HIV in Canada: A primer for service providers

 

Prison-based prevention

Key Points

  • Condoms are available in federal prisons but not in all provincial or territorial prisons.
  • Pilot needle exchange programs opened at one male and one female federal prison in 2018.
  • Programs to initiate methadone treatment for drug users upon incarceration are only available in the federal system and some provincial systems. 
  • In the remaining provinces and territories, methadone is only available if the inmate was on methadone before incarceration.

Condoms are available to inmates of Canada’s federal prisons in an attempt to prevent the sexual transmission of HIV in prisons. Correctional Services of Canada mandates that condoms, water-based lubricants and dental dams are made available discreetly to inmates in three locations within each institution and in all private family visiting units. The availability of condoms varies in provincial and territorial prisons. Some provinces have made condoms available but only through prison health services; prisoners may be reluctant to pick up or request condoms for fear of being identified as engaging in homosexual activity and thus being subject to discrimination.

In 1996, bleach was made available to clean drug-injecting equipment in the federal prison system in an attempt to prevent HIV and hepatitis C transmission among inmates who inject drugs. Bleach is available in some provincial prison systems but not all. However, rinsing needles and syringes with bleach is not an effective way to prevent HIV and hepatitis C transmission. While some studies show that bleach can kill HIV and hepatitis C in needles and syringes in a laboratory setting, this effectiveness does not translate to the real world. The World Health Organization, the Public Health Agency of Canada, and the Best Practice Recommendations for Canadian Harm Reduction Programs do not recommend the use of bleach as an HIV and hepatitis C prevention strategy. 

In 2018, Correctional Service Canada (CSC) announced it will implement a needle exchange program at one men’s and one women’s institution in June 2018. This pilot will be used to inform a full national roll-out. No provincial or territorial prison has implemented a needle exchange program.

There are some community health centres, AIDS service organizations, prisoner justice organizations, Indigenous organizations and public health institutions that run prevention programs inside prison. These are mostly education-based prevention programs.  There are also some peer health groups operated by people who are incarcerated that provide prevention education and connect people with health services.

Methadone maintenance treatment (MMT) is a form of substitution therapy for opiate use. Methadone has been proven to reduce drug injecting and sharing of drug use equipment. Only the federal system and one provincial system have formal methadone programs to start opiate users on MMT in prison. In the remaining provinces and territories, MMT is only available if the person was on MMT before incarceration.

Resource

Prison Needle and Syringe Programs: Policy Brief – Canadian HIV/AIDS Legal Network

Promoting HIV and hepatitis C prevention programming for prisoners in Canada – Canadian HIV/AIDS Legal Network

On Point:  Recommendations for prison based needle and syringe programs in Canada – Ryerson University Department of Criminology, Canadian HIV/AIDS Legal Network, Prisoners with HIV/AIDS Support Action Network (PASAN)

Hard Time: Promoting HIV and hepatitis C prevention programming for prisoners in Canada – Canadian HIV/AIDS Legal Network, PASAN

Prison Health Now

Sources

  1. Prison Needle and Syringe Programs: Policy Brief – Canadian HIV/AIDS Legal Network
  2. Promoting HIV and hepatitis C prevention programming for prisoners in Canada – Canadian HIV/AIDS Legal Network
  3. On Point:  Recommendations for prison based needle and syringe programs in Canada – Ryerson University Department of Criminology, Canadian HIV/AIDS Legal Network, Prisoners with HIV/AIDS Support Action Network (PASAN)
  4. Hard Time: Promoting HIV and hepatitis C prevention programming for prisoners in Canada – Canadian HIV/AIDS Legal Network, PASAN
  5. Prison Health Now
  6. Canadian HIV/AIDS Legal Network. HIV and hepatitis C in prisons. Toronto: Canadian HIV/AIDS Legal Network; 2008. Available from: http://www.aidslaw.ca/site/wp-content/uploads/2013/09/HIV-hepC_Prisons-ENG.pdf
  7. Canadian HIV/AIDS Legal Network. Prison Needle and Syringe Programs: Policy Brief. Toronto: Canadian HIV/AIDS Legal Network, 2012 (Updated 2017). Available from: http://www.aidslaw.ca/site/prison-needle-and-syringe-programs-policy-brief/?lang=en
  8. Jurgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet. 2009;9:57–66.
  9. Claivaz-Lorange, S, Clarke S, Ollner A, et al. On Point: Recommendations for Prison Based Needle and Syringe Programs in Canada. Toronto, 2016. Available from: http://www.aidslaw.ca/site/on-point-recommendations-for-prison-based-nee...
  10. Ryerson University Department of Criminology, Canadian HIV/AIDS Legal Clinic, Prisoner with HIV/AIDS Support Action Network (PASAN). Nearly 250 Organization Across Canada Call For Prison-Based Needle and Syringe Programs, News release, June 1st 2016. Available from: http://www.aidslaw.ca/site/nearly-250-organizations/
  11. Betteridge G, Dias G. Hard times: HIV and hepatitis C prevention programming for prisoners in Canada. Canadian HIV/AIDS Legal Network and Prisoners’ HIV/AIDS Support Action Network (PASAN), Toronto, 2007. Available from: http://library.catie.ca/PDF/P47/24875.pdf
  12. 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