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HIV Seroprevalence in Prisons

Canadian federal prisons
In Canada’s federal prison system (which houses people sentenced to prison terms of two years or more), the number of reported cases of HIV/AIDS rose from 14 in January 1989 to 159 in March 1996 to 251 in 2002 (data for 2002 are preliminary). This means that 2.01 percent of all federal prisoners are known to be HIV-positive. The actual numbers may be even higher : the reported cases, provided by the Correctional Service of Canada (CSC), include only cases of HIV infection and AIDS known to CSC, but many prisoners may not have disclosed their HIV status to CSC, or may not know themselves that they are HIV-positive.

Canadian provincial prisons
In provincial prisons (which house people sentenced to prison terms of less than two years), rates of HIV infection are also high. Studies undertaken in prisons in British Columbia, Ontario, and Québec have all shown that HIV seroprevalence rates in prisons are over 10 times higher than in the general population, ranging from 1.0 to 8.8 percent. For example :

A study released in 2004 of 1,617 prisoners in 7 provincial institutions in Québec found an HIV seroprevalence rate of 2.3 percent among men and 8.8 percent among women.
A 1993 study carried out among over 12,000 people entering Ontario prisons found HIV seroprevalence rates of 1.0 percent among adult men and 1.2 percent among adult women.
As in federal prisons, the number of prisoners living with HIV or AIDS in provincial prisons is on the rise. For example :

In British Columbia, a study conducted in all adult BC provincial prisons in 1993 found an HIV seroprevalence rate of 1.1 percent. The study has not been repeated, but in 1996 a review of known cases alone revealed rates ranging from two to 20 percent in various prisons.
Worldwide
As in Canada, rates of HIV-infection in prison populations worldwide are much higher than in the general population. They are, in general, closely related to two factors : the proportion of prisoners who injected drugs prior to imprisonment, and the rate of HIV infection among injection drug users in the community.

Many of those who are HIV-positive in prison were already living with the virus on the outside. Indeed, the highest rates of HIV infection in prisons can be found in areas where rates of HIV infection are high among injection drug users in the community. Commenting on the situation in the United States, the US National Commission on AIDS stated that “by choosing mass imprisonment as the ... governments’ response to the use of drugs, we have created a de facto policy of incarcerating more and more individuals with HIV infection.”

HIV infection rates are high in many prison systems. In Western Europe, particularly high rates have been reported in Portuguese (20 percent) and Spanish prisons (16.6 percent). Rates are also high in countries such as Switzerland (4 to 12 percent) and Italy (7 percent). In Eastern Europe, 7 percent of Ukrainian prisoners and 15 percent of Lithuania prisoners are HIV-positive. Forty-one percent of South African prisoners are reported to be HIV positive. In Latin America, high rates of HIV infection have been found in Brazil (10.9 - 21.5 percent) and Honduras (7 percent).

In contrast, relatively low rates of HIV prevalence have been reported from Australia. In the United States, the geographic distribution of cases of HIV infection and AIDS is remarkably uneven. Many systems continue to have rates under one percent, while in a few rates approach 10 percent among men and 15 percent among women.

Hepatitis C Seroprevalence
Canada
Hepatitis C (HCV) prevalence rates in prisons are even higher than HIV prevalence rates. Studies undertaken in the early and mid 1990s in Canadian prisons revealed rates of between 28 and 40 percent.

Rates continue to rise. In one federal prison, 33 percent of study participants tested positive in 1998, compared with 27.9 percent in 1995. In 2002, 3,173 federal prisoners were known to be HCV positive : 25.2 percent of male and 33.7 percent of female prisoners.

Worldwide
A review of prevalence and incidence in incarcerated populations worldwide found HCV seroprevalence rates ranging from 4.8 percent in an Indian jail to 92 percent in two prisons in Northern Spain.

Potential for further spread
Most HCV-positive prisoners come to prison already infected, but the potential for further spread is high. HCV is much more easily transmitted than HIV, and transmission has been documented in prisons in several countries, including Canada.

Additional Reading
Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01. A Report of the Correctional Service of Canada’s Infectious Diseases Surveillance System, Ottawa, CSC, 2003. Available at www.csc-scc.gc.ca/text/pblct/infectiousdiseases/index_e.shtml

GE Macalino et al. Hepatitis C infection and incarcerated populations. International Journal of Drug Policy 2004 ; 15 : 103-114. A review of prevalence and incidence of HCV in prisons worldwide.

R Elliott. Prisoners’ Constitutional Right to Sterile Needles and Bleach. Appendix 2 of R Jürgens. HIV/AIDS in Prisons : Final Report. Montréal : Canadian HIV/AIDS Legal Network & Canadian AIDS Society, 1996, at 3-4. Provides a summary of early Canadian seroprevalence studies in prisons. Available at www.aidslaw.ca/Maincontent/issues/prisons/APP2.html.

C Hankins et al. HIV-1 infection in a medium security prison for women - Quebec. Canada Diseases Weekly Report 1989 ; 15(33) : 168-170. The first HIV seroprevalence study in a Canadian prison.

S Landry et al. Étude de prévalence du VIH et du VHC chez les personnes incarcérées au Québec et pistes pour l’intervention. Canadian Journal of Infectious Diseases 2004 ; 15 (Suppl A) : 50A (abstract 306). The most recent Canadian study.

Third, revised and updated version, 2004. Copies of this info sheet are available on the Network website at http://www.aidslaw.ca/Maincontent/issues/prisons.htm and through the Canadian HIV/AIDS Information Centre (email : aids/sida@cpha.ca). Reproduction of the info sheet is encouraged, but copies may not be sold, and the Canadian HIV/AIDS Legal Network must be cited as the source of this information. For further information, contact the Network (tel : 514 397-6828 ; fax : 514 397-8570 ; email : info@aidslaw.ca). Ce feuillet d’information est également disponible en français.

Funded by Health Canada under the Canadian Strategy on HIV/AIDS. The findings, interpretations, and views expressed in this publication are entirely those of the author and do not necessarily reflect the official policy or positions of Health Canada.

© Canadian HIV/AIDS Legal Network, 2004.