Research Reports

Study Materials for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey

2010 No R-212

Dianne Zakaria

Jennie Mae Thompson

&

Frederic Borgatta

Correctional Service of Canada

March 2010

Acknowledgements

The authors would like to thank the National Inmate Infectious Diseases and Risk Behaviours Survey Working Group (Jacqueline Arthur, Neil Burke, Yogesh Choudhri, Katherine Dinner, Tracey Donaldson, Marie-Line Gilbert, Gayatri Jayaraman, Rhonda Kropp, Tammy Maheral, Marissa McGuire, Mary Beth Pongrac, Jonathan Smith, Jill Tarasuk, and Tom Wong), the National Senior Project Manager (Heather Lockwood), the Regional Survey Coordinators (Kimberley Andreassen, Michelle Beyko, Teresa Garrahan, David Lewis, and Hélène Racicot) and the inmates who participated in focus groups for their guidance and insightful feedback during the development of the survey materials.

Table of Contents

• Acknowledgements
• Table of Contents
• List of Appendices
• Introduction
  • Promoting Awareness of the Survey
  • Free and Informed Consent
  • Development of the Questionnaire
  • Informing Inmates about Human Immunodeficiency Virus and Hepatitis C Virus
• References

List of Appendices

• Appendix A: Poster for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey
• Appendix B: Consent Form for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey
• Appendix C: Questionnaire for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey
• Appendix D: Answers to Survey Questions on Human Immunodeficiency Virus and Hepatitis C

Introduction

In 2007, the Correctional Service of Canada conducted the National Inmate Infectious Diseases and Risk Behaviours Survey, a self-administered paper questionnaire focussing on issues relevant to blood-borne and sexually transmitted infections, particularly human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. A random sample of men and all women were invited to complete the questionnaire and 3,370 inmates across Canada voluntarily participated. The primary objectives of the survey were to obtain information regarding inmates’:

1. health risk-behaviours such as illicit drug use, unprotected sex, tattooing and body piercing;
2. awareness and accessing of harm-reduction items and methadone maintenance treatment;
3. participation in health education programs;
4. knowledge of HIV and HCV; and,
5. testing and treatment for HIV and HCV infections.

Important components of the study included: promoting awareness of the survey within federal penitentiaries; ensuring free and informed consent; a comprehensive questionnaire to meet the study objectives; and, informing inmates about HIV and HCV. For reference purposes, this publication provides the key study materials used to achieve these goals. A comprehensive presentation of the methods and findings of the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey is provided by Zakaria, Thompson, Jarvis, and Borgatta (2010).

Promoting Awareness of the Survey

To help promote awareness of the survey within federal penitentiaries, posters announcing the survey were displayed in all institutions (see Appendix A). The poster emphasized the voluntary nature of the survey; guaranteed participants anonymity and confidentiality; and, reinforced that the overall purpose of the survey was to improve inmate health. A small version (13.9 cm by 21.6 cm) of the survey poster was left with each inmate approached for participation in the survey.

Free and Informed Consent

To ensure free and informed consent, the institutional survey coordinators reviewed the content of the consent form with eligible inmates, and invited inmates to participate in the study and to sign the consent form if they agreed (see Appendix B). For efficiency, group information sessions were organized with eligible inmates to describe the survey and review the consent form. Consent, however, was not obtained in a group setting but privately from each inmate. Inmates in segregation were recruited individually.

Development of the Questionnaire

A project team drawn from several federal government departments¹ developed the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey (see Appendix C). Questionnaire development included focus groups with inmates in five different penitentiaries, including a women’s facility and an Aboriginal inmate group. To maximize comprehension, the questions did not exceed a Grade 8 literacy level. Further, inmates could choose between the English or French version of the questionnaire (Zakaria, Thompson, & Borgatta, 2010).

The final questionnaire was 50 pages long and took inmates approximately 45 to 55 minutes to complete. The questionnaire captured information on risk-behaviours associated with the spread of blood-borne and sexually transmitted infections in both the community and prison; inmate awareness and use of health education and harm-reduction programs; inmate testing and treatment for HIV and HCV infections; and, inmate knowledge of HIV and HCV. To optimize recall accuracy, only inmates admitted within the past three years reported on their risk-behaviours during the last six months in the community prior to their current incarceration.

From May 22 to July 6, 2007, an external private firm administered the questionnaire in each institution to those inmates with a signed consent form. The survey coordinator was responsible for organizing inmates for the day and time the survey contractor arrived to distribute questionnaires. Since the contractor did not have the sample list and inmates were specifically instructed not to put their name or the name of anyone else on the questionnaire, it was impossible to link the consent form with the completed questionnaire. In this manner, inmates could be assured of their anonymity and confidentiality.

Each inmate completed the self-administered questionnaire: behind a privacy screen when completed in a group setting; in his/her cell if in segregation; or through private one-on-one interviews if an inmate requested assistance.

The survey contractor retained all completed questionnaires and provided a database of anonymous survey records to the Correctional Service of Canada in August 2007. Preliminary analyses to test the integrity of the data were conducted by the Correctional Service of Canada in the fall and winter of 2007/08. The contractor destroyed all completed questionnaires in June 2008 after all data integrity issues were resolved.

Informing Inmates about Human Immunodeficiency Virus and Hepatitis C Virus

To obtain information about inmates’ knowledge of HIV and HCV, the survey included questions about HIV and HCV. All participating inmates received the answers to the questions after data collection was complete within their institution (see Appendix D). Hence, the survey provided a learning opportunity for all participants.

References

Zakaria, D., Thompson, J., Jarvis, A., & Borgatta, F. (2010). Summary of emerging findings from the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey. Research Report R-211. Ottawa: Correctional Service Canada.

Zakaria, D., J. Thompson et F. Borgatta (2010). Les Matériels d’étude pour le Sondage national de 2007 auprès des détenu(e)s sur les maladies infectieuses et les comportements à risque, Rapport de recherche R-212. Ottawa, Service correctionnel du Canada.

Appendix A: Poster for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey

Appendix B: Consent Form for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey

RESEARCH CONSENT FORM

Invitation to be part of the Survey

The Public Health Agency of Canada and Correctional Service Canada are doing a survey. The survey is with inmates. You are invited to be in this survey.

Title of the Survey

The survey is called the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey.

What the Survey is About

Here’s what the survey is about. The purpose of the survey is to understand better the health needs of inmates. To do this, about 5,000 inmates are being asked to fill in the survey. They come from every federal prison in Canada. Your answers are important to us. This survey will help us understand which programs and services are needed. We will also know what we need to do to improve the programs that are already there.

The survey will ask you about infectious diseases such as hepatitis C and HIV. It also asks you about how these diseases can be spread from one person to another.

A private company has been hired to give you the survey to fill in. The company will take all the survey answers and put them into a computer. The company will not know who filled in the surveys. No one at Correctional Service Canada will be able to identify anyone from the CONFIDENTIAL questionnaires.

It should take about 45-60 minutes to do the study. If you’d like to participate, you need to know that nothing from the study can be used to identify you. Your answers are STRICTLY CONFIDENTIAL and nothing will ever appear in your files. You will not be required to put your name on the survey form.

How were you selected?

The names of all inmates are in a computer called the Offender Management System. Every inmate has a number. The computer chose a person’s number to take part in the study. This means than names were chosen without knowing a person’s health status. All those chosen by the computer can decide whether they want to join the study.

What the questionnaire is about

We will ask you about diseases that can be spread from one person to another. The diseases we will ask about are HIV, hepatitis C and other sexually transmitted infections. We will ask about things that could spread disease in prison and in the community. These things include doing drugs and sharing rigs and works. It also includes sex with men and women. We will also ask if you’ve had testing or treatment in the community and since you were at CSC.

