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Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities

From the HIV Social, Behavioural and Epidemiological Studies Unit (Calzavara, Ramuscak, Myers, Raymond) and the Department of Public Health Sciences (Calzavara, Myers), Faculty of Medicine, University of Toronto, Toronto; the HIV Laboratory (Swantee, Fearon), Central Public Health Laboratory, Ontario Ministry of Health and Long-Term Care, Toronto; and the Department of Medicine (Ford), Queen's University, Kingston, Ont.

Correspondence to: Dr. Liviana Calzavara, HIV Social Behavioural and Epidemiological Studies Unit, Department of Public Health Sciences, University of Toronto, 5th floor, Health Sciences Building, 155 College Street, Toronto ON M5T 3M7; fax 416 971-2704; liviana.calzavara{at}utoronto.ca

Background: Each year more than 56 000 adult and young offenders are admitted to Ontario's remand facilities (jails, detention centres and youth centres). The prevalence of HIV infection in Ontario remand facilities was last measured over a decade ago, and no research on the prevalence of hepatitis C virus (HCV) infection has been conducted in such facilities. We sought to determine the prevalence of HIV infection, HCV infection and HIV–HCV coinfection among inmates in Ontario's remand facilities.

Methods: A voluntary and anonymous cross-sectional prevalence study of HIV and HCV infections was conducted among people admitted to 13 selected remand facilities across Ontario between Feb. 1, 2003, and June 20, 2004. Data collection included a saliva specimen for HIV and HCV antibody screening and an interviewer-administered survey. Prevalence rates and 95% confidence intervals were calculated and examined according to demographic characteristics, region of incarceration and self-reported history of injection drug use.

Results: In total, 1877 participants provided both a saliva specimen and survey information. Among the adult participants, the prevalence of HIV infection was 2.1% among men and 1.8% among women. Adult offenders most likely to have HIV infection were older offenders ( 30 years) and injection drug users. The prevalence of HCV infection was 15.9% among men, 30.2% among women and 54.7% among injection drug users. Adult offenders most likely to have HCV infection were women, older offenders ( 30 years) and injection drug users. The prevalence of HCV–HIV coinfection was 1.2% among men and 1.5% among women. It was highest among older inmates and injection drug users. Among the young offenders, none was HIV positive and 1 (0.4%) was HCV positive. On the basis of the study results, we estimated that 1079 HIV-positive adults and 9208 HCV-positive adults were admitted to remand facilities in Ontario from Apr. 1, 2003, to Mar. 31, 2004.

Interpretation: Adult offenders entering Ontario remand facilities have a considerably higher prevalence of HIV and HCV infections than the general population.

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