Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01

Publications

Infectious Diseases
Prevention and Control
in Canadian Federal
Penitentiaries 2000-01

EXECUTIVE SUMMARY

The prevalence of infectious diseases among inmates of correctional facilities is higher than in the general Canadian population. High-risk behaviours practiced in the community, such as injection drug use and unprotected sexual intercourse, may also be present among many incarcerated individuals. Such behaviours place inmates at risk of bloodborne and sexually transmitted diseases.

At the end of 2001, close to 13,000 inmates were incarcerated in federal penitentiaries in Canada. Over 7,000 offenders either entered for the first time or re-entered the federal correctional system during 2001. Since most inmates eventually return to the community, the correctional system represents an optimal opportunity for effective education, prevention and treatment for infectious diseases prevention and control.

The Correctional Service of Canada (CSC) surveillance system for HIV, hepatitis B and C, and sexually transmitted diseases (STDs) forms part of a comprehensive public health approach aimed at monitoring and managing infectious diseases among inmates. The identification of both new and prevalent disease cases allows CSC to target the specific needs of inmates with regard to prevention, education, treatment and support. Early, effective intervention limits the risk of transmission and reduces the impact of disease on inmates, penitentiaries and communities.

This report presents surveillance data collected by CSC during 2000 and 2001 on reportable infectious diseases in Canadian penitentiaries. Surveillance data are based on results of non-identifying (also called non-nominal), aggregate tests and diagnoses of HIV, hepatitis C, hepatitis B and STDs reported by the 53 participating institutions (see Appendix III). Data are inclusive of inmates who have come forward for testing or who have disclosed their infection status to CSC. Federal inmates housed in provincial facilities are not included in this analysis. For gender-specific comparisons, the category for women includes only offenders housed in women's institutions.

SUMMARY OF FINDINGS

Stable rates of HIV in Canadian penitentiaries

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Compared to the proportion of reported HIV-positive inmates in federal penitentiaries in 2000, the overall rate for 2001 has remained stable. Quebec and Prairie Regions housed the largest proportion of HIV-positive inmates during the two years of surveillance.

In 2001, the number of new positive HIV test reports was highest in Prairie and Quebec Regions and lowest in Atlantic Region. However, in 2000 the greatest numbers of new HIV diagnoses were reported in Ontario and Quebec Regions. The total number of new HIV test reports decreased for all regions in 2001 from levels reported in the Correctional Service of Canada 2000.

Each year, a substantial number of offenders enter the federal correctional system with a previous diagnosis of HIV from the community. In 2001, 123 offenders with such a previous diagnosis entered the Correctional Service of Canada (CSC) at federal reception units, compared to 104 offenders in 2000. In 2001, 178 HIV-positive inmates were released from federal correctional institutions to the community, up from 162 HIV-positive inmates in 2000. At year-end 2001, 113 of 223 HIV-positive inmates (50.7%) were following a course of HIV treatment (Table 5). In 2000, 68 inmates were initiated on therapy and 116 of 214 (54.2%) HIV-positive inmates were on HIV treatment at year-end. Rates of treatment uptake varied widely by region.

HIV IN FEDERAL PRISONS

OVERALL HIV RATES
At year-end 2001, 223 (1.8%) inmates in federal penitentiaries were reported by CSC institutions to be HIV-positive, compared to 214 (1.7%) inmates at the end of 2000.

NEW POSITIVE HIV TEST REPORTS
During the same period, the number of new positive HIV test reports has decreased from 45 in 2000 to 16 in 2001, despite a small increase in the inmate population.

HIV RATES IN MEN VS. WOMEN
The HIV infection rate among women offenders (4.7% in 2001, 5.0% in 2000) was higher than among men offenders (1.7% in 2001, 1.6% in 2000) in all CSC Regions during 2000-01.

 

Hepatitis C rates high among federal inmates

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The rate of reported hepatitis C infection (includes acute and chronic infections) among inmates has increased for all CSC regions since 2000, with the largest change occurring in Pacific and Prairie Regions. The number of new positive hepatitis C test reports was also up from 2000 figures in all regions.

In 2001, 858 offenders with a previous documented diagnosis of hepatitis C entered federal correctional facilities, representing a 15% increase over the number (747) for 2000. Hepatitis C-positive inmates represented 1,506 releases to the community in 2001, compared to 1,156 inmates with the same diagnosis released in 2000.

During 2001, 123 inmates were newly initiated on HCV treatment, in comparison to 91 inmates in 2000.

HEPATITIS C IN FEDERAL PRISONS

OVERALL HCV RATES
The number of reported hepatitis C-positive inmates has increased from 2,542 cases at year-end 2000 to 2,993 cases at the end of 2001, representing 20.1% and 23.6% of the incarcerated population, respectively.

NEW POSITIVE HCV TEST REPORTS
In 2001, 562 newly identified hepatitis C cases were reported by CSC institutions, compared to 533 cases in 2000.

HCV RATES IN MEN VS. WOMEN
Reported rates of hepatitis C infection were higher among women offenders (41.2% in 2001, 42.4% in 2000) than among men offenders (23.2% in 2001, 19.7% in 2000) in all CSC Regions during 2000-01.

 

High rates of hepatitis B and bacterial STDs

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Surveillance data indicate a sharp increase in hepatitis B rates from 0.1% in 2000 to 0.3% in 2001. Most cases of chronic and acute hepatitis B were identified in men offenders during the two-year surveillance period.

Rates of the most commonly reported bacterial STDs, namely chlamydia (0.18% in 2001), gonorrhea (0.10% in 2001) and syphilis (no reported cases in 2001), remained stable over the two years.

Lack of reporting and under-diagnosis of hepatitis B and STDs are likely to result in an underestimate of the actual rates of these infections in inmates.

INFECTIOUS DISEASE TESTING RATES REMAIN LOW

Testing uptake levels for HIV and HCV indicate that up to 70% of inmates may remain unscreened for these infections. As a result, reported infection rates may severely underestimate the true burden of disease within federal correctional facilities.

Many infectious diseases are asymptomatic, so transmission can continue undetected. As in the community, there are likely many infected persons in penitentiaries who are unaware of their infection. Those at highest risk may not use health-care services and, therefore, forgo testing. Thus, creative ways are needed to promote testing and knowledge about prevention to inmates.

Future Directions

The goal of the correctional system is to rehabilitate offenders for their successful reintegration into society. The goal of inmate health care should be no different. The correctional setting may be one of the best opportunities to access high-risk individuals and provide them with preventive services, treatment and the skills necessary to stay healthy when they are no longer under the jurisdiction of the correctional system.

CSC will continue to expand its capacity for surveillance in order to better inform health programs for inmates. CSC is equally committed to improving inmate health by actively promoting screening, education, care and treatment for infectious diseases.