Voluntary Participation

No one can make you take part in the survey. Whether you decide to take part or not is entirely up to you.

You don’t have to answer any of the questions. You can stop at any time. If you decide to stop, put the survey in the envelope. Seal the envelope and give it to the person you got it from. You won’t gain any extra privileges if you do the survey. You won’t lose any privileges if you don’t do the survey.

Confidentiality

Don’t put your name on the survey. Don’t put anyone else’s name on it either. IMPORTANT: this means no one will know who filled in the survey. Other than signing this consent form showing that you agree to do the survey, no information, not even your name, will be collected. This consent form cannot be linked to the survey you fill in.

When you fill in the survey, you will be given a cardboard screen. This screen will stop anyone else from seeing your answers when you fill in the survey.

Disposal of Consent Forms and Questionnaires

The Director, Special Projects, Research Branch at Correctional Service Canada is responsible for the survey. He will keep the consent forms under lock and key. By law, Correctional Service Canada must keep these signed consent forms for two years. After that, the consent forms will be destroyed.

The company looking after the surveys will keep the surveys in a safe place. When the report is ready, they will destroy the survey forms. This will likely happen in the spring of 2008.

Potential Harms, Injuries, Discomforts or Inconvenience

We don’t expect you will be upset by any question. If, however, you are upset or feel uncomfortable at any time, please tell the person who gave the survey to you. If you don’t want to talk about it, you are free to leave the room at any time. You can ask to see an Elder, a psychologist, a nurse or your case management officer.

Potential Benefits

Your help with this survey will greatly help make our programs and services better.

No link with Correctional Service Canada Security

We will not share your personal information with security at Correctional Service Canada.

Sharing of Data

We hired a private company to put all the answers into a computer. They can’t identify you because there won’t be your name on the survey form. When the answers are in the computer, the company will give them to the Director, Special Projects in charge of the survey. Under his supervision, health experts at Correctional Service Canada and the Public Health Agency of Canada will look at all the answers. With these answers, they will write a report. If the report is made public, copies will be put in the prison library.

Reimbursement

You will continue to be paid according to your salary scale while you are taking part in the study.

Waiver of Rights

The researchers doing this study cannot take away any of your legal rights. If you agree to do this survey, you are not giving up any legal rights.

Sponsorship

This research is funded by the Public Health Agency of Canada in partnership with Correctional Service Canada

Contact

If you have any questions about this consent form or about the survey, please speak with your institutional survey coordinator.

Sir or Madame:

If you have any questions about your rights as a research participant, you may contact:

The Research Ethics Board Secretariat
Office of the Chief Scientist
Holland Cross, Tower B, Suite 410
1600 Scott St.,
Ottawa, Ontario
K1A 0K9
Phone: (613) 941-5199 (Collect calls will be accepted.)
Fax: (613) 948-6781

Consent

By checking all the boxes below, Yes or No, I state that:

	Yes	No
The survey has been explained to me.
All my questions about the survey were answered.
I am participating in the study of my own free will.
The possible harms and discomforts and the possible benefits of doing the survey have been explained to me.
I understand that I have the right not to do the survey and the right to stop at any time.
I understand that I may refuse to do the survey and will not be in trouble.
I have a choice of not answering any specific questions.
I am free now, and in the future, to ask any questions about the survey.
I have been told that my personal information will be kept strictly confidential.
I was told that to do the study, my answers will be put into a computer and shared with Research Branch, Correctional Service Canada.
I have been told that that my answers cannot be used to identify me.
I understand that under no circumstances will information be shared with Public Health Agency of Canada and Correctional Service Canada that could identify me in any way.
I consent to allow my answers to be used by Research Branch, Correctional Service Canada under the conditions written above.
I hereby consent to do the survey called “2007 National Inmate Infectious Diseases and Risk Behaviours Survey”.

Name: _____________________ Signature: _________________________

Date: _____________________

Consent Form Errata

Table B1:
Consent Form Errata

Section	Issue	Rectification
How were you selected?	Typographical error: “This means than names were chosen without knowing a person’s health status.”	Should read: “This means that names were chosen without knowing a person’s health status.”
Consent	Typographical error: “I have been told that that my answers cannot be used to identify me.”	Should read: “I have been told that my answers cannot be used to identify me.”

Appendix C: Questionnaire for the 2007 National Inmate Infectious Diseases and Risk Behaviours Survey

N.B. To preserve the accuracy of skip patterns that include page numbers, the original page numbering for the questionnaire has been retained.

2007 National Inmate Infectious Diseases & Risk Behaviours Survey
A Joint Study of the Public Health Agency of Canada and Correctional Service Canada

Funding provided by the Public Health Agency of Canada and Correctional Service Canada

 

 

A. Your life experiences

1. In which institution are you currently serving time? _______________________

2. Are you currently at the reception centre?

• Yes 1
• No   0

3. Are you currently a temporary detainee?

• Yes 1
• No   0

4. In which year and month did you arrive at this institution? (Please specify the year and month)

Year

Month

5. Which language are you most comfortable speaking?

• English 0
• French 1
• Both English and French 2
• Other 3

6. How old are you?  Age

7. Are you …

• Male?   0
• Female?  1
• Transgendered / transsexual? 2

8. Are you …

• Single (never married)? 0
• Living with a common-law partner (when you’re on the outside you live together as a couple but not married)? 1
• Married (and not separated)? 2
• Separated? 3
• Divorced? 4
• Widowed? 5

9. What is your highest level of schooling?

• Never went to school  0
• Kindergarten  1
• Some elementary school (please specify which level you completed) 2  ____________________________
• Completed elementary school 3
• Some high school, but no diploma (please specify which level you completed) 4  ____________________________
• Completed high school or G.E.D. 5
• Some trade school, CEGEP, vocational school, community college, etc. 6
• Completed trade school, CEGEP, vocational school, community college, etc. 7
• Some university  8
• Completed university  9

10. What country were you born in?

• Canada   0 → Go to question 11, next page
• Outside Canada   1 ↓
  • Please specify your country of birth _____________________
  • When did you immigrate to Canada? Year immigrated

11. Are you an Aboriginal person? (Please check one response only)

12. What is your ethnic group or race? (Please check one response only)

• White /Caucasian 0
• South Asian (for example: East Indian, Pakistani, Sri Lankan, etc.) 1
• Latin American 2
• Black 3
• East Asian (for example: Cambodian, Chinese, Indonesian, Laotian, Vietnamese, etc.) 4
• Arab / West Asian (Afghan, Algerian, Iraqi, Iranian, Lebanese, Syrian, etc.) 5
• Mixed race (mother and father of different races) 6
• Not sure 7

13. Do you have any children and / or step-children of school-age still living at home?

• Doesn’t apply, I don’t have children  3
• Don’t know  2
• No  0
• Yes 1
   ↓
  1. Before you went to prison were you the person who mainly took care of your children and / or step-children? By children we mean those of school-age still living at home.
     • No  0
     • Yes 1

14. Do you have friends and / or family outside prison with whom you can keep in touch?

• No  0
• Yes 1
   ↓
  1. How often do you try to stay in touch with friends and / or family?
     • Never   0
     • Rarely   1
     • Often  2
     • Always 3

Time in federal prison

15. Including all the times you’ve been in prison so far, how many years in total have you spent in federal prison?

• Less than 1 year 0
• 1 year or longer  1
   ↓
  1. If you have been in federal prison for 1 year or longer, how many years and months has it been exactly?
     • Years  Months

Time in provincial / territorial jail

16. Including all the times you’ve been in prison so far, how many years in total did you spend in provincial / territorial jail?

