HIV in Canada: A primer for service providers

Canadian prisoners

Key Points

  • HIV prevalence in federal and provincial prisons is estimated at 2% to 8%.
  • HIV among prisoners is associated with injection drug use.

According to a national survey by Correctional Service Canada, prisoners entering federal penitentiaries report a high rate of risky drug and sexual behaviours during their last months before incarceration. In terms of injection drug use, 8% of males and 15% of females reported sharing injecting equipment in the six months prior to incarceration. In terms of sexual activities, 70% of men and 70% of women reported condomless sex with a regular partner in the six months prior to incarceration and 33% of males and 27% of females reported condomless sex with casual partners in the six months prior to incarceration.

According to a national survey by Correctional Service Canada, risky behaviour continued during incarceration but at a lower rate. In terms of injection drug use, 7% of males and 5% of females reported sharing injecting equipment in the past six months while incarcerated. In terms of sexual activities, 5% of men and 18% of women reported condomless sex with a regular partner in the past six months while incarcerated and 2% of males and 11% of females reported condomless sex with casual partners in the past six months while incarcerated.

According to a national survey by Correctional Service Canada, tattooing and body piercing in prison also place people at risk of transmission; roughly 38% of respondents to the survey reported having been tattooed in federal prison and 13% reported having had body piercing performed.

According to a national survey by Correctional Service Canada, among prisoners who had ever been tested for HIV, 4.6% reported they were HIV positive. Females were more likely to report being HIV positive than males (7.9% vs. 4.5%). Aboriginal females were a particularly high-risk group as they reported the highest rates of HIV, at 11.7%. Prisoners may become infected with HIV before or after they enter prisons. HIV infection in Canadian prisons is strongly associated with injection drug use.

According to a qualitative study conducted with former prisoners of federal institutions in Ontario, drugs are more readily available inside the prison than in the community. However, access to injection equipment was extremely limited. Needles were acquired through several routes including getting them from people with insulin-dependent diabetes and stealing them from the healthcare staff. Injection equipment was also made by the prisoners with available items such as pens. Sharing of drug use equipment was reported as very common.

In the research literature, estimates of the HIV prevalence rate in Canadian federal and provincial prisons range from 2% to 8%. These estimates are at least 10 times higher than the reported prevalence in the Canadian population.

Resources

On Point: Recommendations for Prison-Based Needle and Syringe Programs in Canada – Canadian HIV/AIDS Legal Network, Prisoners' HIV/AIDS Support Action Network (PASAN), Ryerson University

HIV prevention, treatment and care in prisons and other closed settings: A comprehensive package of interventions – World Health Organization

Prison Health NOWCanadian HIV/AIDS Legal Network

Sources

  1. Canadian HIV/AIDS Legal Network. Clean switch: the Case for prison needle and syringe programs in Canada. Toronto: Canadian HIV/AIDS Legal Network; 2009. Available from: http://www.aidslaw.ca/site/wp-content/uploads/2013/04/CleanSwitch_142-EN.pdf.
  2. Smith JM. Screening for HIV among new admissions to CSC: Pilot data results. Focus on Infectious Diseases (Newsletter of the National Infectious Disease Program, CSC). 2006;1(2).
  3. Zakaria D, Thompson JM, Jarvis A, et al. Summary of emerging findings from the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey. Ottawa: Correctional Service of Canada; March 2010. Available from: http://publications.gc.ca/collections/collection_2010/scc-csc/PS83-3-211-eng.pdf
  4. van der Meulen A. “It goes on everywhere”: Injection Drug Use in Federal Prisons. Substance Use and Misuse. 2017 Sept;52(7):884-891.