Tattooing in prison represents a unique combination of risk factors for blood borne virus (BBV) transmission because it is illicitly performed by untrained operators with homemade, unsterile, and frequently-shared equipment. It occurs in a setting where a high proportion of people are already infected with hepatitis C virus (HCV) and other BBVs.

This study measured the frequency of tattoo acquisition by prisoners inside and outside prison, and the associations between tattooing, injecting drug use, and HCV infection risk.

A cross-sectional survey was conducted in correctional facilities in Victoria, Australia. Participants completed a questionnaire that asked about injecting drug use and tattooing and provided a finger-prick blood sample that was tested for HCV antibody.

Six hundred and forty-two prisoners participated in the study; 449 had ever been tattooed, of whom 182 (41%) had been tattooed in adult or juvenile prison. Of the participants who were not tattooed professionally, 27% reported someone using the same needle, and 42% reported someone had used the ink before them. Prisoners with a history of drug injection were more likely to have a tattoo and to have acquired a tattoo in prison (OR 3.0; CI 1.7-5.4). The HCV antibody-positive prisoners were more likely to have acquired a tattoo in prison compared with HCV antibody-negative prisoners.

Acquiring a tattoo in prison was common and the reports of sharing the tattooing needle and ink was high, placing prisoners at risk of acquiring HCV through tattooing in prison. Trials need to be undertaken that evaluate the risk and benefits of legal tattoos in prison.