Abstract
Background
Clinicians working in a women’s prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmission inside prison.
Methods
A cross-sectional observational data set was created using an anonymous 61-item self-administered survey.
Results
Eighty-three percent (104/126) of eligible inmates participated. Seventy-four percent (77/104) reported their current prison sentence was related to illicit drug use and 25% (26/104) reported their ethnicity as Aboriginal. Ninety-three percent (97/104) reported a prior history of illicit drug use, of whom 70% (68/97) reported a history of injection drug use. Thirty-six percent (37/104) reported illicit drug use in prison, and 21% (22/104) reported injection drug use in prison. Fifty-two percent (54/104) reported hepatiti C sero-positivity, and 8% (8/104) reported HIV sero-positivity. Of the 22 women who reported prison injection drug use, 91% (20/22) reported hepatitis C infection and 86% (19/22) reported injecting with shared needles inside prison, with or without bleach cleaning. Women were more likely to report illicit drug use in prison if they had had illegal sources of income prior to incarceration (p=0.0081, OR 3.19), had previously injected drugs (p=0.036, OR 2.97), and had first injected drugs at a friend’s house (p=0.066, OR 2.70).
Interpretation
The majority of women reporting prison injection drug use also reported hepatitis C sero-positivity and shared needle use. Canadian prisons are risk situations for transmission of bloodborne pathogens, and provide opportunities for harm reduction strategies.
MeSH terms: Prisoners, high risk women, street drugs, hepatitis C, HIV
Résumé
Contexte
Le personnel clinique d’une prison pour femmes en Colombie-Britannique a observé une séroconversion par le virus de l’hépatite C chez les détenues, ce qui nous a amenés à déterminer, dans le cadre de notre étude, les caractéristiques des femmes qui déclarent ou non avoir consommé des drogues illicites en prison, les tendances de la consommation de drogues en prison, ainsi que les facteurs associés à la consommation de drogues illicites qui pourraient contribuer à la transmission d’infections véhiculées par le sang en prison.
Méthode
Nous avons créé un ensemble de données d’observation transversales d’après les réponses obtenues à un questionnaire anonyme de 61 questions, que les détenues ont rempli par elles-mêmes.
Résultats
Quatre-vingt-trois p. cent (104/126) des détenues admissibles ont participé à l’étude. Soixante-quatorze p. cent (77/104) ont déclaré que leur peine d’emprisonnement actuelle était liée à la consommation de drogues illicites, et 25 % (26/104) ont dit être d’appartenance ethnique autochtone. Quatre-vingt-treize p. cent (97/104) ont fait état d’antécédents de consommation de drogues illicites; de ce chiffre, 70 % (68/97) ont déclaré avoir fait usage de drogues injectables. Trente-six p. cent (37/104) ont déclaré avoir consommé des drogues illicites en prison, et 21 % (22/104), avoir fait usage de drogues injectables en prison. Cinquante-deux p. cent (54/104) ont dit être séropositives pour le VHC, et 8 % (8/104) ont dit être séropositives pour le VIH. Sur les 22 femmes qui s’étaient injecté des drogues en prison, 91 % (20/22) ont dit être infectées par l’hépatite C, et 86 % (19/22) avaient partagé des aiguilles en prison (nettoyées ou non à l’eau de javel au préalable). Les détenues étaient plus susceptibles de déclarer avoir consommé des drogues illicites en prison si elles avaient gagné des revenus de sources illicites avant leur incarcération (p = 0,0081, RC = 3,19), si elles s’étaient déjà injecté des drogues (p = 0,036, RC = 2,97) et si elles s’étaient déjà injecté des drogues au domicile d’un ami ou d’une amie (p = 0,066, RC = 2,70).
Interprétation
La majorité des femmes qui disent avoir fait usage de drogues injectables en prison déclarent aussi être séropositives pour le VHC et avoir partagé des aiguilles. Les prisons canadiennes présentent des risques de transmission des agents pathogènes véhiculés par le sang, et il devrait être possible d’y implanter des stratégies de réduction des méfaits.
Footnotes
The UBC Department of Family Practice supported Jonathan Berkowitz’s statistical consultation time. Valencia Remple was employed as Deborah Money’s research assistant.
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