Fear of infectious diseases and perceived contagion risk count as an occupational health and safety hazard: Accounts from correctional officer recruits in Canada

Abstract

Prisons are poorly ventilated confined spaces with limited physical distancing opportunities, making an environment conducive to the spread of infectious diseases. Based on empirical research with correctional officer recruits in Canada, we analyze the reasons and sources of fear, and the measures that recruits adopt to counter their fear of contagion. Our study marks an advance in the correctional work literature, which, to date, has tended to view perceived contagion risks as a workplace challenge that can be overcome with occupational skill and experience. In contrast with the existing literature, we present fear and perceived contagion risk as an “operational stress injury” that affects all correctional officers; a structural occupational health and safety problem that needs redressing from the labor policy perspective.

Introduction

Prisons are poorly ventilated confined spaces with limited physical distancing opportunities, making an environment conducive to the spread of infectious diseases. Incurable infections and health crises aggravate contagion risks during incarceration, giving full visibility to the health and safety threats that incarcerated persons and employees face daily. The infectious rates of HIV/AIDS and hepatitis C among federal prisoners in Canada have been seven to 32 times higher than in the general population (CSC, 2015a; Zakaria et al., 2010). The likelihood of contracting infectious diseases in prison is high enough that some researchers view transmission as a “death sentence” (Pagliaro & Pagliaro, 1992); risk of contagion becomes an extra punishment for incarcerated populations (De Arimatéia da Cruz & Rich, 2014; Simooya, 2010). The COVID-19 pandemic is the most recent example of the vulnerability of prisoners and correctional workers to infectious diseases.

The COVID-19 pandemic has hit prisons especially hard (Burki, 2020; European Centre for Disease Prevention & Control, 2020; NYC Board of Correction, 2020; Simpson & Butler, 2020). In Canada, the risk of COVID-19 infection among prisoners in federal prisons was three times higher than in the general population between February and December 2020 (i.e., 39 versus 12 cases per thousand individuals; CSC, 2020; Government of Canada, 2020). The risks to contract COVID-19 were even higher in provincial and territorial prisons than federal prisons because of overcrowding (i.e., double-bunking and lack of physical distancing) and high prisoner turnover rates. In Canada, the administration of correctional services is a shared responsibility between the federal, provincial, and territorial governments. Adult offenders (aged 18 and above) serving custodial sentences of two years, or more are housed in federal prisons under the responsibility of the federal agency Correctional Service Canada (CSC), which offer less opportunities for prisoners to have contact with the world outside. Meanwhile, adults serving custodial sentences less than two years and those held while awaiting trial or sentencing, fall under the responsibility of the provincial and territorial correctional systems. In contrast with federal prisoners, prisoners from provincial and territorial prisons have more exchange with the outside. Despite the differences between Canada's correctional institutions, news outlets reported numerous large outbreaks across the country involving incarcerated persons and staff in federal, provincial, and territorial prisons (Boynton, 2020; Dryden, 2020; Unger, 2020). The gravity of infectious diseases in prison, which COVID-19 amplified, offers an opportunity to analyze prisons as workplaces, and reflect on how the possibility of contagion impacts the life of a correctional worker.

In this article, we analyze correctional officer recruit views of infectious diseases in Canadian federal prisons, particularly their fear of contagion and perceived contagion risk. The research team was particularly interested in understanding the fear that correctional officer recruits (henceforth “CORs”) experience and the strategies they adopt to mitigate contagion risks. By studying CORs, we expand the scholarship on infectious diseases in prisons, beyond its traditional focus on the prisoner. We then challenge well-established approaches that normalize contagion risks as “coming with the territory” as well as portray fear of diseases and perceived contagion risks as a metric of work performance and a potential challenge that hinders job satisfaction (Alarid & Marquart, 2009; Mahaffey & Marcus, 1995; McKee et al., 1995; Rotily et al., 2001). Such approaches may have several latent consequences. For instance, they exempt prison administrators and society from treating perceived contagion risks as an occupational hazard eligible for compensation. They also prevent governments and communities from appropriately rewarding the contributions that correctional officers (COs) make to public safety (Ricciardelli, 2019b). Approaching the possibility of contagion as a matter of skill also leaves officers responsible for their fate, potentially feeling guilt for posing risks to their families if they were to become infected. In contrast with the literature available, our analysis presents perceived contagion risks as a long-standing structural occupational health and safety issue that requires redressing from the labor policy perspective. We draw our data from seventy-one interviews with CORs conducted in Ontario, Canada, in 2018–2020, before the COVID-19 pandemic.