• Never been in provincial / territorial jail  0
• Less than 1 year 1
• 1 year or longer  2
   ↓
  1. If you have been in provincial or territorial jails for 1 year or longer, how many years and months was it exactly?
     • Years  Months

17. Since last November, were you in the community outside federal prison on conditional release?

• No  0
• Yes 1
   ↓
  1. Which type of release was it?
     (Please check all that apply if you were out more than once.)
     • Escorted temporary absence    0
     • Unescorted temporary absence  1
     • Work release           2
     • Other (for example: day parole, statutory release, full parole)  3

18. Have you ever had dental surgery or any other surgery in your mouth?

• No  0
• Yes 1
• Don’t know  2

19. Have you ever been diagnosed with haemophilia?

• No  0
• Yes 1
• Don’t know  2

20. Have you ever received a blood transfusion or received other blood products?

• No  0
• Yes 1
• Don’t know  2

21. Have you ever shared personal hygiene items (e.g. your toothbrush, razor) with someone else?

• No  0
• Yes 1
   ↓
  1. Did you know if anyone you shared personal items with was infected with hepatitis B or hepatitis C?
     • No  0
     • Yes 1
     • Don’t know  2

22. Did you ever clean up blood spills while incarcerated in CSC?

• No  0
• Yes 1
   ↓
  1. Did you always have access to protective gloves to clean up the blood spill?
     • No  0
     • Yes 1
        ↓
       1. Did you always wear protective gloves to clean up the blood spill?
          • No  0
          • Yes 1

23. Have you ever been in a fight where you came into contact with someone else’s blood?

• No  0
• Yes 1
   ↓
  1. Do you know if they had hepatitis B or hepatitis C?
     • No  0
     • Yes 1
     • Don’t know  2

24. Have you ever been tattooed?

25. Do you have or have you had any body piercing(s) including piercing(s) for earrings?

Doing drugs and / or chemicals
Doing drugs / chemicals means you did or do illegal, illicit drugs or drugs that were not prescribed to you (including steroids) or chemicals (like glue or gasoline).

26. Have you ever done drugs and / or chemicals?

• No  0→Go to question 50, page 18
• Yes 1→   ↓

27. Have you ever injected drugs (or anything else such as alcohol or chemicals)?

28. Have you ever done drugs (e.g. pot or coke) or chemicals (e.g. glue or gasoline) by snorting, smoking, sniffing or swallowing?

29. Are you currently on methadone treatment?

30. Why are you not currently on methadone treatment in CSC? (Please check one response only)

• The last time I tried I was told I didn’t meet the requirements for treatment 0
• I started treatment and then was taken off because I was selling and / or giving my methadone to someone else 1
• I took myself off  2
• I was taken off methadone treatment for some other reason 3

B. Your experiences in prison in CSC between November 2006 and now

(If you were admitted after November 2006, please answer thinking about your prison experience in CSC since you were admitted.)

31. Since last November in prison, have you done drugs and / or chemicals?

• No  0→Go to question 49, page 18
• Yes 1

32. Since last November in prison, have you injected drugs (or anything else such as alcohol or chemicals)?

• No  0 → Go to question 47, page 17
• Yes 1 → Go to question 33, next page

33. Since last November in prison, how often did you inject drugs (or anything else such as alcohol or chemicals)?

• Daily           0
• Once or twice a week   1
• Once or twice a month  2
• Every couple of months 3
• Every now and then    4
• One time only       5

34. Since last November in prison, how often did you inject drugs “on a binge” (i.e., many times over a short period)?

• Never  0
• Rarely  1
• Often   2
• Always 3

35. Since last November in prison, did you pass a rig on to someone else after you had used it?

36. Since last November in prison, did you use someone else’s rig after they had used it?

37. The last time you used a rig since last November in prison, was it cleaned before you used it?

38. Since last November in prison, which drugs and / or chemicals did you inject most often? (Please specify no more than three.)

1. ____________________________
2. ____________________________
3. ____________________________

39. Since last November in prison have you shared a rig with anyone who you knew was infected with HIV or hepatitis C?

• No  0
• Yes 1
• Didn’t know if they were infected or not 2

40. If you wanted to get a rig in prison, how difficult would it be?

• Not difficult     0
• Somewhat difficult 1
• Quite difficult    2
• Impossible       3

41. Since last November in prison, have you used works (water, filter, cooker / spoon)?

• Yes 1
• No  0  →Go to question 47, page 17

42. Since last November in prison how often did you use works (water, filter, cooker / spoon)?

• Daily             0
• Once or twice a week   1
• Once or twice a month  2
• Every couple of months 3
• Every now and then    4
• One time only       5

43. Since last November in prison, did you pass works on to someone else after you had used them?

44. Since last November in prison, did you use someone else’s works after they had used them?

45. Since last November in prison, which drugs and / or chemicals did you use works with most often? (Please specify no more than three.)

1. _________________________
2. _________________________
3. _________________________

46. Since last November in prison have you ever shared works with anyone who you knew was infected with HIV or hepatitis C?

• No  0
• Yes 1
• Didn’t know if they were infected or not 2

47. Since last November in prison, did you do drugs (e.g. pot or cocaine) or chemicals (e.g. glue, gasoline) by snorting, sniffing, smoking or swallowing (i.e., without using a rig)?

48. Since last November in prison…

1. Did you think your use of drugs was out of control?
   • Never   0
   • Rarely  1
   • Often   2
   • Always  3
2. Did the prospect of missing a fix (or dose) make you anxious or worried?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
3. Did you worry about your use of drugs?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
4. Did you wish you could stop?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
5. How difficult would you find it to stop or go without drugs?
   • Not difficult     0
   • Somewhat difficult 1
   • Quite difficult     2
   • Impossible     3

49. Do the following statements apply to you?

1. I won’t do drugs in prison for fear of being caught
   • No  0
   • Yes 1
   • Don’t know   2
   • Doesn’t apply 3
2. I switched to drugs that are harder to catch in the urinalysis
   • No  0
   • Yes 1
   • Don’t know   2
   • Doesn’t apply 3

Sexual health
Sex with a woman

50. Have you ever had oral, anal or vaginal sex with a woman?

Sex with a man

51. Have you ever had oral, anal or vaginal sex with a man?

52. Have you ever been a sex trade worker (e.g. male or female prostitute / escort)?

53. Have you ever had oral, anal or vaginal sex with a sex trade worker (e.g. male or female prostitute / escort)?

54. Have you ever had oral, anal or vaginal sex with someone who injected drugs?

• No  0
• Yes 1
• Don’t know 2

Sex in prison since November 2006
Note: If you were admitted to CSC after November 2006, please answer the questions below thinking about your prison experience in CSC since then.

55. Since last November in prison, did you have oral, vaginal or anal sex with anyone?

Sex with one or more women

56. Since last November in prison how often did you use …

1. A condom while having vaginal sex?
   • Doesn’t apply 0
   • Never      1
   • Rarely      2
   • Often       3
   • Always      4
2. A condom or dental dam while having oral sex?
   • Doesn’t apply 0
   • Never      1
   • Rarely      2
   • Often       3
   • Always      4
3. A condom while having anal sex?
   • Doesn’t apply 0
   • Never      1
   • Rarely      2
   • Often       3
   • Always      4

Sex with one or more men

57. Since last November in prison how often did you use …

1. A condom while having vaginal sex?
   • Doesn’t apply 0
   • Never      1
   • Rarely      2
   • Often       3
   • Always      4
2. A condom or dental dam while having oral sex?
   • Doesn’t apply 0
   • Never      1
   • Rarely      2
   • Often       3
   • Always      4
3. A condom while having anal sex?
   • Doesn’t apply 0
   • Never      1
   • Rarely      2
   • Often       3
   • Always      4

58. Since last November in prison, did you ever use any object for sex or a sex toy that had been used by someone else?

• No  0
• Yes 1

59. Since last November in prison, did you have unprotected sex with a regular sex partner?

• No  0
• Yes 1

60. Since last November in prison, did you have unprotected sex with a casual sex partner (i.e. someone you didn’t know well)?

