In this issue of CMAJ, two research groups report on the prevalence of HIV and hepatitis C virus (HCV) infections in different inmate populations: people in provincial prisons in Quebec, and adult and young offenders admitted to remand facilities (jails, detention centres and youth centres) in Ontario. The Ontario study is highlighted below; the Quebec study appears in a separate release posted on EurekAlert today. In both studies, injection drug use was the most important risk factor, and the prevalence of hepatitis C virus (HCV) infection was much higher than that of HIV infection. Given the high rates of recidivism and the short stays in remand facilities and provincial prisons, the results of these studies have important public health implications and point to the need for preventive measures.

In this Ontario study, Dr. Liviana Calzavara and colleagues assessed data from 1877 adult and young offenders admitted to 13 remand facilities between Feb. 1, 2003, and June 20, 2004. Among the adult offenders, the rate of HIV infection was 11 times higher and the rate of HCV infection 22 times higher than those in the general population. Rates were highest among inmates aged 30 or more and those who reported a history of injection drug use. A history of injection drug use was reported by 30.3% (477/1576) of the adults and 4.7% (14/299) of the young offenders. Two percent of the adults tested positive for HIV antibodies and 17.6% tested positive for HCV antibodies. None of the 299 young offenders tested positive for HIV antibodies, and 1 tested positive for HCV antibodies. Based on these results, the researcher estimated that 1079 HIV-positive adults and 9208 HCV-positive adults were admitted to Ontario remand facilities from Apr. 1, 2003, to Mar. 31, 2004. They recommend targeted education and prevention efforts.

In a related commentary, Richard Elliott, deputy director of the Canadian HIV/AIDS Legal Network, comments on the continued refusal by federal and provincial governments to implement evidence-based harm reduction measures to prevent HIV and HCV infections in prisons. He postulates that it may be time to put the evidence of this ongoing denial of human rights before the courts.



Source: Dr. Liviana Calzavara
Canadian Medical Association Journal