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Behind the Walls

Living With HIV in Prison Comes With Its Own Set of Challenges, and Some Aren't the Ones You'd Expect

Winter 2011

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Given stories such as Daniels', prison may not seem like the most obvious place to get healthy, but the stability of the daily routine can make it easier to stick with anti-HIV therapy. It was during her second stay in Pine Grove that Daniels got serious about her anti-HIV therapy. She had been taking it on and off for years, but the dependable routines of prison allowed her to take the medications regularly. Still, a majority of people on HIV treatment have reported missing at least one day of therapy while in prison. Sometimes they missed because they decided to stop therapy or forgot to refill their prescription, other times because the prison pharmacy did not have the meds in stock or because treatment was interrupted while they were transferred between prisons.

Treating the symptoms and side effects of HIV and HIV treatment is also trickier in prison. Prisoners with HIV -- who sometimes take medications such as Gravol (dimenhydrate) to counteract nausea and gabapentin (Neurontin) to treat neuropathy -- can be intimidated into handing these over to fellow prisoners who inject them to get high. "What I hear and see is much more abuse of medications. People are injecting garbage like Gravol, and this didn't used to happen," says Dr. Peter Ford, a retired HIV specialist with more than 20 years of experience treating prisoners with HIV in federal institutions in Ontario. As a result, prescriptions written by HIV specialists are sometimes ignored by the prison doctors, who have the final say on which prescriptions are filled.

Just as in the wider community, HIV carries stigma in prisons, so many HIV-positive prisoners keep their status secret or at least try to do so. Mooky Cherian, provincial prison program coordinator at Prisoners' HIV/AIDS Support Action Network (PASAN), an Ontario-based AIDS service organization for HIV-positive prisoners, says that anything, including HIV, that labels someone as weak or vulnerable can lead to problems on the range. During his work in the men's provincial system in Ontario, Cherian has heard many stories of men with HIV whose status becomes known and who then face ostracism and aggression from fellow prisoners.

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Bowditch says her impression is that the experience in the prisons in northern Saskatchewan is different. "The prisoners are very open about their status within the walls. Probably about eight years ago I heard a lot of this [stories of stigma], but I think people are becoming more comfortable," perhaps due to a growing awareness of the epidemic in the region.

Stigma combined with the power imbalance inherent in prisons can give rise to the potential for abuse by staff as well. Cherian, who sees clients in several provincial prisons in Ontario, recounts the story of one man who because of his HIV status receives canned nutrition drinks to help him stay healthy. (While needed, these drinks can be a sign to others of the person's health status.) The man says that guards on occasion take the can from his food tray and drink it in front of him before tossing back the empty can. This kind of intimidation may explain why two-thirds of HIV-positive federal prisoners fear discrimination.

Canada has only one AIDS service organization (ASO) whose sole mandate is to serve prisoners with HIV and advocate on their behalf: PASAN, established in 1991. Because it's the only one, even though it is officially an Ontario organization, PASAN is often thought of as a federal one. It has also taken on work with hepatitis C-infected prisoners. Other ASOs that have broader mandates -- such as the British Columbia Persons with AIDS Society (BCPWA), Centre Action Sida Montréal (CASM) and HIV/AIDS Regional Services in Kingston -- provide prison outreach workers.

Workers from these agencies supply information to prisoners, advocate for access to services within the prison and lend a compassionate ear. To ensure confidentiality to their clients, programs often do not refer to HIV explicitly. Instead, services are offered under the umbrella of sexual health or harm or risk reduction. That way, no one can be sure of a prisoner's HIV status.

Front-line workers are often involved in organizing social services, health care or housing for prisoners who have been discharged. In Daniels' case, the system worked well. "Six months before my release date," she recalls, "I asked Barb [Bowditch] if she could find me a place to stay and a job." As luck would have it, Bowditch knew the director of the local youth centre where Daniels once worked. A few phone calls and Daniels had work at the centre doing outreach. "What I do here is go out in the outreach van and we give out sandwiches, juice, condoms and needles."

The Prince Albert clinic also provides health care to people returning to the community, though that can present challenges. "We have their housing information when they get released," Bowditch says, "but we sometimes lose them, especially if they are homeless or have an addiction issue. We may see them out on the street and try to connect with them there."

It's no surprise that prisoner infection rates for HIV and for HCV are so much higher than those in the general Canadian population. Injection drug use is common in prisons and sharing needles is generally accepted to be the main way HIV and HCV are transmitted there. According to the 2007 national survey, 16 percent of men and 15 percent of women say they have injected drugs while incarcerated. Anecdotal evidence from prisoners puts that percentage higher, often around 30 percent. There's a multitude of reasons for using drugs: drug dependence, mental health issues, the desire to escape the boredom or difficulty of prison life and pressure from other prisoners. "It's a stress-filled environment," Foreman deadpans.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
 
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