• No  0
• Yes 1

61. Since last November in prison, have you had sex with anyone who had HIV, hepatitis C or sexually transmitted infections?

• No  0
• Yes 1
• Don’t know 2

Private family visits in prison since November 2006
If you were admitted after November 2006, please answer thinking about your prison experience in CSC since you were admitted.

62. Since last November in prison, did you participate in any private family visits?

• No  0 → Go to question 65 next page
• Yes 1

63. If you had sex during private family visits, how often did you use a condom or a barrier (dental dam, plastic wrap, cut condom)?

• Didn’t have sex 0→ Go to question 65 below
• Always 1→ Go to question 65 below
• Often   2
• Rarely  3
• Never  4

64. What were the reasons why you didn’t always use a condom and / or a dental dam during private family visits? (please check all that apply)

• There weren’t any when you needed them 0
• One or both were past their “best before” date when you needed them 1
• It was for some other reason 2

65. Since last November in prison, did you ever pay for sex with money, works, rigs, drugs or goods (e.g., tobacco or cigarettes)?

• No  0
• Yes 1

66. Since last November in prison, did someone ever pay you for sex with money, works, rigs, drugs or goods (e.g., tobacco or cigarettes)?

• No  0
• Yes 1

67. Since last November in prison, did you ever pay for drugs with sex?

• No  0
• Yes 1

68. Since last November in prison, did someone ever pay you for drugs with sex?

• No  0
• Yes 1

69. Since last November in prison, did you have sex (oral, vaginal or anal) forced on you when you didn’t want it?

• No  0
• Yes 1

70. In which year did you start your current sentence?

C. Your life experiences during the last 6 months you were free in the community

Doing drugs and / or chemicals during the last 6 months you were free in the community
Doing drugs means you did illegal, illicit drugs or drugs that were not prescribed to you (including steroids) or chemicals (like glue or gasoline).

71. Did you ever do drugs and / or chemicals during the last 6 months you were free in the community?

• No  0 → Go to question 89, page 29
• Yes 1

72. During the last six months you were free in the community, did you ever inject drugs and / or chemicals?

• No  0 → Go to question 80, page 26
• Yes 1 → Go to question 73, next page

73. During the last six months you were free in the community, how often did you inject drugs (or anything else such as alcohol or chemicals)?

• Daily           0
• Once or twice a week   1
• Once or twice a month  2
• Every couple of months 3
• Every now and then    4
• One time only       5

74. During the last six months you were free in the community, how often did you inject drugs “on a binge” (i.e., many times over a short period)?

• Never   0
• Rarely   1
• Often  2
• Always 3

75. During the last six months you were free in the community, did you pass a rig on to someone else after you had used it?

76. During the last six months you were free in the community, did you use someone else’s rig after they had used it?

77. The last time you used a rig during the last six months you were free in the community, was it cleaned before you used it?

78. During the last six months you were free in the community, which drugs and / or chemicals did you inject most often? (Please specify no more than three.)

79. During the last six months you were free in the community, did you ever share a rig with anyone who you knew was infected with HIV or hepatitis C?

• No  0
• Yes 1
• Didn’t know if they were infected or not 2

80. During the last six months you were free in the community, did you ever use works (water, filter, cooker / spoon)?

• No  0 → Go to question 85, page 28
• Yes 1 → Go to question 81, next question

81. During the last six months you were free in the community, did you pass works on to someone else after you had used them?

82. During the last six months you were free in the community, did you use someone else’s works after they had used them?

83. During the last six months you were free in the community, which drugs and / or chemicals did you use works with most often? (Please specify no more than three.)

84. During the last six months you were free in the community did you ever share works with anyone who you knew was infected with HIV or hepatitis C?

• No  0
• Yes 1
• Didn’t know if they were infected or not 2

85. During the last six months you were free in the community, did you do drugs (e.g. pot or cocaine) or chemicals (e.g. glue, gasoline) by snorting, sniffing, smoking or swallowing?

86. During the last 6 months you were free in the community …

1. Did you think your use of drugs was out of control?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
2. Did the prospect of missing a fix (or dose) make you anxious or worried?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
3. Did you worry about your use of drugs?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
4. Did you wish you could stop?
   • Never  0
   • Rarely  1
   • Often   2
   • Always 3
5. How difficult would you have found it to stop or go without drugs?
   • Not difficult     0
   • Somewhat difficult 1
   • Quite difficult     2
   • Impossible      3

Last 6 months you were free in the community

87. Did you ever pay for drugs with sex?

• No  0
• Yes 1

88. Did someone ever pay you for drugs with sex?

• No  0
• Yes 1

Sex during the last 6 months you were free in the community

89. During the last 6 months you were free in the community, did you have oral, anal or vaginal sex with anyone?

• Yes 0
• No  1→Go to question 98, page 31

Sex with one or more women during the last 6 months you were free in the community

90. Did you have oral, anal or vaginal sex with a woman?

Sex with one or more men during the last 6 months you were free in the community

91. Did you have oral, anal or vaginal sex with a man?

• No  0
• Yes 1
   ↓

1. How many men did you have oral, anal or vaginal sex with?
   • 1        1
   • 2 to 5       2
   • 6 to 10     3
   • 11 to 25     4
   • More than 25 5

Last 6 months you were free in the community

92. Considering all the people you had sex with, how often did you use a condom and / or barrier (dental dam, plastic wrap, cut condom) with them?

• Never  0
• Rarely  1
• Often   2
• Always 3

93. Did you have unprotected sex with your regular sex partner(s)?

• No  0
• Yes 1

94. Did you have unprotected sex with casual sex partner(s) (i.e. someone or people you didn’t know well)?

• No  0
• Yes 1

95. Did you ever have sex with anyone who you knew was infected with HIV or hepatitis C?

• No  0
• Yes 1
• Don’t know if they were infected or not 2

Last 6 months you were free in the community

96. Did you ever pay for sex with money, works, rigs, drugs or goods (e.g., tobacco or cigarettes)?

• No  0
• Yes 1

97. Did someone ever pay you for sex with money, works, rigs, drugs or goods (e.g., tobacco or cigarettes)?

• No  0
• Yes 1

98. During the last 6 months you were free in the community, did you ever have sex (oral, vaginal or anal) forced on you when you didn’t want it?

• No  0
• Yes 1

D. Infectious Disease Information and Support for Prevention

The Reception Awareness Program (RAP) is a program. It would have been offered to you when you were first admitted. It is mainly about infectious diseases and health services offered in prison.

99. Did you ever take the Reception Awareness Program (RAP)?

• Yes 2
• Don’t know 1
• No  0
   ↓

1. Why didn’t you take the RAP program? (Please check one response only)
   • I wasn’t interested 0
   • I wasn’t aware CSC had such a program 1
   • I plan to take it sometime soon 2
   • The program did not exist when I was first admitted 3
   • Other 4

The Choosing Health in Prisons (CHIPs) is about healthy living, nutrition and stress. The course is also about how diseases such as can be spread. Diseases that can be spread include HIV, hepatitis and tuberculosis. It is usually offered early in someone’s sentence.

100. Did you ever take the Choosing Health in Prisons (CHIPs) program?

• Yes 2
• Don’t know 1
• No  0
   ↓

1. Why didn’t you take the CHIPs program? (Please check one response only)
   • I wasn’t interested 0
   • I wasn’t aware CSC had such a program 1
   • I plan to take it sometime soon 2
   • Other 3

CSC offers a program called The National HIV/AIDS Peer Education and Counselling Program; PEC for short. The PEC provides information on HIV/AIDS. It also offers information on other infectious diseases. It is a program for inmates to become “peer educators”. Peer educators provide peer support to other inmates. There is a “Women’s Component” of this program. For Aboriginal inmates the program is called Circles of Knowledge Keepers or Chee Mamuk.

