Background: Analyses of the individual-, social- and structural-level factors promoting
the transmission of HIV and other blood-borne pathogens have consistently identified
exposure to correctional environments, especially for individuals who use injection
drugs (IDU), as a risk factor for infection. The objectives of this project were: to review
the epidemiologic literature on incarceration and HIV infection among IDU, critically
examining evidence presented supporting a causal linkage between imprisonment and
infection; to investigate incarceration experiences in a cohort of active IDU; and to
assess the possible effects of incarceration on the post-release risk environment of
active IDU.
Methods: Longitudinal datasets for quantitative analyses were derived from the
Vancouver Injection Drug User Study (VIDUS) and the Scientific Evaluation of
Supervised Injection (SEOSI), both prospective cohorts of IDU in Vancouver’s
Downtown Eastside neighbourhood. In the first analysis, the prevalence and correlates
of reporting incarceration in the the previous six months were identified in SEOSI using
generalized estimating equations (GEE). In the second analysis, the possible effect of
imprisonment on the prevalence of risk factors for HIV infection was estimated in
VIDUS using linear growth curve analysis.
Results: In the first analysis, 902 individuals interviewed at least once between 1 July
2004 and 30 June 2006 were included. Overall, 423 (46.9%) reported an incarceration
event at some point during the study period. In a multivariate GEE model, recent
incarceration was independently associated with a number of high-risk factors,
including syringe sharing. In the second analysis, 1603 individuals were interviewed at
least once between 1 May 1996 and 31 December 2005 and in cluded. Of these, 147
(9.2%) matched the study criteria and were included as cases; 742 (46.3%) were included
as matched controls. In linear growth curve analyses adjusted for age, gender and
ethnicity, syringe sharing was significantly more common in the incarcerated group (p
= 0.03) after incarceration than in the control group.
Conclusions: Our findings support the existence of a role for incarceration in continued
viral transmission. In response, appropriate harm reduction measures should be
expanded within correctional environments and social, political and legal reforms
enacted to reduce the incidence of imprisonment for individuals who use illicit drugs.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:BVAU./3433 |
| Date | 05 1900 |
| Creators | Milloy, Michael-John Sheridan |
| Publisher | University of British Columbia |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | 1091097 bytes, application/pdf |
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