Behind the Walls
Living With HIV in Prison Comes With Its Own Set of Challenges, and Some Aren't the Ones You'd Expect
Douglas Foreman knows firsthand what it is like to live with HIV in prison. At 52, he is a veteran of the Canadian correctional system, incarcerated in 11 different institutions since his first sentence in 1978. A gay man who contracted HIV through sex in the 1980s, Foreman was also diagnosed with hepatitis C virus (HCV) in 1991, although he isn't sure how or when he became infected with it.
That may have happened 32 years ago, during his first year in detention. He was in Quebec's Archambault Institution, at the time a maximum-security penitentiary, when he one day found himself being shot up by a fellow prisoner. "He was sitting beside me and I watched him prepare his hit, then he prepared one for me," recalls Foreman in a telephone interview from his current residence, a medium-security institution in Quebec. "I didn't even know I would shoot up ... I would never have known how to."
After more than three decades in the system, Foreman is well aware that being HIV positive in prison comes with its own challenges -- ones never faced by people with HIV outside prison or by prisoners who are HIV negative. Access to proper medical care is an obvious concern. As well, the HIV stigma and discrimination common in society can be worse inside prison walls. But Foreman's story points to another issue: Because rates of hepatitis C in Canada's prisons are high and access to prevention tools is limited, many prisoners with HIV face the heavy health burden of being co-infected with HCV.
According to published data, between two and eight percent of prisoners in Canada are living with HIV, which is at least 10 times higher than the prevalence of the virus in the general population. Even so, Foreman says, "Rates of HIV in prison are much higher than people say. I was in a minimum security prison three years ago where there were 250 prisoners. At a seminar on HIV, I declared who I was and afterwards 25 men came up and told me they were also HIV positive."
HCV infection is even more prevalent, according to official reports, affecting 19 to 40 percent of prisoners, which is at least 20 times the prevalence in the general population. Most prisoners say they became infected with HIV or HCV through sharing needles and equipment to inject drugs. Perhaps Foreman became infected with HCV through that single time he shared a needle. Or perhaps it was through sex -- there is mounting evidence that HCV may pass sexually, especially among HIV-positive men who have sex with other men.
Mavis Daniels, 33, is a Cree woman living in Prince Albert, Saskatchewan. She was diagnosed with hepatitis C in 1996 and with HIV in 2003. Daniels injected drugs for many years before stopping three years ago. She says she contracted HIV through sex with a former partner. The man, a hemophiliac who contracted HIV in the 1980s during a blood transfusion, never told her of his status. She says that after hearing rumours, she asked him, "'Are you sick? You need to tell me this.' He said, 'No, I'm not. I don't know who's telling you this bullshit.'" The relationship continued and the couple even decided to try to become pregnant. Eventually, a mutual friend told the truth to Daniels. "My heart jumped because I was already having unprotected sex with him for a year." An HIV test came back positive.
Daniels has also spent time in prison, twice -- once in the late 1990s and again from 2007 to 2009 -- in Saskatchewan's Pine Grove Correctional Centre. She is a very real face of some startling statistics, including the fact that the Prairies has nearly half of all HIV-positive federal female prisoners in the country. Aboriginal women in prison are particularly affected -- in a 2007 anonymous survey conducted in federal prisons, about one in 10 (or 11.7 percent) Aboriginal female prisoners was HIV positive and a shocking one in two (49.1 percent) was HCV positive.
One of the most important aspects of living with any chronic medical condition, including HIV, is getting good medical care. In Canada, people have the right to "essential health care" while in prison, which includes treatment for HIV.
Generally, HIV-positive prisoners have at least occasional access to specialist care. Barb Bowditch, HIV case manager and consultant with the Prince Albert Hepatitis C Program in northern Saskatchewan since 2006, says that HIV-positive prisoners in the region's three institutions see an HIV doctor regularly -- about every one to three months depending on the institution -- either at clinics held in the prison or by being escorted to the Prince Albert clinic. Support and clinical services are offered on an ongoing basis. (Between appointments with the HIV specialist, prisoners can request to see a prison doctor. All requests are evaluated by the prison nursing unit and then forwarded or not.)
National data show that about six out of every 10 HIV-positive prisoners is on anti-HIV therapy. In the federal system, people get two weeks' worth of HIV meds at a time, in blister packs that they keep in their cells. People can start HIV therapy while inside if it's necessary and if they are ready. At the Prince Albert clinic, Bowditch says, "it's a decision that's made by the doctor, the patient and one of the nurses. Some may not want to start HIV meds right away and that's OK. But, say their CD4 counts are dropping, we'll at least start them on Septra and azithromycin" to give them some protection from other infections.
Unfortunately, security can trump health in prison. "For three months," Daniels recalls, "I complained to nursing staff that something's wrong with me. I could not eat. Every time I woke up in the morning, I threw up. I told the nurses and they did nothing. I think they assumed that I wanted to make a trip out to the hospital so that someone could come meet me there with drugs." The situation deteriorated and one morning Daniels had a seizure. "When I woke up in the ambulance they said the sleeping meds collided with my HIV meds, Kaletra and Combivir, and it caused a reaction to the brain."
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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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