101. Did you ever take the Peer Education and Counselling Program (the PEC program)?

• Yes 2
• Don’t know 1
• No  0
   ↓

1. Why didn’t you take the PEC program? (Please check one response only)
   • I wasn’t interested 0
   • I wasn’t chosen 1
   • I wasn’t aware CSC had such a program 2
   • I plan to take it sometime soon 3
   • Other 4

102. Have you talked to a PEC counsellor about infectious diseases in prison?

• Yes 0
• No  1
• I’m a PEC counsellor 2

103. Are you aware that CSC has a policy to ensure inmates have easy access to the items listed below? (Please check all that apply)

1. Condoms
   • No  0
   • Yes 1
2. Lubricant
   • No  0
   • Yes 1
3. Dental dams
   • No  0
   • Yes 1
4. Bleach (for cleaning injecting, piercing and / or tattooing equipment)
   • No  0
   • Yes 1

104. Since November 2006 did you have any problems getting condoms in CSC?

• I haven’t tried to get condoms 0
• No, I didn’t have any problems getting condoms 1
• Yes, I had a problem getting condoms 2
   ↓

1. Why did you have a problem getting condoms?
   (Please check all that apply.)
   • Dispensers were empty 0
   • Dispensers were broken 1
   • People could see me take condoms from the dispenser 2
   • Other inmates hoarded them  3
   • Other inmates limited my access to them 4
   • The condoms were damaged 5
   • I had to ask staff to get them 6
   • Other 7

105. Since November 2006 did you have any problems getting dental dams in CSC?

• I haven’t tried to get dental dams 0
• No, I didn’t have any problems getting dental dams 1
• Yes, I had a problem getting dental dams 2
   ↓

1. Why did you have a problem getting dental dams? (Please check all that apply.)
   • Dispensers were empty 0
   • Dispensers were broken 1
   • People could see me take dental dams from the dispenser 2
   • Other inmates hoarded them  3
   • Other inmates limited my access to them 4
   • The dental dams were damaged 5
   • I had to ask staff to get them 6
   • Other 7

106. Since November 2006 did you have any problems getting lubricant in CSC?

• I haven’t tried to get lubricant 0
• No, I didn’t have any problems getting lubricant 1
• Yes, I had a problem getting lubricant 2
   ↓

1. Why did you have a problem getting lubricant? (Please check all that apply)
   • Dispensers were empty 0
   • Dispensers were broken 1
   • People could see me take lubricant from the dispenser 2
   • Other inmates hoarded it  3
   • Other inmates limited my access to it 4
   • The tube of lubricant was damaged 5
   • I had to ask staff to get it 6
   • Other 7

107. Since November 2006 did you have any problems getting bleach in CSC?

• I haven’t tried to get bleach 0
• No, I didn’t have any problems getting bleach 1
• Yes, I had a problem getting bleach 2
   ↓

1. Why did you have a problem getting bleach? (Please check all that apply)
   • Dispensers were empty 0
   • Dispensers were broken 1
   • People could see me take bleach from the dispenser 2
   • Other inmates hoarded it  3
   • Other inmates limited my access to it 4
   • The bleach was diluted 5
   • I had to ask staff to get it 6
   • Other 7

108. Please indicate the extent you agree or disagree with each of the following statements.

1. Getting sterile needles and syringes in prison is difficult for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
2. Getting sterile tattooing equipment in prison is difficult for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
3. Accessing substance abuse programs in prison is difficult for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
4. Getting “female” condoms in prison is difficult for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
5. Having to ask prison health care staff for condoms, dental dams, or lubricant is a problem for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
6. Having to ask prison health care staff for bleach is a problem for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
7. Having other inmates see me take condoms, dental dams, or lubricant from the dispenser is a problem for me.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5
8. I need to know more about how to protect myself from infectious diseases.
   • Strongly Agree   1
   • Agree        2
   • Disagree      3
   • Strongly Disagree 4
   • Doesn’t apply    5

E. Testing and Treatment of Infectious Diseases

Testing for HIV (Human Immunodeficiency Virus) when you were in the community, in provincial / territorial jail or in federal prison for a previous sentence

109. Before being sent to federal prison for your current sentence, were you ever tested for HIV when you were in the community, in provincial / territorial jail or in federal prison for a previous sentence?

• No, I was never tested 0
• Don’t know       1
• Yes, I was tested     2
   ↓

1. Where were you tested? (Please check all that apply)
   • Tested in the community 0
   • Tested in provincial / territorial jail 1
   • Tested in federal prison 2
2. In which year was your last HIV test before being sent to federal prison for your current sentence? 
   • Year 
   • Don’t know 0
3. Where was your last HIV test taken before being sent to federal prison for your current sentence?
   • In the community 0
   • In provincial / territorial jail 1
   • In federal prison 2
4. What was the result of your last HIV test before being sent to federal prison for your current sentence?
   • I was told I didn’t have HIV  0
   • I was told I have HIV  1
   • I don’t know 2

Testing for HIV at admission to CSC

If you have been through intake assessment on more than one occasion, please think now about your most recent admission.

110. At admission to CSC, were you tested for HIV?

Testing for HIV since admission to CSC

111. Since admission to CSC, did you get a blood test for HIV? (If you have had more than one HIV test at CSC, think about the last HIV test you had.)

Treatment for HIV

112. Have you ever been told you have HIV?

113. Has the doctor started you on treatment for HIV (with anti-retroviral medication)?

114. Are you currently taking medication for HIV?

115. Has there ever been a previous occasion in CSC when you were off your HIV medication for at least a day?

116. Do the statements below apply to you? (Please check all that apply)

1. I am worried about being discriminated against in CSC because I have HIV.
   • Yes 1
   • No  0
2. I am afraid of having my name reported in CSC because I have HIV.
   • Yes 1
   • No  0

 → Go to question 118, page 42

117. Do the statements below apply to you? (Please check all that apply)

1. I am worried about being discriminated against in CSC if I test positive for HIV.
   • Yes 1
   • No  0
2. I am afraid of having my name reported in CSC if I test positive for HIV.
   • Yes 1
   • No  0
3. I am not willing to be tested in CSC because I’m afraid of the result of the HIV test.
   • Yes 1
   • No  0
4. I’m now more willing to get tested for HIV than when I went through the admission process to CSC.
   • Yes 1
   • No  0
5. I’m now more willing in CSC to have an HIV test than when I was in the community.
   • Yes 1
   • No  0

Testing for Hepatitis C

Testing for hepatitis C when you were in the community, in provincial / territorial jail or in federal prison for a previous sentence

118. Before serving your current sentence, were you ever tested for Hepatitis C while you were in the community or provincial / territorial jail or in federal prison for a previous sentence?

Testing for hepatitis C at admission to CSC

If you went through intake assessment more than once, please think about your most recent admission.

119. At admission to CSC, did you get tested for hepatitis C?

Testing for hepatitis C since admission to CSC

120. Since admission to CSC, did you get tested for hepatitis C? (If you had more than one hepatitis C test in CSC, think about the last time you were tested for hepatitis C.)

