Coping with HIV/AIDS in Canadian Mens Penitentiaries - Research Paper Example

Coping with HIV/AIDS in Canadian Men’s Penitentiaries Introduction The prison environment has been identified as a high-risk environment for transmissions of the HIV/AIDS disease; yet, adequate measures of tackling the problem have not been effected in Canadian prison systems. Indeed, the prevalence rate of HIV in penitentiaries is ten times more than in the general population. Some factors that contribute to the high transmission of HIV include overcrowding, a culture of violence, lack of information regarding HIV and inadequate health facilities (Satpathy, p.223). According to the National Collaborating Centre for Infectious Diseases (2008), some measures of preventing transmission have been employed in Canada, namely voluntary counseling and testing, needle exchange programs, Methadone Malignance treatment and bleach and condom distribution. Nevertheless, the Canadian authority is not handling the HIV and Aids epidemic in prisons properly compared to other developed countries. Ainslie et al (1992) attribute the dire situation in Canadian prison systems to government’s inaction and notes that the situation can be improved through a comprehensive AIDS/Aids policy, which includes education and prevention programs, and support and medical services. However, Hankins (2006) notes that there is lack of political will to deal with HIV/Aids problem in Canadian correctional institutions. While the citizens’ attitudes regarding investing public resources to dealing with the problems is unclear. This research study examines the current position of men correctional centers in Canada and how they are handling HIV and Aids epidemic. Further, the study evaluates the measures being used in handling HIV disease and sufferers in detention. Moreover, the study will give recommendation to be implemented. Thesis statement: There are a high number of the prisoners infected with HIV/ Aids in Canadian prisons. Moreover, prisons have been identified as high risk environment, since transmission is increasing among incarcerated persons. In most Canadian male penitentiaries, basic HIV prevention and managing measures are limited or absent. However, the government and other not-for–profit institutions are aligning new policies and strategies of handling the problem. HIV/AIDS situation in Canadian Men’s penitentiaries The HIV and Aids epidemic is providing a new and difficult challenge to many governments and prison administrators in the world. Studies have revealed that the prevalence of reported HIV cases is 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 (CSC, 2008). Additionally, there is an increase in number of new infection cases among incarcerated persons in correctional facilities. This situation is a major concern for the government and HIV/AIDS advocacy groups in Canada. However, ‘the Canada’s policy and legal response to HIV/Aids has generally been slow, cautious, and rational hence lacks HIV/Aids-specific legislation’ (Frankowski, p.63). The graph below demonstrates the number of reported cases of HIV infections among prisoners in provisional and federal corrections between 1989 and 2001. Source: Correctional Service of Canada. (2008). Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01. http://www.csc-scc.gc.ca/text/pblct/infectiousdiseases/6-eng.shtml. According to Jurgens (2008), the high prevalence rates of HIV cases in prisons is mainly due to high-risk behaviors engaged by inmates before incarceration. Transmission of HIV and Aids in prison is mainly through sharing of drug injections, sexual activities, tattooing and violence. Despite drugs being illegal substances, incarcerated persons always access drugs while in prisons. Besides, most prisoners have drug addictions; in order to sustain the habit, the prisoners are compelled to share injections. Additionally, other inmates with no previous history of drug taking habit may be lured into the act, as it is a copping mechanism. Few researches have been conducted on the number of inmates who have contracted HIV in prison through drug injections. This is primarily the lack of acknowledgement from the prison administrators that drug use in their institutions is still prevalent. Additionally, the transmission of HIV and Aids in men penitentiaries is predominantly assumed to be spread through illegal acts, hence not addressed. In Canada, ‘11 percent of 4,285 federal prisoners participating in a survey of prisoners self-reported having injected since arriving in their current penal institution. In some regions, up to 23 percent of prisoners reported injection drug use and more recent studies confirm high levels of injection drug use’ (Jurgen, 2003). Another risky behavior that exposes inmates to transmission of HIV and Aids viruses is tattooing which involves sharing of needles. The social culture of tattooing in Canadian penitentiaries is viewed as a badge of honor for persons who have served jail sentences. Thus, many men in jail use shared needles to tattoo one another, hence predisposing themselves to HIV viruses. The Correctional Service of Canada initiated a tattooing pilot project in some federal jails in