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

1994, found that 6.9% of all participants, and 13% of women with a history of injection
drug use, were HIV-positive. 27
• A study released in 2004 of 1617 prisoners in seven provincial institutions in Québec
found an HIV prevalence rate of 2.3 percent among men and 8.8 percent among women. 28
Other countries
High rates of HIV infection among prisoners are not limited to European and North
American jurisdictions. Countries in all parts of the world are also struggling to address this
health crisis. In Africa, reports have cited that as many as 41% of the 175,000 people in South
African prisons are living with HIV or AIDS. 29 Zambia 30 and Nigeria 31 have also reported
high rates of HIV in their prisons. In Latin America, studies have shown HIV prevalence
rates of almost 7% in three urban prisons in Honduras (with almost 5% of males aged 16 to
20 testing positive) 32 and between 10.9 to 21.5% in a selection of Brazilian prisons. 33 In Asia,
numerous studies in Thailand have shown a history of imprisonment to be significantly associated
with HIV infection. 34 A study of 377 prisoners in three prisons in India found that
6.9% were living with HIV, all of these individuals being originally from Thailand and
Myanmar. 35
HCV infection
HCV infection is endemic among prison populations worldwide. In many countries, the high
rates of HIV infection among the prison population are eclipsed by even higher rates of HCV
infection, another bloodborne viral infection that can be transmitted via needle sharing.
Published studies of HCV in the prison setting include those from Australia, Taiwan, India,
Ireland, Denmark, Scotland, Greece, Spain, England, Brazil, the United States, and Canada.
The vast majority of peer-reviewed published studies have found that between 20% and 40%
of prisoners are living with HCV and, within study samples, rates of HCV prevalence among
prisoners who inject drugs are routinely two to three times higher than among prisoners who
have no history of injection drug use. 36 It has been suggested that
the concentration of HCV-infected individuals in prisons may be
related to a number of factors, including high rates of incarceration
among people who inject drugs and among those with previous or
multiple imprisonments; and that imprisonment may be an independent
risk factor for contracting HCV infection. 37
In Canada, 23.6% of federal prisoners who underwent voluntary HCV testing in 2001
tested positive. 38 As with HIV, HCV rates were higher among women prisoners (42.4%) than
among men (23.2%). 39 However, the Correctional Service of Canada report that presented
the 2001 data cautions that HCV may be under-reported because “[p]ersons at highest risk
of infection may be less likely to be tested, leading to biased testing patterns and possible
continued transmission of infection.” 40 This caution is borne out by a 1996 study of 192 prisoners
at a federal men’s institution that revealed that 28% of prisoners were HCV-positive,
with rates significantly higher among people who injected drugs (52%) than those who did
not (3%). 41
Between 20% and 40% of
prisoners are living with HCV.
Drug use in prison
Despite their illegality, the penalties for their use, and the significant amounts of money and
person-hours spent by prison systems to stop their entry, the fact remains that illicit drugs get
into prisons and prisoners consume them. Just as in the community, drugs are present in prisons
because there is a market for them and because there is money to be made selling them.
8 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience