Durban, South Africa (July 19, 2016) While the provision of HIV treatment and care to incarcerated populations is mandated by law, women face challenges in maintaining their HIV treatment in the community post-release. Recent Canadian research has found women living with HIV who have been incarcerated in the past year are three times more likely to have poor adherence to ART, compared with women who have never been incarcerated.
Adherence to combination antiretroviral therapy (ART), the standard of HIV treatment, is critical for both individual health and HIV prevention efforts. The findings, presented at the 21st International AIDS Conference in Durban, South Africa, are from a national community-based survey created and conducted by, with, and for women living with HIV called CHIWOS (the Canadian HIV Women’s Sexual & Reproductive Health Cohort Study). CHIWOS is Canada’s largest multi-site community-based cohort study, with 1,425 women living with HIV enrolled in the provinces of British Columbia, Ontario and Quebec.
Other key findings from the CHIWOS study:
- 30% of study participants had ever been incarcerated.
- 6% of participants had been incarcerated at some point in the previous year.
- Women living with HIV who had recently been incarcerated are three times as likely to have lower income and be living in unstable housing, compared with women who had never been incarcerated.
- Women with incarceration experience are also significantly more likely to be currently engaged in sex work and to be co-infected with hepatitis C.
- Indigenous women living with HIV are overrepresented among recently incarcerated women.
“This research shows the urgent need for programming that provides women with the necessary health and social supports following incarceration,” said Dr. Bob Hogg, a Principal Investigator on the study and Senior Research Scientist at the BC Centre for Excellence in HIV/AIDS (BC-CfE).
“The strong association between recent incarceration and sub-optimal ART adherence underlines the definite need for continued improvements in prison health care and in transitional HIV care programming for women,” said Dr. Angela Kaida, a Principal Investigator on the study, and Associate Faculty Member (External) in the University of British Columbia Division of AIDS.
“Women living with HIV with incarceration history are among the most vulnerable and marginalized members of our community,” said Valerie Nicholson, an Indigenous woman living with HIV, co-Chair of the CHIWOS Community Advisory Board and Chair of the BC Positive Living Society.”We must provide the support necessary to improve their health and minimize the damaging effects of the cycle of poverty, ill health and incarceration.”
Over the last decade, HIV infection among women in Canada has steadily increased. According to the Public Health Agency of Canada, at the end of 2014, an estimated 16,800 Canadian women were living with HIV (23% of all new HIV infections). This is nearly double the estimate in 1999 (12% of all new infections). The prevalence of HIV infection is higher for incarcerated women and men (compared with the general population) in many countries, including Canada.
Women with incarceration experience face numerous social and structural determinants of health that increase their vulnerability to HIV infection, including: poverty, sexual violence, gender and racial discrimination, and barriers to accessing to health services and support.