Injection drug use the most important risk factor for HIV and HCV infections among Quebec prisoners

In this issue of CMAJ, 2 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 Quebec study is highlighted below; the Ontario study appears in a separate release posted at EurekAlert today. In both the 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 the Quebec study, Dr. Céline Poulin and colleagues gathered data from 1607 inmates (1357 men and 250 women) at 7 provincial prisons, where sentences of less than 2 years are served. The overall prevalence of HIV infection was 3.4% (8.8% among the women, and 2.4% among the men). In addition, 18.5% of the study subjects (29.2% of the women and 16.6% of the men) tested positive for HCV antibodies. Most of the HIV-positive men (68.8%) and women (59.1%) also had HCV infection. Interestingly, 20% of the HIV-positive inmates and 40% of the HCV-positive inmates did not know they had these infections. More than 90% of the participants infected by either virus reported being injection drug users before imprisonment. Given these data, the researchers conclude that HIV and HCV antibody testing and counselling should be offered to all inmates entering prison and that education and harm-reduction measures are needed.