1. Access to Services in Prison and Beyond
Jennifer Wheatley, Assistant Commissioner Health Services
Health Services Sector, Correctional Services Canada

2. Background Correctional Services Canada(CSC) is:
Responsible for administering court-imposed sentences of 2 years or more for adult offenders
Mandated under the Corrections and Conditional Release Act (CCRA) to provide all essential health care and access to non-essential mental health services that conforms to professionally accepted standards
Responsible for the safety and security of both staff and offenders and are key priorities for CSC
Responsible for the management of 43 institutions in 5 regions
including institutional health care units, regional mental health treatment centres and regional hospitals
Responsible for 14, 300 offenders in custody of which 95% are male and 5% female1
1Source: CSC Departmental Performance Report, ,
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3. Background
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4. Background Injection Drug Use
There are a number of published reports that give consistent estimates of injection drug use prior to incarceration at CSC:
22% of men and 29% of women reported a lifetime history of injection drug use (anonymous survey)1;
21% of men reported a history of injection drug use on a standardized intake assessment instrument2,3;
Studies based on the self-reported health status of federally sentenced offenders at intake found that 21% of men and 27% of women reported ever-having injected drugs4;
Data from 2007 found that 17% of inmates reported injecting drugs (at least once) in the past 6 months1
1- Research Report: Emerging Findings from the Inmate Survey” April 2010;
2 - Research Snippet “Prevalence of Injection Drug Use among Male Offenders”. October 2010, Number 10-2;
3 - Research in Brief “Lifetime Substance Use Patterns of Men Offenders”, February 2015, Number 14-43;
4 - Emerging Research Results “Self-Reported Physical Health Status of Incoming Federally-Sentenced Women Offenders: Comparison to Men Offenders”, March 2014, Number 14-5
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5. HIV / HCV Prevention and Treatment
CSC has policies and programs that support all 15 of UNODC recommendations for HIV prevention, including
HIV / HCV screening and testing on admission and throughout incarceration
Access to counselling and medical treatment
Pre-Exposure Prophylaxis (PrEP)
Health promotion and peer support programs
Access to harm reduction (condoms, dental dams, bleach)
Opiate Substitution Therapy (OST)
Nasal naloxone
Take-home Naloxone program at release
Prison Needle Exchange Program (PNEP)
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6. HIV in CSC
The prevalence of HIV among CSC inmates has declined from 2.02% in 2007 to 1.19% in 2014 and 1.28% in 2016 (
Through the Government of Canada, CSC supports UNAIDS HIV ‘‘treatment as prevention’’ targets of ‘‘ ’’ by the year 2020.
Preliminary results for CSC in 2016–2017 indicate that:
- 96% of newly admitted offenders to CSC accepted a voluntary blood test for HIV;
- 94% of inmates known to be living with HIV were on HIV treatment; and
- 91% of inmates on HIV treatment demonstrated viral suppression at follow-up
( health/services/publications/diseases- conditions/backgrounder-progress hiv- targets.html)
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7. HEPATITIS C VIRUS
CSC’s proactive ‘‘treatment as prevention’’ approach with all-oral anti-hepatitis C medications (doubled from 300 in 2015–2016 to over 600 in 2016–2017) has contributed to a 50% decline in HCV prevalence from 18% in 2014 to 7.7% in 2016. (
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8. Pre-Exposure Prophylaxis (PrEP)
Pre-exposure Prophylaxis (PrEP) is available to inmates at high-risk of HIV acquisition
Sexual transmission of HIV (including MSM, sero-discordant partners, and sex work)
Injection drug use
Inmates are assessed for HIV risk by institutional physician
Agree to baseline testing and follow up
Formal program launched July 2018
NOTE: post-exposure prophylaxis (PEP) is also available for inmates
References: CATIE; CDC; Government of Canada; Justin Sullivan via Getty Images
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9. Health Promotion
Health Promotion and Harm Reduction information at admission
Inmate fact sheets on a wide number of health topics
Peer support programs in place
Mental Health Workshops
Anti HIV-stigma campaigns
Inmate television and inmate library
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10. Harm Reduction Condom/dental damn and lubricant distribution
Bleach distribution
Nasal naloxone (correctional officers)
Take-home Naloxone program at release
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11. Opiate Substitution Therapy Drug Counselling & Treatment
Offenders may participate in Narcotics Anonymous (NA) during incarceration (inreach or outreach)
Access to counselling from Mental Health Services
Access to Opioid Substitution Therapy (OST) since 2001
Implementing Suboxone® film and injectable buprenorphine (Fall 2018)
25% increase in the number of inmates on OST since Oct 2016
> inmates were on OST Dec. 2017
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12. Prison-based Needle Exchange Program (PNEP)
PNEP is a Health Services Harm reduction program consistent with Government of Canada Canadian Drug and Substance Strategy (CDSS)
ARE YOU AT RISK ?
Do you inject drugs and share needles or rigs?
Do you re-use a cooker or a spoon when injecting drugs?
PNEP launched June 2018 as a phased-in approach at one female institution in the Ontario Region and one male institution in Atlantic Region
Objectives are to reduce rigs and needle sharing, reduce skin-soft tissue infection (SSTI), reduce HIV / HCV transmission, promote referral to counselling and addictions treatment
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