Risk factors of sexually transmitted and blood-borne infections and access to harm reduction in Canadian federal prisons

Background: Incarcerated people are disproportionally affected by sexually transmitted and blood-borne infections (STBBI) and have a high prevalence of STBBI risk factors.Objective: This study aimed to determine the prevalence of risk factors for STBBI (tattooing and sexual activities in the last six months), as well as the awareness of, and utilization of harm reduction resources in federal prison.Methods: A cross-sectional survey was developed and administered across Canada between September 2022 and January 2023.Participants included people who were incarcerated in federal men's and women's institutions in the last six months.Results: In total, 1,404 people who are incarcerated responded to the survey: 91.5% from men's institutions, and 8.5% from women's institutions.Overall, 44.6% reported that they had received a tattoo at some point during incarceration, and 8.8% reported having had sex in the last six months.Difficulties in accessing barrier-type items for sexual protection were reported by 5.0% of all participants, of which a majority reported difficulties in accessing condoms.Awareness of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was reported by 8.7% and 7.1% of participants, respectively.However, utilization was below 1% for both.Conclusion: Tattooing and sex without barriers could contribute to the transmission of STBBI among people who are incarcerated.Increased efforts to ensure that harm reduction supplies are available in sufficient quantities and in private and known locations are recommended to maximize their utilization.Education on PrEP and PEP availability should be improved to ensure an optimal use by those who could benefit from it.