order to reduce cases of infection through sharing non sterile of tattooing equipment (Canadian HIV/AIDS Legal Network, p.6). According to BonnyCastle (2011) participation of prison tattooing is very common among all races of prisoners. Further, unprotected sex between males in prison has also contributed to increase of transmission of HIV and Aids. Although sexual activities between inmates are outlawed, the practice continues to flourish in the overcrowded Canadian penitentiaries. Moreover, the government does not compel involuntary antibody testing among inmates upon entrance into correctional facilities (Jurgen, p. 22). Research done by others Most researchers have recognized that Canada lags behind other developed countries in dealing with HIV and Aids in correctional institution. However, few researchers have given appropriate recommendations concerning the issue. Therefore, this research study will not only present the current situation in corrections facilities but also give appropriate recommendation. The National Collaborating Centre for Infectious Diseases (2008) have outlined some strategies that can used in Canada to limited the spread of HIV and Aids. These measures include voluntary counseling and testing, needle exchange programs, Methadone Malignance treatment and bleach and condom distribution. This research study will evaluate the effectiveness of the various approaches used to handle HIV and Aids. For example, in spite of Canadian government policy of providing condoms to its penitentiaries; several provincial institutions have failed to implement the policy (Hankins, p.1). The race or ethnicity of an inmate may predispose one to HIV and Aids due to their socialization. Canadian Aboriginal Aids Network (2006) notes that there are few studies conducted on the effects and prevalence of HIV and Aids among the Aboriginal communities. According to Hankins (2006), all new HIV infections in Canadian correctional institutions are directly linked taking of drugs through injection before incarceration. This research will demonstrate that new infections in Canadian systems are not only linked IUD before incarceration but also other additional factors like tattooing and sexual activities. Limitation of the study Due to the sensitive and personal nature of information required, most studies relied on self-reporting studies rather than randomly selection of a sample. Further, the federal and provisional correctional centers do not give confidential information regarding the inmates in their institutions. Researchers are not able to identify the actual mode of HIV transmission since most inmates are involved in multiple behaviors which predisposed them to the virus. For examples inmates are likely to use drugs through shared injection and at the same time share needles for tattooing. Besides it is difficult to establish the actual prevalence rate with prison systems since some prisoners do not get tested. The researchers have no access to data of incarcerated aboriginals people in Canada infected with HIV and Aids; thus, the study cannot provide comparative findings between races (CCL, 2008). Significance of the study The significance of this research study is that the study will gather up to date information and knowledge on the issue of HIV/ AIDS in men prisons. Thus the government and other non-government organizations can handle the problem from an informed point of view. A model policy for dealing with HIV/AIDS in the Canadian prison system is proposed which will build on many of the recommendations. Moreover, ‘the information obtained from this study can be used to inform public health practitioners and community-based workers and guide their practice’ (National Collaborating Centre for Infectious Diseases, 2008). Further, information gathered can be used to appraise the current methods of coping with HIV and Aids been utilized in Canadian correction institutions. The study, in addition looks at issues affecting Aboriginal community in prisons. Research questions The following research questions will be used to analyze how men correctional centers in Canada are coping with HIV/Aids. The questions will also guide on identifying factors promoting the spread of HIV and Aids. Moreover, the policies set by the federal or provincial governments on handling HIV related issues. 1. Does one need to get tested for HIV/AIDS prior to their prison stay? 2. If one happens to catch the virus, are there any available medical treatments in prison? If so, how accessible are they to the patients? 3. If one is infected, are they given special treatments in a secluded cell to help fight the virus? Or are they given no such privileges in prison? 4. Do the administrators of the prison have governmental rules to follow that will be communicated to their guardians and medical specialists? 5. Are there treatment programs? 