Canadian Journal of Public Health

, Volume 110, Issue 5, pp 675–682 | Cite as

A comparison of the observed and expected prevalence of HIV in persons released from Ontario provincial prisons in 2010

  • Ryan Van Meer
  • Tony Antoniou
  • Daniel McCormack
  • Sumeet Khanna
  • Claire Kendall
  • Lori Kiefer
  • Fiona G. KouyoumdjianEmail author
Quantitative Research



To estimate the prevalence of HIV infection in persons released from Ontario prisons in 2010 using administrative health data, and to compare this observed prevalence with the expected prevalence based on the most recently available biological sampling data.


We linked identifying data for all adults released from Ontario provincial prisons in 2010 with administrative health data, and applied a validated algorithm to determine the observed HIV prevalence. We calculated the expected HIV prevalence using 2003–2004 age stratum-specific data from a published study using salivary sampling. We calculated an indirect standardized prevalence ratio of the observed to expected prevalence and 95% confidence intervals. Finally, we conducted sensitivity analyses to adjust for the sensitivity of the algorithm to identify persons with HIV and for undiagnosed HIV infection.


Of 52,313 persons released from Ontario prisons in 2010, we identified 363 persons with HIV, for an observed prevalence of 0.69%. The expected prevalence was 2.38%. Standardized for age, we found a prevalence ratio of 0.29 (95% CI, 0.17–0.77). Sensitivity analyses adjusting for the algorithm’s sensitivity and further adjusting for undiagnosed HIV infection produced standardized prevalence ratios of 0.30 and 0.38, respectively.


Our findings suggest that a high proportion of persons with HIV recently released from provincial prisons either do not know they have HIV infection or do know about their infection but are not engaged in care. Interventions are required to screen people for HIV in prison and to link persons with care following release.


HIV Prisoners Diagnosis Canada 



Estimer la prévalence des infections à VIH chez les personnes libérées de prison en Ontario en 2010 à l’aide de données administratives sur la santé, et comparer cette prévalence observée à la prévalence attendue d’après les données d’échantillonnage biologique les plus récentes.


Nous avons jumelé les données d’identification de tous les adultes libérés des prisons ontariennes en 2010 avec les données administratives sur la santé et appliqué un algorithme validé pour déterminer la prévalence observée du VIH. Nous avons calculé la prévalence attendue du VIH à l’aide des données de 2003-2004 différenciées par strate d’âge tirées d’une étude publiée ayant utilisé des échantillons de salive. Nous avons calculé le ratio de prévalence standardisé indirect de la prévalence observée à la prévalence attendue et l’intervalle de confiance de 95 %. Enfin, nous avons mené des analyses de sensibilité pour tenir compte de la sensibilité de l’algorithme à repérer les personnes atteintes du VIH et les infections à VIH non diagnostiquées.


Sur les 52 313 personnes libérées de prison en Ontario en 2010, nous avons trouvé 363 personnes atteintes du VIH, soit une prévalence observée de 0,69 %. La prévalence attendue était de 2,38 %. En standardisant les données selon l’âge, nous avons obtenu un ratio de prévalence de 0,29 (IC de 95 % : 0,17-0,77). Des analyses de sensibilité ajustées selon la sensibilité de l’algorithme, puis selon les infections à VIH non diagnostiquées ont produit des ratios de prévalence standardisés de 0,30 et de 0,38, respectivement.


Nos constatations indiquent qu’une proportion élevée de personnes atteintes du VIH récemment libérées des prisons provinciales ignorent qu’elles ont une infection à VIH ou savent qu’elles sont infectées, mais ne sont pas soignées. Des interventions sont nécessaires pour dépister le VIH en prison et pour diriger les personnes infectées vers les soins appropriés après leur libération.


VIH Prisonniers Diagnostic Canada 



  1. A health care needs assessment of federal inmates in Canada. [Supplement] Canadian Journal of Public Health 2004; 95 Suppl 1, S9–63.Google Scholar
  2. Antoniou, T., Zagorski, B., Loutfy, M. R., Strike, C., & Glazier, R. H. (2011). Validation of case-finding algorithms derived from administrative data for identifying adults living with human immunodeficiency virus infection. PLoS One, 6(6), e21748.CrossRefGoogle Scholar
  3. Bonnycastle, K. D., & Villebrun, C. (2011). Injecting risk into prison sentences: a quantitative analysis of a prisoner-driven survey to measure HCV/HIV seroprevalence, risk practices, and viral testing at one Canadian male federal prison. Prison Journal, 91(3), 325–346.CrossRefGoogle Scholar
  4. Burchell, A. N., Calzavara, L. M., Myers, T., et al. (2003). Voluntary HIV testing among inmates: sociodemographic, behavioral risk, and attitudinal correlates. Journal of Acquired Immune Deficiency Syndromes: JAIDS, 32(5), 534–541.CrossRefGoogle Scholar
  5. Buxton, J. A., Rothon, D., Durigon, M., et al. (2009). Hepatitis C and HIV prevalence using oral mucosal transudate, and reported drug use and sexual behaviours of youth in custody in British Columbia. Canadian Journal of Public Health, 100(2), 121–124.CrossRefGoogle Scholar
  6. Calzavara, L. M., Major, C., Myers, T., et al. (1995). The prevalence of HIV-1 infection among inmates in Ontario, Canada. Canadian Journal of Public Health, 86(5), 335–339.PubMedGoogle Scholar
  7. Calzavara, L., Ramuscak, N., Burchell, A. N., et al. (2007). Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities. Canadian Medical Association Journal, 177(3), 257–261.CrossRefGoogle Scholar
  8. Correctional Service Canada. (2016). Human Immunodeficiency Virus (HIV) Age, Gender and Indigenous Ancestry. (accessed September 24 2018).
  9. Courtemanche, Y., Poulin, C., Serhir, B., & Alary, M. (2018). HIV and hepatitis C virus infections in Quebec’s provincial detention centres: comparing prevalence and related risky behaviours between 2003 and 2014-2015. Canadian Journal of Public Health, 109(3), 353–361.CrossRefGoogle Scholar
  10. De, P., Connor, N., Bouchard, F., & Sutherland, D. (2004). HIV and hepatitis C virus testing and seropositivity rates in Canadian federal penitentiaries: a critical opportunity for care and prevention. Canadian Journal of Infectious Diseases and Medical Microbiology, 15(4), 221–225.CrossRefGoogle Scholar
  11. Dufour, A., Alary, M., Poulin, C., et al. (1996). Prevalence and risk behaviours for HIV infection among inmates of a provincial prison in Quebec City. AIDS, 10(9), 1009–1015.CrossRefGoogle Scholar
  12. Ford, P. M., White, C., Kaufmann, H., et al. (1995). Voluntary anonymous linked study of the prevalence of HIV infection and hepatitis C among inmates in a Canadian federal penitentiary for women. CMAJ Canadian Medical Association Journal, 153(11), 1605–1609.PubMedPubMedCentralGoogle Scholar
  13. Ford, P. M., Pearson, M., Sankar-Mistry, P., Stevenson, T., Bell, D., & Austin, J. (2000). HIV, hepatitis C and risk behaviour in a Canadian medium-security federal penitentiary. Queen’s University HIV Prison Study Group. Qjm, 93(2), 113–119.CrossRefGoogle Scholar
  14. Gagnon, H., Godin, G., Alary, M., Lambert, G., Lambert, L. D., & Landry, S. (2007). Prison inmates’ intention to demand that bleach be used for cleaning tattooing and piercing equipment. Canadian Journal of Public Health, 98(4), 297–300.CrossRefGoogle Scholar
  15. Iroh, P. A., Mayo, H., & Nijhawan, A. E. (2015). The HIV care cascade before, during, and after incarceration: a systematic review and data synthesis. American Journal of Public Health, 105(7), e5–e16.Google Scholar
  16. Kamarulzaman, A., Reid, S. E., Schwitters, A., et al. (2016). Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners. Lancet, 388(10049), 1115–1126.CrossRefGoogle Scholar
  17. Khanna S, Leah J, Fung K, Antoniou T, Kouyoumdjian F. (2019). Health care utilization by people with HIV on release from provincial prison in Ontario, Canada in 2010: a retrospective cohort study. AIDS Care, 31(7), 785-792.Google Scholar
