Women living with HIV (WLWH) are over-represented in corrections in Canada, yet little is known about women’s experiences post-release. We used CHIWOS cross-sectional data from WLWH to estimate associations between social determinants of health and HIV-related care outcomes among WLWH with recent (within past year) or ever (before past year) incarceration experience. Lifetime incarceration prevalence was 36.9% (6.5% recent; 30.4% ever), with significant differences by province of residence (British Columbia: 10% recent; 52% ever; Ontario: 5%; 24%; Quebec: 6%; 22%; p < 0.001). In adjusted multinomial logistic regression analyses, compared with never incarcerated, recent incarceration was associated with Indigenous ancestry, lower annual income (< $20,000 CAD), unstable housing, current sex work, injection drug use (IDU), and sub-optimal antiretroviral therapy (ART) adherence, while ever incarceration was associated with current sex work, IDU, and experiencing adulthood violence. Our findings have implications regarding supports needed by WLWH in the post-release period, including ART adherence and achieving health and social goals.
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Zinger I. Annual report: office of the correctional investigator. In: Canada CS, editor; 2017.
Canada S. Census profile, 2016 census: Canada; 2017.
PHAC. Summary: estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2016; 2018.
Canada CS. Human immunodeficiency virus (HIV) age, gender and indigenous ancestry. In: Canada CS, editor; 2016.
Abraham M, Tastsoglou E. Addressing domestic violence in Canada and the United States: the uneasy co-habitation of women and the state. Curr Sociol. 2016;64(4):568–85.
Statistics Canada. The violence against women survey. Ottawa: Statistics Canada; 1993.
Canadian Women’s Foundation. Fact sheet: moving women out of violence; 2016.
Kramer K, Comfort M. Considerations in HIV prevention for women affected by the criminal justice system. Women’s Health Issues. 2011;21(6S):S272–7.
Wise A, Finlayson T, Nerlander L, Sionean C, Paz-Bailey G. Incarceration, sexual risk-related behaviors, and HIV infection among women at increased risk of HIV infection, 20 United States Cities. J Acquir Immune Defic Syndr. 2017;75(3):S261–7.
Collica K. Women, prison and, HIV: an introduction. Female prisoners, AIDS, and peer programs: how female offenders transform their lives. New York: Springer; 2013. p. 1–16.
McKeown I, Reid S, Orr P. Experiences of sexual violence and relocation in the lives of HIV infected Canadian women. Int J Circumpolar Health. 2004;63(Suppl 2):399–404.
Burch T. Skin color and the criminal justice system: beyond black-white disparities in sentencing. J Empir Legal Stud. 2015;12(3):395–420.
Allen S, Flaherty C, Ely G. Throwaway moms: maternal incarceration and the criminalization of female poverty affilia. J Women Soc Work. 2010;25(2):160–72.
Western B, Pettit B. Incarceration & social inequality. Daedalus. 2010;139(3):8–19.
Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.
Baillargeon JGT, Rich JD, Wu ZH, Wells K, Pollock BH, Paar DP. Accessing antiretroviral therapy following release from prison. JAMA. 2009;301(8):848–57.
Althoff A, Zelenev A, Meyer J, Fu J, Brown S, Vagenas P, et al. Correlates of retention in HIV care after release from jail: results from a multi-site study. AIDS Behav. 2013;17(2):S156–70.
Haley DF, Golin CE, Farel CE, Wohl DA, Scheyett AM, Garrett JJ, Rosen DL, Parker SD. Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry. BMC Public Health. 2014;14(1):1253.
Booker C, Flygare C, Solomon L, Ball S, Pustell M, Bazerman L, et al. Linkage to HIV care for jail detainees: findings from detention to the first 30 days after release. AIDS Behav. 2013;17:S128–36.
Savage L. Female offenders in Canada, 2017; 2019 10, January 2019.
Correctional Service Canada. Women in prison: a literature review; 2015.
Tyagi S. Victimization, adversity and survival in the lives of women offenders implications for social policy and correctional practice. Can Woman Stud. 2006;25(1):133–8.
van den Bergh BJ, Gatherer A, Fraser A, Moller L. Imprisonment and women’s health: concerns about gender sensitivity, human rights and public health. Bull World Health Organ. 2011;89(9):621–700.