6. Also, although we know drugs are illegal in this kind of institution – are there any politics for the distribution for clean syringes for prisoners? Additionally, there are some core issues investigated concerning coping with HIV and Aids in Canadian penitentiaries; firstly, the use of drugs especially through injections. The study of use of drugs in prisons is significant to prevalence of HIV/Aids; due to restrictions inmates are compelled to share needles and syringes which increase transmission of the disease. Besides, it is estimated that between twenty and seventy four percent of male Canadian incarcerated persons in federal institutions are or have used drugs while serving their sentences (National Collaborating Centre for Infectious Diseases, 2008). Further, random urine testing to detect inmates taking drugs has not been effective, since inmates have resulted to using intravenous drugs which have a short window of detection. Moreover, persons living with HIV and taking drugs require additional specialized management. Secondly, sexual activities among inmates both with consent and without were investigated. Despite sexual activities being outlaw in Canadian penitentiaries, these acts are very prevalent. Scientific studies have established that men who have sex with other men have higher chances of contracting HIV and Aids. Besides, the major motor of HIV transmission in Canada is through homosexuals and bisexual men (Hankins, p.2). Indeed, it is reported that six percent of federal inmates in Canada engaged in sexual activities with other prisoners; and only two-thirds had used condoms. Prevention of transmission of sexually transmitted diseases through use of condoms depends on knowledge of appropriate use of condoms. Despite availability of condoms, there is no adequate knowledge on their usage, hence limiting their effectiveness. Thirdly, educational and mental levels of the inmates were evaluated; the level of education attained by inmates is a factor that contributes to the understanding of transmission, and prevention methods of Aids. Inmates with basic education are easily taught and informed of HIV and Aids compared to their illiterate counterparts. Moreover understanding of the education level is essential in order to prepare appropriate language and tools when training them. Due to the harsh conditions in penitentiaries, most prisoners lack mental stability which affects the choice of decisions or they subjected to violence attacks and rape from other inmates. Besides, caring or training of HIV patients with mental illness requires more specialization (Citron et al, 2005). Fourthly, the legality and the practice of prison tattooing was explored; the culture of tattooing in male prisons is very dominant. In 2006, a Canadian conservative minister terminated a tattooing project since there was no clarity of its significance or legality of tattooing (BonnyCastle, 2011). Additionally, the culture of tattooing is more prevent than injection of drugs (Satpathy, p.231). However, the inmates lack appropriate and safe equipment for making tattoos leading sharing of non sterile surgical needles and other equipment that transmit HIV and Aids. Some policies, of providing bleach to prisoners to sterile their tattooing equipment has been drafted, however there are concerns about the safety of prisoners handling the bleach (Smith, p.216). Subsequently, another key factor influencing HIV and Aids in Canadian prisons is race and ethnicity. Jurgen (1994) asserts that there are different challenges when handling issues relating to HIV and Aids among Aboriginals inmates compared with other Canadians. This is due to the presence of cultural barriers to overcome in order to prevent new infections and care for those already infected effectively (Jurgen, p. 9). The aboriginal community in prison who has generally lower health status may require specialized care and treatment. Besides, they face a lot of racism. According to CCL (2008), the Aboriginal people represented 18.8 percent in 1998 and 25.5 percent in 2003 of the 30 percent HIV reported cases in prisons. These statistics illustrate that there could be factors predisposing Aboriginals to HIV more than other races. Finally, I also investigated policies regarding confidentially and social stigma. Social stigmatization is one factor limiting persons from getting tested hence a lot of people are living in the dark. Moreover, inmates getting tested for HIV and Aids in penitentiaries are concerned with confidentially of their health status. Additionally, many inmates who are sexually active are not confident enough to pick condoms provided in prisons in fear of victimization. Lack of confidentiality discourages inmates from disclosing their drug use behaviors (Hankins, p.2). Further, Hankins, (2006) suggest that the low confidential services provided by nominal basis could be a deterrent for inmates to get tested. Thus, there is need to understand the government policy governing confidentiality of health status of persons in prisons. Conclusions From this, it is clear that enough effort to prevent of new transmission, care, and treatment of inmates infected with HIV and Aids and provision of support has not been done. In spite of having policies in place like distribution of condoms and bleach, the effectiveness of these policies is not apparent. Thus, the government needs to review and monitor how prison administrators are running projects geared towards coping with HIV and Aids. Additionally, the government has failed