Estimates of the prevalence of HIV in Canadian prisons range from 2% to 8%, close to 10 times the national prevalence for the general population.[1] Substance use is prohibited inside Canadian prisons, yet contraband is relatively easy to secure and few harm reduction options are available.[2] Incarcerated people are given an HIV test upon admission to prison, and HIV antiretrovirals (ARVs) are available to people who contract HIV inside Canadian prisons. Most incarcerated people return to their communities at the end of their sentences, making continuity of care for HIV diagnoses a significant concern.[1]

When looking up the prescription history for a patient who has recently been released from prison on PharmaNet, instead of a name, ARVs are listed as “non-benefit drugs.” This category is overbroad and could lead to disruptions in the continuity of care. Without knowing this crucial piece of information, it would be relatively easy to gloss over this detail and affect continuity of care. A patient who initiated ARVs inside prison and was then released to reintegrate back into the community could easily fall through the cracks and not adhere to their medication regimen. Naturally, this information is widely applicable to all HIV-positive patients on ARVs. 

The Collaborating Centre for Prison Health and Education at UBC recently released Guidelines for Family Physicians Working with Formerly Incarcerated People, which provides support to family physicians caring for this population. The guidelines are available online: http://ccphe.ubc.ca/guidelines-for-family-physicians [10].
—Blake Stitilis, MPH
—Ruth Elwood Martin, MD
Collaborating Centre for Prison Health and Education
School of Population and Public Health, UBC Faculty of Medicine 

References

1. Lines R, Jurgens R, Glenn B, et al. Prison needle exchange: Lessons from a comprehensive review of international evidence and experience. Canadian HIV/AIDS Legal Network; 2004.
2. Public Health Agency of Canada. The effectiveness of bleach in the prevention of Hepatitis C transmission. Final Report. Ottawa, ON; 2004.