Osazuwa E. Canadian women in prison: a racial and gendered discursive analysis. [MSc]: Wilfrid Laurier University; 2015.
Weber RRM, Rickenbach M, Spoerri A, Furrer H, Battegay M, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. HIV Med. 2013;14(4):195–207.
Gardner EMYB. The HIV care cascade through time. Lancet Infect. 2013;14(1):5–6.
Gardner EM, Young B. The HIV care cascade through time. Lancet Infect Dis. 2014;14(1):5.
Hellinger F, Encinosa W. Antiretroviral therapy and health care utilization: a study of privately insured men and women with HIV disease. Health Serv Res. 2004;39(4):949–68.
Kerkerian G, Kestler M, Carter A, Wang L, Kronfli N, Sereda P, et al. Attrition across the HIV cascade of care among a diverse cohort of women living with HIV in Canada. J Acquir Immune Defic Syndr. 2018;79(2):226–36.
Moneyham L, McLeod J, Boehme A, Wright L, Mugavero M, Seal P, et al. Perceived barriers to HIV care among HIV-infected women in the deep south. J Assoc Nurses AIDS Care. 2010;21(6):467–77.
Johnson M, Samarina A, Xi H, Valdez Ramalho Madruga J, Hocqueloux L, Loutfy M, et al. Barriers to access to care reported by women living with HIV across 27 countries. AIDS Care. 2015;27(10):1220–30.
Cohen MH, Cook JA, Grey D, Young M, Hanau LH, Tien P, et al. Medically eligible women who do not use HAART: the importance of abuse, drug use, and race. Am J Public Health. 2004;94(7):1147.
Smith LR, Yore J, Triplett DP, Urada L, Nemoto T, Kaiser Permanente Community-Based HIV Test and Treat Study Team, et al. Impact of sexual violence across the lifespan on HIV risk behaviors among transgender women and cisgender people living with HIV. J Acquir Immune Defic Syndr. 2017;75(4):408–16.
Aziz M, Smith KY. Challenges and successes in linking HIV-infected women to care in the United States. Clin Infect Dis. 2011;52(2):S231–7.
Sun S, Crooks N, Kemnitz R, Westergaard RP. Re-entry experiences of Black men living with HIV/AIDS after release from prison: intersectionality and implications for care. Soc Sci Med. 2018;211:78–86.
Stephens T, Braithwaite R, Tiggs C. Correlates of inmates’ self-reported HIV/AIDS risk behaviors, prior incarceration, and Marijuana use. Am J Drug Alcohol Abuse. 2004;30(2):287–98.
Haley DF, Golin CE, Farel CE, Wohl DA, Scheyett AM, Garrett JJ, et al. Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry. BMC Public Health. 2014;14:1253.
Williams CT, Seijeoung K, Meyer J, Spaulding A, Teixeira P, Avery A, et al. Gender differences in baseline health, needs at release, and predictors of care engagement among HIV-positive clients leaving jail. AIDS Behav. 2013;17:S195–202.
Loutfy M, de Pokomandy A, Carter A, O’Brien N, Lewis J, Nicholson V, et al. Cohort profile: the Canadian HIV women’s sexual and reproductive health cohort study (CHIWOS). PLoS ONE. 2017;12(9):e0184708.
Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19(1):173–202.
Wuest J, Merritt-Gray M, Berman H, Ford-Gilboe M. Illuminating social determinants of women’s health using grounded theory. Health Care Women Int. 2002;23:794–808.
Harnois CE. Feminist measures in survey research. California: SAGE Publications; 2013.
Carter A, Greene S, Nicholson V, O’Brien N, Sanchez M, Pokomandy AD, et al. Breaking the glass ceiling: increasing the meaningful involvement of women living with HIV/AIDS (MIWA) in the design and delivery of HIV/AIDS services. Health Care Women Int. 2014;36(8):936–64.
Loutfy M, Greene S, Kennedy VL, Lewis J, Thomas-Pavanel J, Conway T, et al. Establishing the Canadian HIV women’s sexual and reproductive health cohort study (CHIWOS): operationalizing community-based research in a large national quantitative study. BMC Med Res Methodol. 2016;16(1):101–10.
Kaida A, Carter A, Nicholson V, Lemay J, O’Brien N, Greene S, et al. Hiring, training and supporting peer research associates: operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV. Harm Reduct J. 2019;16:47.