to meet its moral and legal obligation of providing prevention and care for HIV patients, as it has failed to fund and support some initiatives (Frankowski, p.116). Moreover, the government and prison administrators have not dealt with the issue of compassionate or medical parole to inmates in their advanced stages of Aids (Smith, 1998). The prisoners need empowerment so as to facilitate them in making sound decisions concerning their health. Most prisoners have no adequate understanding of consequences of some behaviors they involve in. Thus, a comprehensive educational program can be used to empower the inmates. Testing and treating should be done by staff from community-based organizations rather than prison staff to ensure total confidentiality (PACAS, 1992). Moreover, when designing the HIV programs some critical factors should be considered namely culture, gender, sexual orientation and mental and physical ability. For example, creation of Aboriginal peer education and counseling groups may be more effective than groups comprising different races. The HIV programs used in incarceration institutions should address prevention of new infections and care of inmates who are infected with the HIV virus. These issues can be addressed through education; through education the inmates can learn the risks behaviors. Additionally, anti-stigmatization programs can be used to educate all persons in the correctional systems on the negative effects of stigmatization. Non-nominal testing, where personal information is not recorded should be introduced to enhance confidentiality hence encourage more inmates to get tested (Hankins, p.3). Thus, the most appropriate program is one that encourages maximum risks assessment and testing. According to Satpathy (2003), healthcare provision in Canadian penitentiaries should be provided by public health staff rather than prison management. Because, studies have indicated that public health officer provide better services compared to prison management; this can be attributed to the relationship between prisoners and the prison staff. The method used by prison administrators to distribute condoms is not effective hence deterring inmates from using them. Therefore, a more discrete method should be used, for example dispensing machines. Another scheme for preventing spread of HIV is through the use of needles and syringes exchange programs where inmates exchange used syringes and needles for new ones. This practice is very controversial since drugs are illegal and facilitation of easier access to needles and syringes is seen as promoting drug abuse by some administrators. Methadone is provided prisons for inmates wishing to withdraw drug taking; however inconsistent supply cause some inmates to discontinue with the program. The environment of the prisons is contributing to spread of HIV and Aids since most penitentiaries are highly overcrowded. The prisons systems are in poor hygienic condition which promotes spread of other opportunistic diseases especially to prisoners already infected with HIV virus (Satpathy, 2003). Works Cited Ainslie, Donald et al. “HIV/AIDS in Prison Systems: A Comprehensive Strategy”. Prisoners with HIV/AIDS Support Action Network. 1992. 29 March 2011. http://www.heart-intl.net/HEART/120104/HIV-AIDSinPrisonSystems92.pdf. BonnyCastle, Kevin, “The Social Organisation of Penal Tattooing in Two Canadian Federal Male Prisons: Locating Sites of Risk for Empirically-Based Health Care Interventions.” The Howard Journal, Vol. 50 No. 1, pp. 17–33. February 2011. 29 March 2011. http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2311.2010.00632.x/pdf. Canadian HIV/AIDS Legal Network. HIV and Hepatitis C in prisons. 2003. 29 March 2011.http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=1309. Citron, Kenneth, et al. HIV and psychiatry: training and resource manual. NY: Cambridge: Cambridge University Press. 2005. Correctional Service of Canada. Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01. 2008. 29 March 2011. http://www.csc-scc.gc.ca/text/pblct/infectiousdiseases/6-eng.shtml Frankowski, Stanslaw. Legal responses to AIDS in comparative perspective. Hague: Martinus Nijhoff Publishers. 1998. Hankins, Catherine. Confronting HIV infection in prisons. 2006. 29 March 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337128/pdf/cmaj00054-0025.pdf. Jurgen, Ralf. Final report of the Expert Committee on AIDS and Prisons. Ontario: DIANE Publishing. 1994. Jurgen, Ralf. HIV/Aids Prevention For Drug Dependent Persons Within The Criminal Justice System. 1992. 29 March 2011. http://www.harm-reduction.org/ru/images/stories/doc/Sekc/RU_Harm%20reduction%20in%20prisons/HIVAIDS%20PREVENTION%20FOR%20DRUG%20DEPENDENT%20PERSONS.pdf. National Collaborating Centre for Infectious Diseases. Primary HIV Prevention Interventions in Prisons and Upon Release. 2008. 29 March 2011. http://www.nccid.ca/en/files/Evidence_reviews/HIV_Prevention_in_Prison_Eng_2008_04_18.pdf. Satpathy, G. C. Encyclopedia of Aids. Volume 6. New Delhi: Gyan Publishing House. 2003. Smith, Raymond. Encyclopedia of AIDS: a social, political, cultural, and scientific record of the HIV epidemic. Chicago: Taylor & Francis. 1998. Read More