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The Numbers
Seroprevalence studies undertaken in Canadian prisons, as well as a series of studies undertaken in prison systems in other countries, have shown that HIV infection is prevalent among women prisoners, in particular among those who have a history of injection drug use. Indeed, HIV seroprevalence among women prisoners generally exceeds that of male prisoners. For example, in a recent study in provincial prisons in Québec, the HIV-seroprevalence rate among women was 8.8 percent, while it was 2.3. among male prisoners. Similarly, in 2002, 3.71 percent of prisoners in federal women’s institutions, compared to 1.96 percent of male prisoners in the Canadian federal prison system, were known to be HIV-positive.

At the same time, Canadian women - not just women prisoners - are increasingly becoming infected with HIV, especially those who use injection drugs and whose sexual partners are at increased risk for HIV :

The proportion of AIDS cases among women has increased from 5.6 percent of all AIDS cases before 1990 to 8.3 percent in 1995 and 16 percent in 2001.
The proportion of AIDS cases among adult women attributed to injection drug use has increased dramatically from 7.3 percent before 1990 to 26.6 percent in 1994 and 45.5 percent in the first half of 2002.
It is estimated that by the end of 1999, 6,800 women in Canada were living with HIV, out of an estimated total of 49,800 people with HIV.
Women accounted for 25.8 percent of all HIV-positive test reports in the first half of 2002 that included information on gender. Injection drug use was a risk factor for 35.5 percent of these HIV-positive women.
What Must Be Done ?
Women prisoners need the same preventive measures (see info sheets 4-7), and the same level of care, treatment, and support (see info sheet 8) as male prisoners.

In addition, however, there is a need for initiatives that acknowledge that the problems encountered by women in the correctional environment often reflect, and are augmented by, their vulnerability and the abuse many of them have suffered outside prison. The task of protecting women prisoners from HIV transmission therefore presents different - and sometimes greater - challenges than that of preventing HIV infection in male prisoners.

Underlying issues
Underlying many of the problems that women in prison encounter is the fact that “[t]he majority of women in prisons are members of social groups marginalized not only on the basis of gender, but also on the basis of race, class, sexual orientation, disability, substance use, and/or occupation as sex workers.” Women prisoners often have more health problems than male prisoners. Many suffer from chronic health conditions resulting from lives of poverty, drug use, family violence, sexual assault, adolescent pregnancy, malnutrition, and poor preventive health care.

Many HIV-positive women do not receive the diagnostic and treatment services that could benefit them as early as do HIV-positive men. Among the reasons for this is that women are often unaware of having been exposed to HIV by their sexual or drug-using partners and as a result do not seek counselling, HIV testing, and care and treatment. Second, the needs of HIV-positive women differ from those of men, and social and community support are often less frequently available and less accessible. As a consequence, women are often less educated than men about HIV infection and AIDS and do not have the support structures they need. Third, disease manifestations attributable to HIV infection or AIDS are often different in women, which has led to underrecognition or delays in diagnosis. Thus, women who are infected have often been diagnosed as infected or having AIDS later than men.

For all these reasons, the educational needs of women prisoners regarding HIV/AIDS are different from the needs of male prisoners and the need for HIV prevention programs in women’s prisons may be even more pressing than in men’s prisons.

Recommendation
Prison systems need to take immediate action to develop and implement effective education and prevention programs targeted specifically to female prisoners.
 

Additional Reading
A DiCenso, G Dias, J Gahagan. Unlocking Our Futures : A National Study on Women, Prisons, HIV, and Hepatitis C. Toronto : PASAN, 2003. The most comprehensive Canadian report on HIV and incarcerated women. A must read. Available at www.pasan.org.

R Lines. Action on HIV/AIDS in Prisons : Too Little, Too Late - A Report Card. Montreal : Canadian HIV/AIDS Legal Network, 2002. Reviews HIV/AIDS programs for women in Canadian prisons. Available at www.aidslaw.ca/Maincontent/issues/prisons/reportcard/toc.htm

Correctional Service Canada. HIV/AIDS in Prisons : Final Report of the Expert Committee on AIDS and Prisons. Ottawa : Minister of Supply and Services Canada, 1994. Pages 109-113 discuss issues of particular relevance to women in Canadian prisons.

Health Canada. HIV/AIDS Epi Update : HIV and AIDS among Women in Canada. Ottawa, April 2003. Information on the status of HIV and AIDS among women in Canada. Available at http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/epiu-aepi

World Health Organization. WHO Guidelines on HIV Infection and AIDS in Prisons. Geneva : WHO, 1993 (WHO/GPA/DIR/93.3). Recommendations 44-46 concern incarcerated women. Available at http://www.aidslaw.ca/Maincontent/issues/prisons/APP5.html

Third, revised and updated version, 2004. Copies of this info sheet are available on the Network website at http://www.aidslaw.ca/Maincontent/issues/prisons.htm and through the Canadian HIV/AIDS Information Centre (email : aids/sida@cpha.ca). Reproduction of the info sheet is encouraged, but copies may not be sold, and the Canadian HIV/AIDS Legal Network must be cited as the source of this information. For further information, contact the Network (tel : 514 397-6828 ; fax : 514 397-8570 ; email : info@aidslaw.ca). Ce feuillet d’information est également disponible en français.

Funded by Health Canada under the Canadian Strategy on HIV/AIDS. The findingsm interpretations, and views expressed in this publication are entirely those of the author and do not necessarily reflect the policy or positions of Health Canada.

© Canadian HIV/AIDS Legal Network, 2004