• Yes, I’ve been tested since admission 1
   ↓

1. In which year was your last test for hepatitis C?
   • Year
2. What was the result of your last hepatitis C test?
   • I was told I didn’t have hepatitis C 0
   • I found out I had hepatitis C 1
   • The test confirmed I had hepatitis C 2
   • I don’t know 3

• Don't know 2→ Go to question 121 below
  
  
• No, I haven’t been tested since admission 0
   ↓

1. Why haven’t you been tested for hepatitis C since admission to CSC? (Please check all that apply)
   • It wasn’t offered to me 0
   • I don’t think I’m at risk 1
   • I am at risk, but I don’t want to know 2
   • I am afraid of having my name reported in CSC if I go for testing 3
   • I am afraid of being discriminated against in CSC if I go for testing 4
   • I have hepatitis C 5
   • I don’t have hepatitis C 6

121. Have you ever been told you had hepatitis C?

Treatment for hepatitis C

122. Did you take the medication for hepatitis C?

123. Do the statements below apply to you? (Please check all that apply)

1. I am worried about being discriminated against at CSC because I have hepatitis C.
   • Yes 1
   • No  0
2. I am afraid of having my name reported at CSC because I have hepatitis C.
   • Yes 1
   • No  0

→ Go to question 125, next page

124. Do any of the statements below apply to you? Please check all that apply.

1. I am worried about being discriminated against at CSC if I tested positive for hepatitis C.
   • Yes 1
   • No  0
2. I am afraid of having my name reported at CSC if I tested positive for hepatitis C.
   • Yes 1
   • No  0
3. I am not willing to be tested at CSC because I’m afraid of the result of the hepatitis C test.
   • Yes 1
   • No  0
4. I’m now more willing to have a hepatitis C test than when I was first admitted to CSC.
   • Yes 1
   • No  0
5. I’m now more likely to get tested for hepatitis C at CSC than when I was in the community.
   • Yes 1
   • No  0

Sexually Transmitted Infections (STIs)

125. Have you ever been told you had any of the infections in the list below? Please check all that apply.

1. Chlamydia
   • No  0
   • Yes 1
   • Don’t Know  2
2. Gonorrhoea
   • No  0
   • Yes 1
   • Don’t Know  2
3. Syphilis
   • No  0
   • Yes 1
   • Don’t Know  2
4. Genital Herpes (HSV – herpes simplex virus)
   • No  0
   • Yes 1
   • Don’t Know  2
5. Genital warts (HPV – human papillomavirus)
   • No  0
   • Yes 1
   • Don’t Know  2
6. Other sexually transmitted infections
   • No  0
   • Yes 1
   • Don’t Know  2

126. Since your admission to CSC for your current sentence, have you ever been told you had any of the infections in the list below? Please check all that apply.

1. Chlamydia
   • No  0
   • Yes 1
   • Don’t Know  2
2. Gonorrhoea
   • No  0
   • Yes 1
   • Don’t Know  2
3. Syphilis
   • No  0
   • Yes 1
   • Don’t Know  2
4. Genital Herpes (HSV – herpes simplex virus)
   • No  0
   • Yes 1
   • Don’t Know  2
5. Genital warts (HPV – human papillomavirus)
   • No  0
   • Yes 1
   • Don’t Know  2
6. Other sexually transmitted infections
   • No  0
   • Yes 1
   • Don’t Know  2

Testing and vaccinations for Hepatitis A and B

127. Have you ever been vaccinated for hepatitis A?

• No, I have never been vaccinated 0
    ↓
  1. Were you ever told you had hepatitis A?
     • No  0
     • Yes 1
       
       
• Don’t know 1  → Go to question 128 below
  
  
• Yes, I have been vaccinated 2
    ↓
  1. Did you get your vaccination in CSC?
     • No  0
     • Yes 1

128. Have you ever been vaccinated for hepatitis B?

• No, I have never been vaccinated 0
    ↓
  1. Were you ever told you had hepatitis B?
     • No  0
     • Yes 1
       
       
• Don’t know 1  → Go to Section F, next page
  
  
• Yes, I have been vaccinated 2
    ↓
  1. Did you get your vaccination in CSC?
     • No  0
     • Yes 1

F. Your knowledge of infectious diseases and risk behaviours

Questions about HIV (Human immunodeficiency virus)

129. Please answer Yes or No to each question below.  If you aren’t sure or don’t know the answer, check Don’t Know.

1. Is HIV spread by coughing or sneezing?
   • Yes 1
   • No  0
   • Don’t Know 2
2. Can a woman protect herself from getting HIV during sexual intercourse if the man pulls out his penis before he climaxes / cums?
   • Yes 1
   • No  0
   • Don’t Know 2
3. Is there a risk of getting HIV if a person has unprotected anal sex?
   • Yes 1
   • No  0
   • Don’t Know 2
4. If a person washes their genitals/private parts after sex, can they protect themselves from getting HIV?
   • Yes 1
   • No  0
   • Don’t Know 2
5. Is there such a thing as a female condom that can be used by women to protect themselves from getting HIV during sexual intercourse?
   • Yes 1
   • No  0
   • Don’t Know 2
6. Is HIV spread from one person to another if they share a drink?
   • Yes 1
   • No  0
   • Don’t Know 2
7. If a person is taking antibiotics, are they protected from getting HIV?
   • Yes 1
   • No  0
   • Don’t Know 2
8. Is HIV spread in swimming pools and hot tubs?
   • Yes 1
   • No  0
   • Don’t Know 2
9. Is it possible to get HIV from oral sex?
   • Yes 1
   • No  0
   • Don’t Know 2
10. If a person uses Vaseline or baby oil with a condom, does this lower their chance of getting HIV?
    • Yes 1
    • No  0
    • Don’t Know 2
11. Is there a risk of getting HIV if a person shoots up with a needle used by someone else?
    • Yes 1
    • No  0
    • Don’t Know 2
12. Is HIV spread through food?
    • Yes 1
    • No  0
    • Don’t Know 2
13. Is there medication a person can take that will cure HIV?
    • Yes 1
    • No  0
    • Don’t Know 2
14. Is plastic wrap (Saran wrap) as effective as a condom in protecting a person from getting HIV during sexual intercourse?
    • Yes 1
    • No  0
    • Don’t Know 2

The answers to question 129 will be given to you when you’ve finished the survey.

Questions about hepatitis C

130. Please answer Yes or No to each question below.  If you aren’t sure or don’t know the answer, check Don’t Know.

1. Is it possible for someone to get hepatitis C if they borrow straws and / or crack pipes to snort or smoke cocaine?
   • Yes 1
   • No  0
   • Don’t Know 2
2. Is it possible for a person to get hepatitis C if they have unprotected sexual intercourse?
   • Yes 1
   • No  0
   • Don’t Know 2
3. Is there a risk of getting infected with hepatitis C while getting a tattoo or piercing?
   • Yes 1
   • No  0
   • Don’t Know 2
4. Is hepatitis C spread through food?
   • Yes 1
   • No  0
   • Don’t Know 2
5. Is there a vaccine that can prevent people from getting hepatitis C?
   • Yes 1
   • No  0
   • Don’t Know 2
6. Is there a risk of getting hepatitis C if a person injects with a needle used by someone else?
   • Yes 1
   • No  0
   • Don’t Know 2
7. Is hepatitis C spread in hot tubs and swimming pools?
   • Yes 1
   • No  0
   • Don’t Know 2
8. Is it true that some people live for many years with hepatitis C without feeling sick?
   • Yes 1
   • No  0
   • Don’t Know 2
9. Is it possible, with the use of medication, to no longer be able to detect hepatitis C in a person’s blood?
   • Yes 1
   • No  0
   • Don’t Know 2
10. Is hepatitis C spread by coughing or sneezing?
    • Yes 1
    • No  0
    • Don’t Know 2
11. Once a person’s hepatitis C has been treated and the virus can’t be detected in their blood, is it possible for them to get re-infected with hepatitis C?
    • Yes 1
    • No  0
    • Don’t Know 2
12. If a person is taking antibiotics, are they safe from getting hepatitis C?
    • Yes 1
    • No  0
    • Don’t Know 2
13. Is hepatitis C spread from one person to another if they share a drink?
    • Yes 1
    • No  0
    • Don’t Know 2
14. Is it possible for a person to get hepatitis C if they borrow a razor or toothbrush from someone?
    • Yes 1
    • No  0
    • Don’t Know 2

The answers to question 130 will be given to you when you’ve finished the survey.