Wagnild G, Young H. Development and psychometric validation of the resilience scale. J Nurs Meas. 1993;1:165–78.
Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV + youth. J Adolesc Health. 2007;40(1):96–8.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale¶. Res Nurs Health. 2001;24(6):518–29.
Zhang W, O’Brien N, Forrest JI, Salters KA, Patterson TL, Montaner JS, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE. 2012;7(7):e40793.
Carter A, de Pokomandy A, Loutfy M, Ding E, Sereda P, Webster K, et al. Validating a self-report measure of HIV viral suppression: an analysis of linked questionnaire and clinical data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study. BMC Res Notes. 2017;10(1):138–45.
Fu JJ, Herme M, Wickersham JA, Zelenev A, Althoff A, Zaller ND, et al. Understanding the revolving door: individual and structural-level predictors of recidivism among individuals with HIV leaving jail. AIDS Behav. 2013;17(2):S145–55.
Subramanian Y, Khan MN, Berger S, Foisy M, Singh A, Woods D, et al. HIV outcomes at a Canadian remand centre. Int J Prison Health. 2016;12(3):145–56.
Loeliger KB, Altice FL, Desai MM, Ciarleglio MM, Gallagher C, Meyer JP. Predictors of linkage to HIV care and viral suppression after release from jails and prisons: a retrospective cohort study. Lancet HIV. 2018;5:e96–106.
Martin R, Hanson D, Hemingway C, Ramsden V, Buxton J, Granger-Brown A, et al. Homelessness as viewed by incarcerated women: participatory research. Int J Prison Health. 2012;8(3–4):108–16.
Elwood Martin R, Buxton J, Smith M, Hislop G. The scope of the problem: the health of incarcerated women in BC. BC Med J. 2012;54(10):502–8.
Fogel C, Belyea M. The lives of incarcerated women: violence, substance abuse, and at risk for HIV. J Assoc Nurses AIDS Care. 1999;10(6):66–74.
Kouyoumdjian F, Mcisaac K, Liauw J, Green S, Karachiwalla F, Siu W, et al. A systematic review of randomized controlled trials of interventions to improve the health of persons during imprisonment and in the year after release. Am J Public Health. 2015;105(4):E13–33.
Binswanger IA, Mueller SR, Beaty BL, Min S-J, Corsi KF. Gender and risk behaviors for HIV and sexually transmitted infections among recently released inmates: a prospective cohort study. AIDS Care. 2013;26(7):872–81.
Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, et al. Interactive computer-based interventions for sexual health promotion. Cochrane Database of Syst Rev. 2010;9:CD006483.
Bombay A, Matheson K, Anisman H. The intergenerational effects of Indian Residential Schools: implications for the concept of historical trauma. Transcult Psychiatry. 2014;51(3):320–38.
Adelson N. The embodiment of inequity: health disparities in aboriginal Canada. Can J Public Health. 2005;96(2):S45–61.
Proulx C. Colonizing surveillance: Canada constructs an indigenous terror threat. Anthropologica. 2014;56(1):83–100.
Greenwood ML, de Leeuw SN. Social determinants of health and the future well-being of Aboriginal children in Canada. Paediatr Child Health. 2012;17(7):381–4.
Elwood Martin R, Stitilis B. Guidelines for working with formerly incarcerated people This Changed My Practice 2018.
Baillargeon J, Giordano T, Harzke A, Spaulding A, Wu Z, Grady J, et al. Predictors of reincarceration and disease progression among released HIV-infected inmates. AIDS Patient Care STDS. 2010;24(6):389–94.
Wakeman SE, Rich JDHIV. treatment in US prisons. HIV Ther. 2010;4(4):505–10.
Wood E, Schachar J, Li K, Stoltz JA, Shannon K, Miller C, et al. Sex trade involvement is associated with elevated HIV incidence among injection drug users in Vancouver. Addict Res Theory. 2007;15(3):321–5.
Fontenot HB, Fantasia HC, Lee-St. John TJ, Sutherland MA. The effects of intimate partner violence duration on individual and partner-related sexual risk factors among women. J Midwifery Women’s Health. 2014;59(1):67–73.
Alam N, Chowdhury ME, Mridha MK, Ahmed A, Reichenbach LJ, Streatfield PK, et al. Factors associated with condom use negotiation by female sex workers in Bangladesh. Int J STD AIDS. 2013;24(10):813–21.