Infectious diseases in prison

Studies on infectious diseases in prison usually explore the overrepresentation of HIV/AIDS and other incurable infectious diseases among prisoners (Hammett, 2006; Gough et al., 2010; Larney et al., 2013; WHO, 2020), leaving correctional officers aside. They focus on two large areas: predictive modelling and health service provisions for prisoners. Modelling studies usually conclude that, among other environmental fixtures, overcrowding and the lack of ventilation represent the main predictors of transmission in prison (Johnstone-Robertson et al., 2011; Ndeffo-Mbah et al., 2018). Researchers also indicate that systematic screening programs can effectively stop outbreaks (De Arimatéia da Cruz & Rich, 2014; Hammett, 2006; Nick et al., 2015). Meanwhile, studies on healthcare analyze diagnosis and treatment (Beyrer et al., 2016; Tang, 2011), harm reduction measures (Barro et al., 2014), and post-release programs (Gough et al., 2010; Maruschak et al., 2009). Researchers conclude that most prisons lack a comprehensive policy that effectively tackles prisoners’ health problems (Hammett, 2006; Kamarulzaman et al., 2016).

Concerned with the effectiveness of healthcare in prison, some scholars add that the creation of efficient programs depends on overcoming the stigma that surrounds infectious diseases inside and outside prison (De Arimatéia da Cruz & Rich, 2014; Topp et al., 2018). Regardless of topic and context, studies centered on prisoner's health call governments and societies to consider incarceration alternatives (Beyrer et al., 2016; Dumont et al., 2012; Kamarulzaman et al., 2016). Lastly, these studies also advise against stigmatizing prisons as “infection breeding grounds” (De Arimatéia da Cruz & Rich, 2014; Hammett, 2006), an image that assumes a fallacious analytical divide between prison and the outside world, as the daily flows of prisoners, staff, and visitors connect prisons and surrounding communities. In fact, the COVID-19 pandemic and the decarceration trends that followed made the link between prison and public health apparent.

The perception of prison as a high-risk and stressful environment has prompted a small group of researchers to explore the topic of infectious diseases from the perspective of the prison employee. Thus, a limited but relevant body of literature emerged in the mid-1990s discussing infectious diseases as a workplace challenge that stresses COs and undermines their job satisfaction. One of the first comprehensive studies on this topic happened in seven Scottish prisons. Led by McKee, the study interviewed prison workers to learn their concerns, attitudes, and perceived risk of HIV/AIDS (McKee et al., 1995). In addition to indicating infectious diseases as a significant source of stress among prison employees, McKee's study paved the way for researchers to consider fear of infectious diseases as a determinant of prison job satisfaction (Lambert et al., 2018; Lambert & Paoline , 2005).

After conducting comprehensive studies in the United States (Alarid & Marquart, 2009; Mahaffey & Marcus, 1995) and Europe (Dillon & Allwright, 2005; Rotily et al., 2001), researchers exploring employee fear of infectious diseases reported that correctional workers who were more knowledgeable of infectious diseases were less likely to fear for their well-being (i.e., knowledge was a significant correlate of contagion fear). Despite contributing to the field by tracing fear of infectious diseases to the lack of knowledge on the subject matter, those researchers did not problematize the origins of that knowledge (or lack of). Instead, they approached knowledge as an attribute inherent to correctional workers, as opposed to developed via training or other sources. In doing so, researchers inadvertently naturalized the correctional worker's ability to remain fear-free, implying that not fearing contagion and infection is a matter of skill level (Alarid & Marquart, 2009; De Perio et al., 2015; Kamerman, 1991; Mahaffey & Marcus, 1995; Rotily et al., 2001). Within this analytical framework, avoiding unintentional contagion becomes a source of status that hierarchizes COs according to their “skill” to control the uncontrollable. Those who avoid exposure are at the top, while those who experience a potentially contagious event, such as being pricked by a sharp object, fall to the bottom. The skill framework implies that COs are the sole responsible for their personal health and workplace safety, preemptively excusing prison administrators from any responsibility.