131. How at risk are you of getting infected with HIV while in prison?

• No risk        0
• Low risk        1
• Medium risk     2
• High risk        3
• I’m already infected 4

132. How at risk are you of getting infected with hepatitis C while in prison?

• No risk        0
• Low risk        1
• Medium risk      2
• High risk        3
• I’m already infected 4

133. How at risk are you of getting a sexually transmitted infection while in prison?

• No risk        0
• Low risk        1
• Medium risk      2
• High risk        3
• I’m already infected 4

Place your completed questionnaire in the envelope, seal it well and hand it to the survey administrator.

DO NOT PUT YOUR NAME (OR ANYONE ELSE’S NAME) ON THE QUESTIONNAIRE OR THE ENVELOPE.

Your health is very important!

For more information, the survey administrator will give you the answers to questions 129 and 130 on HIV and hepatitis C.

If you think you may be at risk or think you’ve been exposed to HIV, hepatitis C, or other infectious diseases, see the health care staff as soon as possible.

Thank you very much for your time and participation!

 

Questionnaire Errata

Table C1:
Questionnaire Errata

Section/ Question	Issue	Rectification
Transition statement, section B, p.12	Inconsistent wording between English and French. English: If you were admitted after November 2006, please answer thinking about your prison experience in CSC since you were admitted. French: If you were admitted after November 1, 2006, please answer for the period since your admission until today.	Make French version consistent with English version.
Q39	Inconsistent wording of response options in English and French. English: 0 = No 1 = Yes 2 = Didn’t know if they were infected or not French: 0 = No 1 = Yes, I knew this person was infected 2 = Yes, I thought or I suspected this person to be infected	Make French version consistent with English version.
Q48a to Q48d	Inconsistent wording of response options in English and French. English: 0 = Never 1 = Rarely 2 = Often 3 = Always French: 0 = Never 1 = Sometimes 2 = Often 3 = Always	Make French version consistent with English version.
Q49a Q49b	Inconsistent coding of response options in English and French. English: 0 = No 1 = Yes 2 = Don’t know 3 = Doesn’t apply French: 0 = Yes 1 = No 2 = I don’t know 3 = Doesn’t apply	Make French version consistent with English version.
Transition statement, section B, p.20	Inconsistent wording between English and French. English: Note: If you were admitted to CSC after November 2006, please answer the questions below thinking about your prison experience in CSC since then. French: If you were admitted after November 1, 2006, please answer for the period since your admission until today.	Make French version consistent with English version.
Q61	Inconsistent wording of question across English and French versions. English: Since last November in prison, have you had sex with anyone who had HIV, hepatitis C or sexually transmitted infections? French: Since last November in the institution, have you had unprotected sexual relations with a person with HIV, hepatitis C or with a sexually transmitted infection?	Make French version consistent with English version.
Transition statement, section B, p.21	Inconsistent wording between English and French. English: If you were admitted after November 2006, please answer thinking about your prison experience in CSC since you were admitted. French: If you were admitted after November 1, 2006, please answer for the period since your admission until today.	Make French version consistent with English version.
Q74	Inconsistent coding of response options in English and French. English: 0 = Never 1 = Rarely 2 = Often 3 = Always French: 0 = Never 1 = Rarely 1 = Often 1 = Always	Make French version consistent with English version.
Q79	Inconsistent wording of response options in English and French. English: 0 = No 1 = Yes 2 = Didn’t know if they were infected or not French: 0 = No 1 = Yes, I knew this person was infected 2 = I didn’t know if the person was infected	Make French version consistent with English version.
Q84	Inconsistent wording of response options in English and French. English: 0 = No 1 = Yes 2 = Didn’t know if they were infected or not French: 0 = No 1 = Yes, I knew this person was infected 2 = I didn’t know if the person was infected	Make French version consistent with English version.
Q86a to Q86d	Inconsistent wording of response options in English and French. English: 0 = Never 1 = Rarely 2 = Often 3 = Always French: 0 = Never 1 = Sometimes 2 = Often 3 = Always	Make French version consistent with English version.
Q100	In the English version, the program description has a typographical error in the following sentence: “The course is also about how diseases such as can be spread.”	The sentence should read as follows: “The course is also about how diseases can be spread.”
Q102	Inconsistent coding of response options in English and French. English: 0 = Yes 1 = No 2 = I’m a PEC counsellor French: 0 = No 1 = Yes 2 = I’m a PEC counsellor	Make French version consistent with English version.
Q109	Inconsistent coding of response options in English and French. English: 0 = No, I was never tested 1 = Don’t know 2 = Yes, I was tested French: 0 = No, I was never tested 1 = Yes, I was tested 2 = I don’t know	Make French version consistent with English version.
Q110, No, a	Inconsistent wording of response options in English and French. English: 5 = I have HIV 6 = I was already tested and was negative French: 5 = I already knew I had HIV 6 = I already knew I didn’t have HIV	Make French version consistent with English version.
Q114	Error in coding of English question. 1 = No, I’m not currently taking HIV medication 1 = Yes, I’m still taking my HIV medication	Code as follows: 0 = No, I’m not currently taking HIV medication 1 = Yes, I’m still taking my HIV medication
Q120,Yes, b	Inconsistent wording of question across English and French versions. English: What was the result of your last hepatitis C test? French: What was the result of the hepatitis C test at admission?	Make French version consistent with English version.

Appendix D: Answers to Survey Questions on Human Immunodeficiency Virus and Hepatitis C

HIV FACTS

• You can’t tell if a person has HIV just by looking at them.
• HIV can be found in blood, semen (cum), vaginal fluid (cum), and breast milk of an infected person.
• You can get HIV if you have unprotected sex (if you don’t use a condom or dental dam) with a person who has HIV.
• You can get HIV if you share rigs (needles/syringes) and works (water, cooker, spoons, cotton) with someone who has HIV.
• You can get HIV if you share tattooing or piercing equipment with someone who has HIV.
• HIV can enter through cuts and open sores on the skin and in the vagina, rectum (bum), mouth and nose.
• To find out if you have HIV, ask a nurse in Health Care for a blood test.