Spaulding AC, Messina LC, Kim BI, et al. Planning for success predicts virus suppressed: results of a non-controlled, observational study of factors associated with viral suppression among HIV-Positive persons following jail release. AIDS Behav. 2013;17:203–11.
Machtinger EL, Cuca YP, Khanna N, Rose CD, Kimberg LS. From treatment to healing: the promise of trauma-informed primary care. Women’s Health Issues. 2015;25(3):193–7.
HARS. HIV/AIDS Regional Services Prison Support 2017 http://hars.ca/prison-support/.
POP. Positive Living Society of British Columbia Prison Outreach Program 2019. https://positivelivingbc.org/services/prison-outreach/.
PASAN. PASAN n.d. http://www.pasan.org.
CCPHE, FNHA. Unlocking The Gates (UTG) Peer Health Mentoring Program 2014. http://ccphe.ubc.ca/projects/unlocking-the-gates-utg-peer-health-mentoring-program/.
Ministry of Social Development and Social Innovation, Ministry of Justice. IOM/HIP Pilot Project: Evaluation and Final Report. British Columbia; 2013/2014.
Milloy M, Kerr T, Buxton J, Rhodes T, Guillemi S, Hogg R, et al. Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. J Infect Dis. 2011;203(9):1215–21.
The CHIWOS Research Team thanks women living with HIV for their contributions to this study, and the national team of co-investigators, collaborators and peer research associates. We acknowledge the national steering committee; our three provincial community advisory boards; the national CHIWOS Aboriginal Board; the national CHIWOS African, Caribbean and Black Advisory Board; the British Columbia Centre for Excellence in HIV/AIDS; and all of our partnering organizations. CHIWOS is funded by the Canadian Institutes of Health Research (CIHR), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network (OHTN), and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund.
CHIWOS Research Team Rahma Abdul-Noor (Women’s College Research Institute), Aranka Anema (Harvard Medical School), Jonathan Angel (Ottawa Hospital Research Institute), Dada Mamvula Bakombo (McGill University Health Centre), Fatimatou Barry (Women’s College Research Institute), Greta Bauer (University of Western Ontario), Kerrigan Beaver (Women’s College Research Institute), Marc Boucher (CHU Ste-Justine), Isabelle Boucoiran (CHU Ste-Justine), Jason Brophy (Children's Hospital of Eastern Ontario), Lori Brotto (University of British Columbia), Ann Burchell (St, Michael’s Hospital), Claudette Cardinal (Simon Fraser University), Allison Carter (Kirby Institute), Lynne Cioppa (Women’s College Research Institute), Tracey Conway (Women’s College Research Institute), José Côté (Centre Hospitalier de l’Université de Montréal), Jasmine Cotnam (Canadian Aboriginal AIDS Network), Cori d’Ambrumenil (AIDS Vancouver Island), Janice Dayle, (McGill University Health Centre), Erin Ding (British Columbia Centre for Excellence in HIV/AIDS), Danièle Dubuc, (McGill University Health Centre), Janice Duddy (Pacific AIDS Network), Mylène Fernet (Université du Québec à Montréal), Annette Fraleigh (Women’s College Research Institute), Peggy Frank (Simon Fraser University), Brenda Gagnier (Women’s College Research Institute), Marilou Gagnon (University of Victoria), Jacqueline Gahagan (Dalhousie University), Claudine Gasingirwa (Women’s College Research Institute), Nada Gataric (British Columbia Centre for Excellence in HIV/AIDS), Rebecca Gormley (British Columbia Centre for Excellence in HIV/AIDS), Saara Greene (McMaster University), Danielle Groleau (McGill University), Charlotte Guerlotté (COCQ-SIDA), Trevor Hart (Ryerson University), Catherine Hankins (McGill University), Roula Hawa (Women’s College Research Institute), Emily Heer (Alberta Health Services), Robert S. Hogg (British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University), Terry Howard (Glasshouse Consultants), Shazia Islam (Women’s College Research Institute), Joseph Jean-Gilles (GAP-VIES), Hermione Jefferis (AIDS Vancouver Island), Evin Jones (Pacific AIDS Network), Charu Kaushic (McMaster University), Mina Kazemi (Women’s College Research Institute), Mary Kestler (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Maxime Kiboyogo (McGill University Health Centre), Marina Klein (McGill University Health Centre), Nadine Kronfli (McGill University Health Center), Gladys Kwaramba (Women’s College Research Institute), Gary Lacasse (Canadian AIDS Society), Ashley Lacombe-Duncan (University of Michigan), Melanie Lee (Simon Fraser University), Rebecca Lee (CIHR Canadian HIV Trials Network), Jenny Li (British Columbia Centre for Excellence in HIV/AIDS), Viviane Lima (British Columbia Centre for Excellence in HIV/AIDS), Elisa Lloyd-Smith (Vancouver General Hospital), Carmen Logie (University of Toronto), Evelyn Maan (Oak Tree Clinic), Valérie Martel-Lafrenière (Centre Hospitalier de l’Université de Montréal), Carrie Martin (Canadian Aboriginal AIDS Network), Renee Masching (Canadian Aboriginal AIDS Network), Lyne Massie (Université du Québec à Montréal), Melissa Medjuck (formerly of the Positive Women’s Network), Brigitte Ménard, (McGill University Health Centre), Cari L. Miller (formerly of Simon Fraser University), Judy Mitchell (Positive Living North), Gerardo Mondragon (British Columbia Centre for Excellence), Deborah Money (Women’s Health Research Institute and Faculty of Medicine at UBC), Ken Monteith (COCQ-SIDA), Marvelous Muchenje (Women’s Health in Women’s Hands CHC), Florida Mukandamutsa (CASM), Mary Ndung'u (African Partnership Against AIDS), Valerie Nicholson (Simon Fraser University), Kelly O’Brien (University of Toronto), Nadia O'Brien (McGill University Health Centre and McGill University), Gina Ogilvie (University of British Columbia, Women’s Health Research Institute), Susanna Ogunnaike-Cooke (Public Health Agency of Canada), Joanne Otis (Université du Québec à Montréal), Rebeccah Parry (Simon Fraser University), Sophie Patterson (Simon Fraser University), Angela Paul (Positive Living North), Doris Peltier (Canadian Aboriginal AIDS Network), Neora Pick (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Alie Pierre (McGill University Health Centre), Jeff Powis (Michael Garron Hospital), Karène Proulx-Boucher (McGill University Health Centre), Corinna Quan (Windsor Regional Hospital), Jesleen Rana (Women’s Health in Women’s Hands CHC), Eric Roth (University of Victoria), Danielle Rouleau (Centre Hospitalier de l’Université de Montréal), Geneviève Rouleau (Centre Hospitalier de l’Université de Montréal), Sergio Rueda (Centre for Addiction and Metal Health), Kate Salters (Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS), Margarite Sanchez (ViVA, Southern Gulf Islands AIDS Society, Simon Fraser University), Roger Sandre (Haven Clinic), Jacquie Sas (CIHR Canadian HIV Trials Network), Édénia Savoie (McGill University Health Centre), Paul Sereda (British Columbia Centre for Excellence in HIV/AIDS), Stephanie Smith (Women’s College Research Institute), Marcie Summers (formerly of the Positive Women’s Network), Wangari Tharao (Women’s Health in Women’s Hands CHC), Christina Tom (Simon Fraser University), Cécile Tremblay (Centre Hospitalier de l’Université de Montréal), Jason Trigg (British Columbia Centre for Excellence in HIV/AIDS), Sylvie Trottier (Centre Hospitalier Universitaire de Québec), Angela Underhill (Women’s College Research Institute), Anne Wagner (Ryerson University), Sharon Walmsley (University Health Network), Clara Wang (British Columbia Centre for Excellence), Kath Webster (Simon Fraser University), Wendy Wobeser (Queen’s University), Denise Wozniak (Positive Living Society of British Columbia), Mark Yudin (St. Michael’s Hospital), Wendy Zhang (British Columbia Centre for Excellence in HIV/AIDS), Julia Zhu (British Columbia Centre for Excellence in HIV/AIDS). All other CHIWOS Research Team Members who wish to remain anonymous.
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Gormley, R., Lin, S.Y., Carter, A. et al. Social Determinants of Health and Retention in HIV Care Among Recently Incarcerated Women Living with HIV in Canada. AIDS Behav 24, 1212–1225 (2020). https://doi.org/10.1007/s10461-019-02666-7
- Social determinants of health