Rates of reported HIV and HCV infections since admission to canadian federal prison and associated incarceration characteristics and drug-related risk-behaviours

Correctional Service Canada (CSC) conducted this study to obtain information about inmates' health risk-behaviours, use of health programs, and knowledge of human immunodeficiency virus (HIV) and hepatitis C virus (HCV). This report focuses on the rate of self-reported HIV and HCV infections since admission to CSC, and characteristics related to these infections. This information will help CSC to better address the health needs of inmates.

In collaboration with inmates and the Public Health Agency of Canada, CSC developed a self-administered questionnaire that asked inmates about their risk-behaviours, such as drug use and sexual activity, and use of health programs offered by CSC. A random sample of men and all women were invited to complete the questionnaire. Inmate participation was voluntary. To ensure privacy and confidentiality, an external private company administered and retained the anonymous questionnaires, and provided CSC with an anonymous database for analysis. In total, 3,370 inmates across Canada completed the questionnaire in 2007.

Among male inmates, the estimated rate of self-reported HCV infections since admission was about 16 per 1,000 person-years. Put differently, if 1,000 uninfected men were followed for one year after admission, approximately 16 or 1.6% would report an HCV infection.

None of the women inmates reported an HCV infection since admission, but this may be the consequence of a small sample followed for a short period of time rather than a true lack of risk.

Among the men, having served a longer duration of one's current sentence and injecting with a needle previously used by someone else were associated with an increased risk of reporting an HCV infection since admission.

It is estimated that 33% of HCV infections self-reported by men since admission may be attributable to injecting drugs with a needle previously used by someone else.

Privacy issues prevent presentation of results regarding self-reported HIV infections since admission because too few cases were self-reported.

This survey found that injecting with a needle previously used by someone else and a longer duration of incarceration were related to an increased risk of self-reported HCV infection since admission to CSC. Serving time does not cause an HCV infection, however, time-served may be a surrogate for magnitude of exposure (e.g., number of drug injections using someone else's used needle). Although CSC offers education, prevention and treatment programs, and harm-reduction measures, such as bleach, inmates may not access or consistently use them. Moreover, bleach use does not eliminate the risk for infection among inmates who continue to inject drugs.

Zakaria, D., Thompson, J., & Borgatta, F. (2010). Rates of Reported HIV and HCV Infections since Admission to Canadian Federal Prison and Associated Incarceration Characteristics and Drug-Related Risk-Behaviours. Research Report R-199. Ottawa: Correctional Service Canada.

To obtain a PDF version of the full report, contact the following address: research@csc-scc.gc.ca

Prepared by: Dianne Zakaria Ph.D.