Taylor Susie, Haworth-Brockman Margaret, Keynan Yoav
National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada.
Health Justice. 2021 Nov 29;9(1):35. doi: 10.1186/s40352-021-00157-3.
The relationship between incarceration and women's vulnerability to sexually transmitted and blood-borne infections (STBBI) is understudied in Canada, despite numerous studies showing that justice-involved women experience very high rates of infection. Justice-involved women in Canada are highly mobile, as a result of high rates of incarceration and extremely short sentences. From a public health perspective, it is productive to understand how the mobility of justice-involved women shapes their vulnerability to STBBI.
This narrative review demonstrates that mobility between incarceration facilities and communities drives sexually transmitted and blood-borne disease risk for justice-involved women in Canada. Associations and interactions between epidemics of gender-based and intimate partner violence, substance use, and STBBIs shape the experiences of justice-involved women in Canada. In correctional facilities, the pre-existing vulnerability of justice-involved women is compounded by a lack of comprehensive STBBI care and limited harm reduction services. On release, unstable housing, disruptions to social support networks, interruptions in medical care, and relapse to or continuation of substance use, significantly increase individual disease risk and the likelihood of community transmission. High rates of incarceration for short periods perpetuate this cycle and complicate the delivery of healthcare.
The review provides evidence of the need for stronger gender-transformative public health planning and responses for incarcerated women, in both federal and provincial corrections settings in Canada. A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women - one that that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration - could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, as well as safe housing, harm reduction and other supports, can improve outcomes as well. Lastly, metrics to measure performance of STBBI management during incarceration and upon release would help to identify gaps and improve outcomes for justice-involved women in the Canadian context.
在加拿大，尽管有大量研究表明涉司法系统的女性感染率极高，但监禁与女性易感染性传播和血源性感染（STBBI）之间的关系却鲜有研究。由于监禁率高且刑期极短，加拿大涉司法系统的女性流动性很大。从公共卫生的角度来看，了解涉司法系统女性的流动性如何影响她们感染STBBI的易感性是很有意义的。
本叙述性综述表明，在加拿大，监禁场所与社区之间的流动增加了涉司法系统女性感染性传播和血源性疾病的风险。基于性别的暴力、亲密伴侣暴力、药物使用和STBBI流行之间的关联和相互作用，塑造了加拿大涉司法系统女性的经历。在惩教机构中，缺乏全面的STBBI护理和有限的减少伤害服务，使涉司法系统女性原有的脆弱性更加复杂。释放后，住房不稳定、社会支持网络中断、医疗服务中断以及药物使用复发或持续，显著增加了个体疾病风险和社区传播的可能性。短期的高监禁率使这一循环持续存在，并使医疗保健的提供变得复杂。
该综述提供了证据，表明在加拿大联邦和省级惩教机构中，需要针对被监禁女性制定更强有力的性别变革性公共卫生规划和应对措施。一种支持性的、基于证据的方法来识别和治疗被监禁女性的STBBI——一种消除耻辱感、维护隐私并改善获取途径的方法，再加上预防监禁的结构性政策——可以降低STBBI的发病率，并中断监禁和不良健康结果的循环。一个协调且负责的重新融入计划，促进对STBBI的公共卫生干预的连续性，以及安全住房、减少伤害和其他支持，也可以改善结果。最后，衡量监禁期间和释放后STBBI管理绩效的指标，将有助于发现差距并改善加拿大背景下涉司法系统女性的结果。
