Background In Guatemala, there is limited information on the situation of HIV in prisoners. Therefore performed the first representative Behavior Surveillance Survey (BSS) and Prevalence of HIV and syphilis conducted among inmate population in country.

Methods From September to December 2012, inmates were recruited in 6 prisons located in Guatemala City. A two-stage random cluster sampling and a face-to-face standardised questionnaire were applied. Those who met eligibility criteria and signed informed consent were selected as participants, being all of them tested for HIV and syphilis. The proportions, medians, interquartile range (IQR) and confidence intervals (CI: 95%) were obtained using STATA 11.1.

Results 605 inmates wererecruited, 87% male/13% female. The median age was 31 years (IQR 25–38). 50% had 1–5 years of imprisonment; the median was 2 years (IQR 0.8–4). Nearly 30% reported > 2 sexual partners in the last 12 months; only 23% used a condom at last intercourse. Consistent condom use in the past 30 days with regular partner, casual and business was 13%, 43%, 78% respectively. The 51% and 58%reported illicit drug use at some time- in life and in the last 30 days, 5% and 1% used injection drugs in the same periods respectively. The Index of adequate knowledge about HIV was 32%. The prevalence of HIV was 0.76% (CI 0.24–1.76) and syphilis 3.5% (CI: 2.23–5.20).

Conclusions A low HIV prevalence and syphilis among inmates in Guatemala were found. However, sexual risk behaviours and low HIV knowledge put them at risk of HIV infection. Drug use was higher than reported in other Central American BSS (< 1%). It is necessary that the state as guarantor of inmates ensures access to prevention and control of STIs and HIV, emphasising the use of condoms in all sexual relations and the use of sterile injecting equipment for intravenous drug users.