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Drug Use
Despite the sustained efforts of prison systems to prevent drug use by prisoners - by doing what they can to prevent the entry of drugs into prisons - the reality is that drugs can and do enter. A number of studies have provided evidence of the extent of injection and other drug use in prisons.

Canada
In a survey carried out by the Correctional Service of Canada (CSC) in 1995, 40 percent of 4285 federal prisoners self-reported having used drugs since arriving at their current institution. Injection drug use is also prevalent, and the scarcity of needles often leads to needle sharing. Members of the Expert Committee on AIDS and Prisons were told by prisoners that injection drug use and needle sharing are frequent and that sometimes 15 to 20 people will use one needle. Many staff also acknowledge that drug use is a reality, admitting that “drugs are part of prison culture and reality” and that “there does not seem to be a way to ensure that there will be no use of drugs.”

Such anecdotal evidence of the prevalence of injection drug use is confirmed by many studies :

In a study released in 2004, 76 percent of 1,475 injection drug users enrolled into the Vancouver Injection Drug Users Study reported a history of incarceration since they first began injecting drugs. Of these, 31 percent reported injecting in prison.
In a 2003 study of federally incarcerated women, 19 percent reported injection drug use in prison.
In a 1998 study, 24.3 percent of prisoners at Joyceville Penitentiary in Kingston, Ontario reported using injection drugs in prison, compared to 12 percent in a similar study at the same prison in 1995.
In a study among incarcerated men and women in provincial prisons in Montréal, 73.3 percent of men and 15 percent of women reported drug use while incarcerated. Of these, 6.2 percent of men and 1.5 percent of women injected drugs.
In a study among prisoners of a provincial prison in Québec City, twelve of 499 admitted injecting drugs during imprisonment, of whom 11 shared needles and three were HIV- positive.
In CSC’s 1995 inmate survey, 11 percent of 4285 federal prisoners reported having injected since arriving in their current institution. Injection drug use was particularly high in the Pacific Region, with 23 percent reporting injection drug use.
Worldwide
Many other countries report high rates of injection drug use behind bars. Typically, injection drug use decreases in prisons among prisoners who were users on the outside. However, prisoners are more likely to inject in an unsafe manner when they do inject, and a significant number of people start injecting while in prison. Studies have therefore concluded that imprisonment increases the risk of contracting HIV infection. The following are data from some recent studies :

A 2002 report prepared for the European Union found that between 0.3 and 34 percent of prisoners in the European Union and Norway injected while incarcerated ; that between 0.4 and 21 percent of injection drug users started injecting in prison, and that a high proportion of injection drug users in prison share injection equipment.
In Russia, a study among 1,087 prisoners found that 43 percent had injected a drug ever in their lives, and that 20 percent had injected while incarcerated. Of these, 64 percent used injection equipment that had already been used by somebody else, and 13.5 percent started injecting in prison.
In Mexico, a study in two jails found rates of IDU of 37 percent and 24 percent respectively.
Sexual Activity
In prisons, sexual activity is considered to be a less significant risk factor for HIV and hepatitis C transmission than sharing of injection equipment. Nevertheless, it does occur and puts prisoners at risk of contracting HIV infection.

Homosexual activity occurs inside prisons, as it does outside, as a consequence of sexual orientation. In addition, prison life produces conditions that encourage homosexual activity and the establishment of homosexual relationships between prisoners who do not identify themselves as homosexuals. The prevalence of sexual activity in prison is based on such factors as whether the accommodation is single-cell or dormitory, the duration of the sentence, the security classification, and the extent to which conjugal visits are permitted. Studies of sexual contact in prison have shown “inmate involvement to vary greatly.” In a study in state prisons and city jails in New York, prisoners reported frequent instances of unprotected sex behind bars. One woman summarized the prevalence and range of sexual activity :

Male CO’s [correctional officers] are having sex with females. Female CO’s are having sex with female inmates, and the male inmates are having sex with male inmates. Male inmates are having sex with female inmates. In a survey conducted among 1100 male prisoners in Russia, only 10 to 15 percent of the prisoners reported having had no sexual contacts while serving their term. Non-consensual sexual activity was prevalent.

In Canada, according to CSC’s 1995 survey, six percent of federal prisoners reported having had sex with another prisoner. This is consistent with the results of studies in provincial prisons. More recently, in a 2002 study of federal women prisoners, 37 percent reported being sexually active in prison.

Tattooing
In prison, tattooing is a social activity and involves sharing needles, which makes it risky. In Canada, 45 percent of federal prisoners reported having had a tattoo done in prison. In 2004, the Correctional Service of Canada announced that it will conduct a pilot “safer tattooing practices initiative.”

Additional Reading
R Lines et al. Prison Needle Exchange : A Review of International Evidence and Experience. Montreal : Canadian HIV/AIDS Legal Network, 2004. Contains an overview of research on injection drug use in prison. Available at www.aidslaw.ca/Maincontent/issues/prisons.htm

A DiCenso, G Dias, J Gahagan. Unlocking Our Futures : A National Study on Women, Prisons, HIV, and Hepatitis C. Toronto : PASAN, 2003. Contains info on risk behaviours among federally incarcerated women in Canada. Available at www.pasan.org .

Correctional Service Canada. 1995 National Inmate Survey : Final Report. Ottawa : The Service (Correctional Research and Development), 1996, No SR-02. The results of CSC’s 1995 inmate survey. Available at www.csc-scc.gc.ca .

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 : aidssida@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 position of Health Canada.

© Canadian HIV/AIDS Legal Network, 2004.