HIV/AIDS and Men in Prison

Key Issues:

• There are several risk behaviours that men are exposed to while in prison: unprotected sex; tattooing; and sharing needles and other drug equipment.
• Methadone treatment should be available in all prisons.
• Prevention tools (such as condoms and clean needles) and educational HIV/AIDS material must be made available to all inmates in a discreet manner.

For men in prison, rules set out by the correctional facility, codes of conduct among prisoners and engaging in risky behaviours can increase the risk of contracting HIV and other diseases such as Hepatitis C while in prison.

According to Correctional Services Canada (CSC) Surveillance Data from June, 2000, approximately two-percent of federal inmates are HIV-positive; up from the one percent reported in 1995¹. This number does not include those men who have not disclosed their HIV status to prison officials; or those who are HIV-positive but have not been tested for the virus. The rates of HIV infection among men in Canadian prisons is increasing and reflects trends among certain groups outside of prisons, for example among injection drug users.

While in prison there are several activities behaviours that men can and sometimes do engage in that put them at risk for HIV infection. These activities include sharing needles and other drug injection equipment; tattooing (which also involves sharing needles) and engaging in unprotected sex.

Drug use is strictly forbidden inside Canada's prisons but it nevertheless occurs. In a 1995 CSC survey, 40% of the 4285 federal inmates surveyed reported having used drugs since arriving in prison. Sharing needles with other prisoners also occurs widely; it has been reported, by inmates, that one needle can be shared among 15 or 20 men. From the same 1995 CSC survey, 11% of the inmates surveyed reported that they had injected drugs while in prison².

When an inmate has the necessary drug injection equipment (a "rig"), he may be expected to share it with other inmates. Sharing equipment is a sign that the inmate is part of the prison community, by sharing equipment he is seen as "solid" (part of the community) by other inmates. However it is often the case that sharing needles and other equipment is the only alternative since sterile needles are not made available within prisons.

Consistent use of sterile needles is effective in preventing the spread of HIV among drug users. But they are not available in either federal or provincial prisons in Canada. They are available however in prisons in several other countries and in those countries HIV transmission among inmates who use needle exchange programs has decreased³.

Currently, drug use is treated as a crime. Incarcerated users are at risk of contracting and transmitting HIV because federal and provincial prisons do not provide needle exchange programs. This might change by treating drug dependency as a health issue rather than as a criminal one. Access to needle exchange programs has proven to be effective in reducing risk behaviours associated with HIV infection among drug users in and out of prison. However, these programs are not available to all injection drug users.

Tattooing is a social activity in prison and is often seen as a badge of honour for men serving a prison sentence. According to the same 1995 CSC survey, 45% of federal inmates reported having had a tattoo done while in prison. Tattooing, like sharing needles for drug use, can place a man at greater risk of contracting and transmitting HIV.

Unprotected sexual activity among inmates is yet another risk for HIV infection. Although sexual activity in prison is frowned upon, prison officials do recognize that it happens. In 1992, condoms were made available to prisoners in federal prisons. However many prisoners reported that they were afraid to ask for condoms because they did not want to be singled out and identified as engaging in sexual activity. They also expressed fear of being discriminated against on these grounds⁴.

All men in prison should be encouraged, and provided the tools with which to protect themselves against contracting and transmitting HIV and other blood borne diseases. Condoms are made available but some inmates fear stigmatization and discrimination associated with having sex with another man. There are a number of precautions that men inside correctional facilities can take in order to reduce their risk of HIV infection.

Ideally condom use should be consistent but in order to promote consistent condom use, prisons must make them widely available and easily accessible. This includes making condoms accessible during private family visit (PFV).

Educational HIV/AIDS material must be widely and easily available to all inmates. Condoms must be easily and discreetly available in all correctional institutions so that prisoners need not fear being discriminated against. Until sterile needles are widely available, bleach needs to be more readily available so that shared needles and other drug equipment can be properly cleaned. Alternative methods, such a methadone treatment (an oral substitute for opiate-based drugs) should be made available to all inmates that are drug dependent.⁵

For more information on how to prevent HIV infection, please contact the Canadian AIDS Society at 1-800-499-1986 or visit our web-site at www.cdnaids.ca.

1. HIV/AIDS and Hepatitis C in Prisons: The Facts, Canadian HIV/AIDS Legal Network, 1999
2. High-Risk Behaviours Behind Bars, Canadian HIV/AIDS Legal Network, 1999
3. Prevention: Bleach, Canadian HIV/AIDS Legal Network, 1999
4. Prevention: Condoms, Canadian HIV/AIDS Legal Network, 1999
5. Prevention and Treatment: Methadone, Canadian HIV/AIDS Legal Network, 1999