Let's Talk

Addressing Infectious Disease Issues for Aboriginal Offenders

Enhanced capacities to provide effective interventions for First Nations, Métis and Inuit Offenders

INFORMATION PROVIDED BY Health Services, Correctional Operations and Programs, Correctional Service of Canada

Rates of blood-borne and sexually transmitted infections in prison populations the world over are much higher than in the outside population and, generally, are dependent on various factors including intravenous drug use, the rates of infection among intravenous drug users in the community, high risk sexual behaviour and sharing unsterilized tattoo equipment.

In the Canadian federal correctional system, the number of reported cases of HIV/ AIDS at year end 2004 was 188, an overall prevalence of 1.43 percent. In the same year, a total of 3,303 federal inmates were known to test positive for hepatitis C, or 25.2 percent (24.8 percent of men and 37.6 percent of women) of the offender population.

Overall, the estimated rate of HIV infection among inmates is 7-10 times higher than the Canadian population while the prevalence of hepatitis C is estimated at 25-30 times higher.

Routine health data on Aboriginals in the Canadian population are not collected and neither is it available for Aboriginal offenders in CSC; therefore, it is impossible to determine the specific prevalence of infectious diseases among Aboriginal populations. However, of the 30 percent of case reports where ethnicity is available, Aboriginal people represented 18.8 percent in 1998 and 25.5 percent in 2003. This data is in the form of diagnosis reports and not incidence of HIV infection. The large proportion of missing data makes interpretation difficult; nonetheless, it does suggest a higher burden of HIV among Aboriginal peoples in Canada. National HIV surveillance data capture only those who are tested, whose HIV infection is diagnosed and whose positive test results are reported to the Public Health Agency of Canada. Surveillance data, therefore, does not describe the full scope of the epidemic; however, calculations using these data and other sources of data are carried out to estimate the total number of people living with HIV (prevalence) and the number newly infected with HIV (incidence). In 2002, it was estimated that Aboriginal people accounted for 5 to 8 percent (or 3,000 to 4,000) of prevalent infections and 6 to 12 percent (or 250 to 450) of new infections. This is noteworthy because the proportion of the population in Canada represented by Aboriginal people is 3.3 percent, while the proportion in CSC is 17 percent; thus it is clear that Aboriginals are likely over-represented in the epidemic.

A Long-Term Strategy

This t-shirt was designed by an Aboriginal inmate at Westmorland Institution with funding he received under CSC’s Special Initiatives Program. The goal of the program is for inmates to engage in activities and projects that promote HIV (and other infectious disease) prevention for other inmates. In addition to English and French, the message on the t-shirt is written in Micmac and Maliseet.

What has been adopted by CSC in recent years is a long-term strategic approach to the issue of infectious diseases among offenders that includes close collaboration with the Public Health Agency of Canada and Health Canada, and infectious disease and drug education programs for inmates and staff. Harm reduction measures within CSC include the provision of condoms, dental dams, and water-based lubricant, bleach for cleaning injecting, tattooing and piercing equipment and a methadone maintenance program.

Upon admission and throughout incarceration inmates are encouraged to undergo voluntary testing for HIV/AIDS, hepatitis A, B, and C, sexually transmitted infections, and tuberculosis. Those who test positive for any infectious disease have access to medical specialists and treatment.

Aboriginal Peer Education and Counselling Program

The A-PEC program – implemented in all five regions and in most institutions – is a new educational program that addresses the issues of HIV/AIDS, hepatitis C and other infectious diseases faced by Aboriginal offenders. Its primary goal is to train Aboriginal inmates to become peer helpers within their institutions.

A-PEC distinguishes itself from the regular Peer Education Counselling (PEC) program by including Aboriginal traditional healing practices: sweats, smudging and employing Elders as regular participants offering spiritual guidance. This approach emphasizes the mental, spiritual, physical and emotional balance that is necessary for complete wellness.

A-PEC training is presented by a nurse, a trained member of an Aboriginal Aids Service organization or by the regional health coordinator. Training provides participants with up-to-date medical information on infectious diseases, skills needed to lead information sessions with peers, education on use of harm reduction measures and also training in the principles of the PEC program, including confidentiality, a non-judgemental approach, and respect for lifestyles and views of others. Some graduating participants are chosen as volunteers and one is chosen as the peer leader whose paid position is known as the A-PEC coordinator.

Prairie Regional Aboriginal Health Coordinator Curtis Charney describes it as “new and exciting.” Gil L. Carriere, CSC National Aboriginal Health Coordinator firmly believes that “CSC is making inroads in the fight against infectious diseases through this educational program. The great success is the result of the hard work by CSC Aboriginal health coordinators, regional health staff, Aboriginal stakeholders and especially the Elders, peer coordinators and volunteers.”

Links to the Community

Developing and maintaining strong ties to the Aboriginal community is a vital component of this initiative, as it is part of CSC’s commitment to involve community partners throughout the offender’s sentence. This has been accomplished by using Aboriginal organizations whenever possible and ensuring open communication with the community.

Curtis Charney, Regional Health Coordinator, Prairie Region

“Aboriginal community partners will continue to play a significant role in the successes that A-PEC will undoubtedly achieve in the future,” says Charney.

In the Pacific Region, Aboriginal Health Coordinator Jane Whiting says, “We have great goals for Aboriginal health for all eight institutions and our one healing lodge. The A-PEC program has been especially tailored to reach Aboriginal people from the West Coast culture.

“Not only will the Pacific Region be delivering A-PEC, but we are adding a component that will deal with diabetes, cancer, nutrition and basic health wellness. This ensures that Aboriginal offenders will be educated on many health issues that could affect them or their community.”

Charney, Whiting and others have their work cut out for them. Program training is a constant exercise in renewal as new inmates enter the institutions and others leave on various forms of release. The coordinators often spend a month at a time on the road, travelling from one institution to another, liaising with regional infectious disease coordinators, chiefs of Health Services, and Elders, and ensuring that all goes well with the new program. ♦