HIV in Canada: A primer for service providers

Canadian prisoners

Key Points

  • HIV prevalence in federal and provincial prisons is estimated at 1% to 8%.
  • HIV among prisoners is associated with injection drug use.
  • In May 2018, Correctional Service Canada announced it will begin to open needle exchange programs within federal prisons starting in June.

According to a national survey by Correctional Service Canada (CSC) conducted in 2007, prisoners entering federal penitentiaries report high rates 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.

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.

Tattooing and body piercing in prison also place people at risk of transmission; roughly 38% of federal prisoners reported having been tattooed in federal prison and 13% reported having had body piercing performed.

Among federal prisoners who had ever been tested for HIV, 4.6% reported they were HIV positive (2007). Females were more likely to report being HIV positive than males (7.9% vs. 4.5%). Indigenous 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 data released in 2016 by the CSC, the estimated prevalence of HIV was 1.76% among federal inmates between 2005 and 2012. Among males the estimated prevalence was 1.65% and among females it was 3.35%. Indigenous ancestry further increased the likelihood of having HIV. Among Indigenous females the rate of HIV was 6.03% compared to non-Indigenous females at 2.16%. Among Indigenous males, the rate of HIV was 2.27% compared to non-indigenous males at 1.47%.

According to data released in 2018 by the CSC, the prevalence of HIV declined from 2.02% in 2007 to 1.2% in 2017.

In the general 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.

In May 2018, CSC announced it will implement a needle exchange program at one men's and one women's federal institution in June of 2018 to help reduce the risk of HIV and hepatitis C within federal prisons. These will be the first to open, with the intention to implement needle exchange programs across CSC institutions. From 2016-2017, CSC estimates that 96% of newly admitted inmates accepted a voluntary blood test for HIV; 94% of inmates known to have HIV were on treatment; and 91% had viral suppression.

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

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.

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).

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

Correctional Service Canada. Health Services Quick Facts: Human Immunodeficiency Virus (HIV) Age, Gender and Indigenous Ancestry. September 2016. Available from: http://www.csc-scc.gc.ca/publications/005007-3034-eng.shtml

Correctional Service Canada. Backgrounder: Correctional Service Canada Prison Needle Exchange Program. Available from: https://www.canada.ca/en/correctional-service/news/2018/05/backgrounder-correctional-service-canada-prison-needle-exchange-program.html

Canadian HIV/AIDS Legal Network. Statement: Advocates welcome major concessions in Government of Canada’s prison needle exchange announcement. Available from: http://www.aidslaw.ca/site/advocates-welcome-major-concessions-in-government-of-canadas-prison-needle-exchange-announcement/?lang=en