Prison Needle Exchange: Lessons from a Comprehensive Review ...

to the United States. Thus, the situation described by the National Commission on AIDS is
evident in numerous countries.
Western Europe, Australia, and the United States
High rates of HIV infection among incarcerated populations have been reported in numerous
countries. In Spain, it is estimated that the overall rate of HIV infection among prisoners
is 16.6%, with a figure as high as 38% among some prison populations. 4 In Italy, a rate
of 17% has been reported. 5 High HIV infection rates among prisoners have also been reported
in France (13%; testing of 500 consecutive entries), Switzerland (11%; cross-sectional
study in five prisons in the Canton of Berne), and the Netherlands (11%; screening of a sample
of prisoners in Amsterdam). 6 In contrast, some European countries, including Belgium,
Finland, Iceland, Ireland, and some Länder in Germany, report lower levels of HIV prevalence.
7 Relatively low rates of HIV prevalence have also been reported from Australia. 8
A recent US study found that an estimated 25% of all HIV-infected citizens pass through
a correctional facility in the US each year. 9 In the US, the geographic distribution of cases of
HIV infection and AIDS is uneven. Many systems have reported HIV prevalence rates under
1%, while others have rates that approach or exceed 8%. 10
Central and Eastern Europe and the former Soviet Union
In the countries of Central and Eastern Europe and the former Soviet Union, high rates of
HIV infection among people who inject drugs and among prisoners is a growing concern. In
the Russian Federation, by late 2002 the registered number of peo-
ple living with HIV/AIDS in the penal system exceeded 36,000,
representing approximately 20% of known HIV cases. 11 In Ukraine,
where 69% of HIV infection is linked to injection drug use, 12 it is
estimated that 7% of the prison population is HIV-positive. 13 In
Latvia it is estimated that prisoners comprise a third of the country’s
HIV-positive population, and that a fourth of all HIV-positive persons
in Latvia were infected while in prison. 14 In Lithuania, in May
2002 the number of new HIV-positive test results among prisoners
found in a two-week period equalled all the cases of HIV identified in the entire country during
all of the previous years combined. 15 In total, 284 prisoners (15% of the total Lithuanian
prison population) were diagnosed HIV-positive between May and August 2002. 16
In the Russian Federation, the
registered number of people
living with HIV/AIDS in the
penal system exceeds 36,000.
Canada
Estimates of HIV prevalence in Canadian federal and provincial prisons range from 2% to
8% 17 , while studies of HIV prevalence in individual prisons report rates of between 1% and
11.94% . 18 Even adopting a conservative approach, these estimates place the HIV prevalence
rate in prisons at 10 times the prevalence rate in the general Canadian population. 19
According to preliminary data, 2.01% of all prisoners in Canadian federal prisons were
known to be HIV-positive, with higher rates among women (3.71%). 20 Among the five
Correctional Service Canada regions, the rate of reported HIV cases was highest in the
Québec region (2.7%) and lowest in the Ontario region (0.7%). 21 A number of HIV prevalence
studies have been conducted in federal and provincial prisons, including:
• The first HIV prevalence and risk behaviour study in a Canadian prison was undertaken
in a medium-security prison for women in Montréal. 22 Of the 321 participants, 23
(7.2%) were HIV-positive and 160 (49.8%) reported injection drug use. Non-sterile
6 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience