90-90-90 for everyone?: Access to HIV care and treatment for people with HIV who experience imprisonment in Ontario, Canada

ABSTRACT

We examined HIV care and treatment in prison and after release for people with HIV in Ontario, Canada, and compared HIV care and treatment with the general population. We used administrative data to identify people with HIV released from provincial prison in 2010 and in the general population. We calculated the proportion of people with HIV who accessed HIV care in prison. We compared HIV care use between people with HIV on prison release and in the general population. We estimated the proportion of people with HIV on antiretroviral therapy in prison as the ratio of the average numbers of people prescribed antiretroviral therapy in prison in 2009/2010 and people with HIV in prison in January 2010. We compared the proportion of people with HIV on public drug benefits that filled an antiretroviral therapy prescription within 6 months for people postrelease and in the general population. Of 344 people with HIV on prison admission, 34.0% received HIV care in prison. Over 1 year, 63.6% of 330 people with HIV on prison release and 67.7% of 15,819 people with HIV in the general population accessed HIV care (p = 0.118), and 43.3% of people with HIV on prison release and 55.2% of people with HIV in the general population had 2 or more HIV care visits (p < 0.001). In prison, 52.4% of people with HIV (39.5/75.4) were on antiretroviral therapy. Of those accessing drug benefits, 60.1% of 226 people with HIV on prison release and 79.6% of 7458 people with HIV in the general population claimed an antiretroviral therapy prescription within 6 months (p < 0.001). Access to HIV care and treatment were suboptimal in prison, and sustained HIV care and treatment were worse for people post-release compared to the general population. Interventions are needed to support HIV care for this population.

KEYWORDS:

• HIV
• prisoners
• prisons
• quality of health care
• delivery of health care

Acknowledgments

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. We acknowledge the Ontario Ministry of Community Safety and Correctional Services, which provided data for the study. No endorsement by ICES, the Ontario Ministry of Health and Long-Term Care, or the Ministry of Community Safety and Correctional Services is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the authors, and not necessarily those of CIHI.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

We are not able to share data because of restrictions specified in our Research Agreement with the Ministry of Community Safety and Correctional Services (MCSCS) and in the data sharing agreements of ICES. Anyone who would like to request access to data from the MCSCS would need permission from the MCSCS, and should direct requests to Michael Kirk at [email protected]. Access to data at ICES can be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/ Requests to access ICES data for research purposes may be submitted to ICES’ Data and Analytic Services, with information at http://www.ices.on.ca/DAS and contact: [email protected].

Additional information

Funding

This study was funded by an Emerging Priority Award (#1081) from the Ontario HIV Treatment Network.