Question	Answer	Here’s why
a. Is HIV spread by coughing or sneezing?	No	There are no reports of anyone getting HIV from being exposed to coughing or sneezing by a person who has HIV. There can be a small amount of HIV in saliva (spit) but not enough to infect a person.
b. Is a woman protected from HIV during sexual intercourse if the man pulls out his penis before he climaxes/cums?	No	HIV could be in his ejaculate (cum) and in his pre-ejaculate (or “pre-cum” - liquid that is released from the penis before he cums). Even if he pulls out his penis before he cums, the “pre-cum” will have already entered the woman. This also explains why women can get pregnant even if a man pulls out his penis before he cums. Sexual intercourse (penile-vaginal) without a condom is a high-risk activity for getting HIV.
c. Is there a risk of getting HIV if a person has unprotected anal sex?	Yes	The skin inside the bum is thin and can be easily cut. If HIV-infected cum or blood enters the cut, a person could HIV. Anal sex without a condom is a high-risk activity for getting HIV. Always use a condom and lots of water-based lubricant when having anal sex.
d. If a person washes their genitals/private parts after sex, can they protect themselves from getting HIV?	No	The HIV will have entered your body during sex, so washing after sex will not kill the HIV. Urinating (peeing) or douching after sex will not kill the HIV either. Always use protection (condom, dental dam or non-microwavable plastic wrap) when having sex.
e. Is there such a thing as a female condom that can be used by women to protect themselves from getting HIV during sexual intercourse?	Yes	With the female condom, a woman does not have to depend on her male partner to wear a condom. The woman puts the female condom in her vagina. Some people use the female condom for anal sex. The female condom is inserted in the bum. Lots of water-based lubricant should be used as the condom could tear.
f. Is HIV spread from one person to another if they share a drink?	No	There have been no reports of getting HIV by drinking from the same glass as someone with HIV. There can be HIV in saliva (spit), but not enough to infect a person.
g. If a person is taking antibiotics, are they protected from getting HIV?	No	There are no medications that you can take to prevent you from getting HIV. You can prevent yourself from getting HIV by: using condoms and dental dams; not using someone else’s rigs and works; and; not using someone else’s tattooing or piercing equipment.
h. Is HIV spread in swimming pools and hot tubs?	No	There are no reports of someone getting HIV by sharing a hot tub or swimming in a pool with a person who has HIV.
i. Is it possible to get HIV from oral sex?	Yes	HIV can be found in ejaculate (cum) and vaginal fluids. If you have an open sore in your mouth and you go down on someone with HIV, the virus could enter your body through the open sore. Unprotected oral sex is a low-risk activity for getting HIV, but you should always use a non-lubricated condom when going down on a man. Use a dental dam or non-microwavable plastic wrap as a barrier when going down on a woman.
j. If a person uses Vaseline or baby oil with a condom, does this lower their chance of getting HIV?	No	Vaseline or baby oil will weaken a latex condom making it easier for the condom to break. Use only water-based lubricants
k. Is there a risk of getting HIV if a person shoots up with a needle used by someone else?	Yes	Using someone else’s rig (syringe/needle) is a high-risk activity for getting HIV. Full strength bleach will kill HIV and should be used if you use someone else’s syringe.
l. Is HIV spread through food?	No	There are no reports of a person getting HIV from food.
m. Is there medication a person can take that will cure HIV?	No	There is no cure for HIV. There are drugs that a person with HIV can take to help them live longer.
n. Is plastic wrap (Saran wrap) as effective as a condom in protecting a person from getting HIV during sexual intercourse?	No	Plastic wrap can easily slip off a penis during and after insertion. For oral sex, you can use plastic wrap (the non-microwavable kind) instead of a dental dam.

More about HIV

If you have a sexually transmitted infection (STI), such as chlamydia, gonorrhoea, syphilis, herpes, or genital warts, you could be at high-risk for getting HIV.

Here’s why

• Some STIs can cause open sores in and/or around the genitals and anus.  You may have open sores and not even know it.  When you use a condom or dental dam, you can protect yourself and your partner from not only HIV, but other STIs as well.
• If you have any open sores in and/or around your genitals or anus, or you think you might have sores in your vagina or bum, see a nurse in health care.  STIs can be treated and cured.

HEPATITIS C FACTS

• You can’t tell if a person has hepatitis C just by looking at them.
• The hepatitis C virus can be found in the blood of an infected person.
• You can get hepatitis C if you have blood to blood contact (an open bleeding cut comes into contact with an open bleeding cut) with a person who has hepatitis C.
• You can get hepatitis C if you share rigs (needles/syringes) and works (water, cooker, spoons, cotton) with someone who has hepatitis C.
• You can get hepatitis C if you share tattooing or piercing equipment with someone who has hepatitis C.
• You can get hepatitis C if you have unprotected sex (if you don’t use a condom or dental dam) with a person who has hepatitis C.
• Hepatitis C can enter through cuts and open sores on the skin and in the vagina, rectum (bum), mouth and nose.
• The hepatitis C virus can live for a long time in blood outside the body – up to 4 days.
• To find out if you have hepatitis C, ask a nurse in Health Care for a blood test.

Question	Answer	Here’s why
a. Is it possible for someone to get hepatitis C if they borrow straws and / or crack pipes to snort or smoke cocaine?	Yes	There could be hepatitis C-infected blood on the straw or crack pipe that you might not be able to see. When the cocaine is snorted or smoked, hepatitis C-infected blood can enter the body through cuts in your nose or on your lips.
b. Is it possible for a person to get hepatitis C if they have unprotected sexual intercourse?	Yes	Hepatitis C is spread through blood to blood contact. If there are open sores on the penis, in the vagina or in the bum, you could get hepatitis C if you have unprotected sexual intercourse with a hepatitis C-infected person who also has open sores. Unprotected sexual intercourse is a low-risk activity for getting hepatitis C. You should use a condom to protect yourself from hepatitis C, because you may have cuts or open sores you’re not aware of.
c. Is there a risk of getting infected with hepatitis C while getting a tattoo or piercing?	Yes	There may be hepatitis C-infected blood that you cannot see on the piercing and tattooing equipment. There could be also be blood in the inks used for tattooing. Using someone else’s tattooing or piercing equipment is a high-risk activity for getting hepatitis C.
d. Is hepatitis C spread through food?	No	There are no reports of a person getting hepatitis C from food
e. Is there a vaccine that can prevent people from getting hepatitis C?	No	There are vaccines to prevent people from getting hepatitis A and B, but there is no vaccine to prevent someone from getting hepatitis C.
f. Is there a risk of getting hepatitis C if a person injects with a needle used by someone else?	Yes	Blood is almost always present in a used needle or syringe, even though you may not be able to see it. Using a needle/syringe that has been used by someone else is a high-risk activity for getting hepatitis C.
g. Is hepatitis C spread in hot tubs and swimming pools?	No	There are no reports of someone getting hepatitis C by sharing a hot tub or swimming in a pool with someone who has hepatitis C.
h. Is it true that some people live for many years with hepatitis C without feeling sick?	Yes	Some people live for many years with hepatitis C and do not feel sick. However, even though they feel fine, they are infectious and can infect others if their blood comes into contact with the blood of another person.
i. Is it possible, with the use of medications, to no longer be able to detect hepatitis C in a person’s blood?	Yes	Until recently, doctors would tell their hepatitis C patients that they had “cleared the virus”. This means that the virus could no longer be detected in their blood. Some doctors are now saying that the hepatitis is cured when it can no longer be detected in the blood.
j. Is hepatitis C spread by coughing or sneezing?	No	There are no reports of anyone getting hepatitis C from being exposed to coughing or sneezing by a person who has hepatitis C.
k. Once a person’s hepatitis C has been treated and the virus can’t be detected in their blood, is it possible for them to get re-infected with hepatitis C?	Yes	A person can get infected with hepatitis C again if they continue to practice risk behaviours such as sharing injecting, tattooing and piercing equipment, sharing razors or toothbrushes, or having unprotected sex where there is blood to blood contact.
l. If a person is taking antibiotics, are they safe from getting hepatitis C?	No	There are no medications that you can take to prevent you from getting hepatitis C. You can prevent yourself from getting hepatitis C by: using condoms and dental dams; not using someone else’s rigs and works; not using someone else’s razor or toothbrush; and; not using someone else’s tattooing or piercing equipment.
m. Is hepatitis C spread from one person to another if they share a drink?	No	There are no reports of someone getting hepatitis C by drinking from the same glass as someone with hepatitis C.
n. Is it possible for a person to get hepatitis C if they borrow a razor or toothbrush from someone?	Yes	There could be blood on the razor or toothbrush which you may not be able to see. If you have open cuts on your face, you could get hepatitis C from a razor used by someone who has hepatitis C. If you have open sores in your mouth, you could get hepatitis C from a toothbrush used by someone who has hepatitis C.

Answers to Survey Questions Errata

Table D1:
Answers to Survey Questions Errata

Question	Issue	Rectification
HIV, question c	Typographical error: “If HIV-infected cum or blood enters the cut, a person could HIV.”	Should read: “If HIV-infected cum or blood enters the cut, a person could get HIV.”
HIV, question g	Typographical error: “not using someone else’s rigs and works; and;”	Should read: “not using someone else’s rigs and works; and,”
Hepatitis C, question c	Typographical error: “There could be also be blood in the inks used for tattooing.”	Should read: “There could also be blood in the inks used for tattooing.”
Hepatitis C, question l	Typographical error: “not using someone else’s razor or toothbrush; and;”	Should read: “not using someone else’s razor or toothbrush; and,”

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