  18. Kouyoumdjian, F., Calzavara, L. M., Kiefer, L., Main, C., & Bondy, S. J. (2014). Drug use prior to incarceration and associated socio-behavioural factors among males in a provincial correctional facility in Ontario, Canada. Canadian Journal of Public Health, 105(3), 198–202.CrossRefGoogle Scholar
  19. Kouyoumdjian, F., Schuler, A., Matheson, F. I., & Hwang, S. W. (2016). Health status of prisoners in Canada: narrative review. Canadian Family Physician, 62(3), 215–222.PubMedPubMedCentralGoogle Scholar
  20. Kouyoumdjian, F. G., Cheng, S. Y., Fung, K., et al. (2018). The health care utilization of people in prison and after prison release: a population-based cohort study in Ontario, Canada. PLoS One, 13(8), e0201592.CrossRefGoogle Scholar
  21. Martin, R. E., Gold, F., Murphy, W., Remple, V., Berkowitz, J., & Money, D. (2005). Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia. Canadian Journal of Public Health, 96(2), 97–101.CrossRefGoogle Scholar
  22. Poulin, C., Alary, M., Lambert, G., et al. (2007). Prevalence of HIV and hepatitis C virus infections among inmates of Quebec provincial prisons. Canadian Medical Association Journal, 177(3), 252–256.CrossRefGoogle Scholar
  23. Public Health Agency of Canada 2014. Summary: estimates of HIV incidence, prevalence and proportion undiagnosed in Canada. 2015. (accessed September 24 2018).
  24. Public Health Agency of Canada 2016. Summary: measuring Canada’s progress on the 90-90-90 HIV targets, 2016Google Scholar
  25. Reitano J. 2017. Adult correctional statistics in Canada, 2015/2016. (accessed October 18 2018).
  26. Rich, J. D., DiClemente, R., Levy, J., et al. (2013). Correctional facilities as partners in reducing HIV disparities. Journal of Acquired Immune Deficiency Syndromes, 63(Suppl 1), S49–S53.CrossRefGoogle Scholar
  27. Rich, J. D., Beckwith, C. G., Macmadu, A., et al. (2016). Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis. Lancet, 388(10049), 1103–1114.CrossRefGoogle Scholar
  28. Robinson D, Mirabelli, L. 1996. Summary of findings of the 1995 CSC National Inmate Survey. (accessed November 18 2014).
  29. Rothon, D. A., Mathias, R. G., & Schechter, M. T. (1994). Prevalence of HIV infection in provincial prisons in British Columbia. CMAJ Canadian Medical Association Journal, 151(6), 781–787.PubMedPubMedCentralGoogle Scholar
  30. Smith A, Cox K, Poon C, Stewart D 2013. McCreary Centre Society. Time Out III: a profile of BC youth in custody. (accessed December 1 2014).
  31. Statistics Canada 2014. Canada’s population estimates: age and sex, 2014. (accessed October 18 2018).
  32. Thompson J, Zakaria D, Grant B 2011. Aboriginal men: a summary of the findings of the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey, R-237. (accessed June 16 2014).
  33. Wood, E., Li, K., Small, W., Montaner, J. S., Schechter, W. T., & Kerr, T. (2005). Recent incarceration independently associated with syringe sharing by injection drug users. Public Health Reports, 120(2), 150–156.CrossRefGoogle Scholar
  34. World Health Organization 2016. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, updated version. (accessed September 24 2018).
  35. Zakaria D, Thompson JM, Jarvis A, Borgatta F. 2010. Summary of emerging findings from the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey. (accessed June 16 2014).

Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  • Ryan Van Meer
    • 1
  • Tony Antoniou
    • 2
    • 3
    • 4
  • Daniel McCormack
    • 2
  • Sumeet Khanna
    • 3
  • Claire Kendall
    • 2
    • 5
    • 6
  • Lori Kiefer
    • 7
    • 8
  • Fiona G. Kouyoumdjian
    • 2
    • 9
    • 10
    Email author
  1. 1.Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
  2. 2.ICESTorontoCanada
  3. 3.Department of Family and Community MedicineSt. Michael’s Hospital and University of TorontoTorontoCanada
  4. 4.Li Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  5. 5.C.T. Lamont Primary Health Care Research Group, Bruyère Research InstituteOttawaCanada
  6. 6.Department of Family MedicineUniversity of OttawaOttawaCanada
  7. 7.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  8. 8.Ministry of Community Safety and Correctional ServicesTorontoCanada
  9. 9.Department of Family MedicineMcMaster UniversityHamiltonCanada
  10. 10.MAP Centre for Urban Health Solutions, St. Michael’s HospitalTorontoCanada

Personalised recommendations