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HIV/AIDS and Hepatitis C in Prisons: The
HIV Seroprevalence in Prisons
Canadian federal prisons
In Canada’s federal prison system (which houses people sentenced to
prison terms of two years or more), the number of reported cases of HIV/AIDS
rose from 14 in January 1989 to 159 in March 1996 to 251 in 2002 (data for
2002 are preliminary). This means that 2.01 percent of all federal prisoners
are known to be HIV-positive. The actual numbers may be even higher:
the reported cases, provided by the Correctional Service of Canada (CSC),
include only cases of HIV infection and AIDS known to CSC, but many
prisoners may not have disclosed their HIV status to CSC, or may not know
themselves that they are HIV-positive.
Canadian provincial prisons
In provincial prisons (which house people sentenced to prison terms of less
than two years), rates of HIV infection are also high. Studies undertaken in
prisons in British Columbia, Ontario, and Québec have all shown that HIV
seroprevalence rates in prisons are over 10 times higher than in the general
population, ranging from 1.0 to 8.8 percent. For example:
- A study released in 2004 of 1,617 prisoners in 7
provincial institutions in Québec found an HIV seroprevalence rate of 2.3
percent among men and 8.8 percent among women.
- A 1993 study carried out among over 12,000 people
entering Ontario prisons found HIV seroprevalence rates of 1.0 percent
among adult men and 1.2 percent among adult women.
As in federal prisons, the number of prisoners living with HIV or AIDS in
provincial prisons is on the rise. For example:
- In British Columbia, a study conducted in all adult
BC provincial prisons in 1993 found an HIV seroprevalence rate of 1.1
percent. The study has not been repeated, but in 1996 a review of known
cases alone revealed rates ranging from two to 20 percent in various
As in Canada, rates of HIV-infection in prison populations worldwide are
much higher than in the general population. They are, in general, closely
related to two factors: the proportion of prisoners who injected drugs prior
to imprisonment, and the rate of HIV infection among injection drug users in
Many of those who are HIV-positive in prison were already living with the
virus on the outside. Indeed, the highest rates of HIV infection in prisons
can be found in areas where rates of HIV infection are high among injection
drug users in the community. Commenting on the situation in the United
States, the US National Commission on AIDS stated that “by choosing mass
imprisonment as the ... governments’ response to the use of drugs, we have
created a de facto policy of incarcerating more and more individuals with
HIV infection rates are high in many prison systems. In Western Europe,
particularly high rates have been reported in Portuguese (20 percent) and
Spanish prisons (16.6 percent). Rates are also high in countries such as
Switzerland (4 to 12 percent) and Italy (7 percent). In Eastern Europe, 7
percent of Ukrainian prisoners and 15 percent of Lithuania prisoners are
HIV-positive. Forty-one percent of South African prisoners are reported to
be HIV positive. In Latin America, high rates of HIV infection have been
found in Brazil (10.9 - 21.5 percent) and Honduras (7 percent).
In contrast, relatively low rates of HIV prevalence have been reported from
Australia. In the United States, the geographic distribution of cases of HIV
infection and AIDS is remarkably uneven. Many systems continue to have rates
under one percent, while in a few rates approach 10 percent among men and 15
percent among women.
Hepatitis C Seroprevalence
Hepatitis C (HCV) prevalence rates in prisons are even higher than HIV
prevalence rates. Studies undertaken in the early and mid 1990s in Canadian
prisons revealed rates of between 28 and 40 percent.
Rates continue to rise. In one federal prison, 33 percent of study
participants tested positive in 1998, compared with 27.9 percent in 1995. In
2002, 3,173 federal prisoners were known to be HCV positive: 25.2 percent of
male and 33.7 percent of female prisoners.
A review of prevalence and incidence in incarcerated populations worldwide
found HCV seroprevalence rates ranging from 4.8 percent in an Indian jail to
92 percent in two prisons in Northern Spain.
Potential for further spread
Most HCV-positive prisoners come to prison already infected, but the
potential for further spread is high. HCV is much more easily transmitted
than HIV, and transmission has been documented in prisons in several
countries, including Canada.
Infectious Diseases Prevention and Control in Canadian Federal
Penitentiaries 2000-01. A Report of the Correctional Service of Canada's
Infectious Diseases Surveillance System, Ottawa, CSC, 2003. Available at
GE Macalino et al. Hepatitis C infection and incarcerated populations.
International Journal of Drug Policy 2004; 15: 103-114. A review of
prevalence and incidence of HCV in prisons worldwide.
R Elliott. Prisoners’ Constitutional Right to Sterile Needles and Bleach.
Appendix 2 of R Jürgens. HIV/AIDS in Prisons: Final Report. Montréal:
Canadian HIV/AIDS Legal Network & Canadian AIDS Society, 1996, at 3-4.
Provides a summary of early Canadian seroprevalence studies in prisons.
C Hankins et al. HIV-1 infection in a medium security prison for women –
Quebec. Canada Diseases Weekly Report 1989; 15(33): 168-170. The
first HIV seroprevalence study in a Canadian prison.
S Landry et al. Étude de prévalence du VIH et du VHC chez les personnes
incarcérées au Québec et pistes pour l'intervention. Canadian Journal of
Infectious Diseases 2004; 15 (Suppl A): 50A (abstract 306). The most
recent Canadian study.