256,261],"coauthors":[105],"class_list":["post-543676","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cover","category-humanities","category-science","tag-public-health","tag-public-policies","tag-sociology"],"acf":[],"_links":{"self":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/543676","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/comments?post=543676"}],"version-history":[{"count":7,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/543676\/revisions"}],"predecessor-version":[{"id":547485,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/543676\/revisions\/547485"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media\/543678"}],"wp:attachment":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media?parent=543676"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/categories?post=543676"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/tags?post=543676"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/coauthors?post=543676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}