The few studies that break with the “skill” analytical framework found that contagion risk is an occupational problem, not an outcome of poor skills, and sought to understand the factors that could contribute to the CO fear of infectious diseases and perceived risks. After surveying over a thousand correctional employees in the US, Lambert and Paoline (2005) found that almost three-quarters of participants reported prisoners’ privacy rights compromised their safety. Thus, to protect the prisoner's right to privacy and safety, legislation and protocols usually prohibit prison employees from accessing and disclosing prisoner medical information, safeguarding incarcerated persons from potential discrimination (CSC, 2015b). The possibility of prisoner-on-officer confrontation is another factor contributing to elevate the officer's fear and perception of risk. Such confrontations increase the officer's chances of being exposed to contaminants such as blood and saliva (Boyd, 2011).

In Canada, more than 60 percent of prison staff have experienced physical violence (Ling, 2021). Also, prisoner-officer confrontations do not necessarily involve a physical fight. Prisoners can engage in long-distance confrontations by weaponizing their bodily fluids against the officers (Bick, 2007; Boyd, 2011). Daily events that enhance the CO's perception of contagion risk also include illicit drug use, tattooing, and piercing. Some prisoners may conceal needles and other sharps, which become potential pitfalls for infection during daily cell and body searches (Alarid & Marquart, 2009; Fazel et al., 2006; Lazarus et al., 2018). Focusing on job satisfaction and stress, Hartley et al. (2013) argued that heightened fear of contagion and perceived risks are primarily associated with supervisory support and availability of training on infectious disease, emphasizing the organizational dimension of fear. Hartley's emphasis on organizational factors, including institutional support, places the responsibility for resolving the fear that CO experience on the employer's shoulders (Hartley et al., 2013). Regardless of their analytical foci, none of the studies cited thus far present feelings (fear) and perceptions (perceived risks) as a concrete and constant health and safety hazard. Instead, they approach fear from the individual perspective, as if fear was only a matter of how different prison workers, regarding gender, ethnicity, age, marital status, education, and income, view or perceive the threat, as opposed to a force that results from a threat that is inherent to the prison environment and correctional work (i.e., a social problem within correctional services). The risk of contagion in environments that are confined, often overcrowded, and violent exist, regardless of the officers’ perceptions and views; the COVID-19 pandemic is evidence of that risk. Also, dismissing the risk of contagion as something unreasonable or unrealistic means disregarding the structural vulnerabilities that mark correctional work. In contrast with the literature available, this article advances fear and perceived risk of contagion as an occupational health and safety hazard, thereby exploring the social psychological dimension of correctional work as a dangerous and insalubrity activity.

Methods

The interviews supporting this article result from a broader multi-year, mixed method longitudinal study (2018 to approximately 2028) that intends to map and analyze the structural and contextual factors that impact the occupational health of COs working federal prisons in Canada. Referred to as CCWORK (Canadian Correctional Workers’ Well-being, Organizations, Roles and Knowledge) the study aims, among other tasks, to interview CORs entering Canada's federal correctional services annually (approximately 300 individuals). Participants are interviewed during training and recruitment (i.e., baseline), before being deployed to a prison, and annually thereafter (i.e., follow-up waves). Semi-structured, the interviews with recruits and officers inquire into their expectations, experiences, and perceptions of correctional work, including correctional policies. The 71 interviews (about 25 percent of all individuals entering the federal correctional career annually) used to support the analysis comprise a subset of 126 baseline interviews conducted with recruits during CCWORK's first and second fiscal year (38 interviews from August 2018 to April 2019 and 32 interviews from April 2019 to March 2020). We interviewed participants at CSC's National Training Academy in Kingston, Ontario, when they were completing the in person component of the Correctional Officer Training Program (CTP) as part of their training and recruitment process.

The CTP trains recruits on, among other content, risk of exposure to infectious diseases, transmission patterns, and safety protocols. Safety protocols detail procedures for, alongside other tasks, cell search and body search, as well as the use of personal protective equipment (PPE). When in CTP, CORs also learn “dynamic security practices,” a series of strategies that help officers build respect-based relationship with prisoners (i.e., “rapport”) (CSC, 2014; Ricciardelli, 2019a). One of the goals of dynamic security is to enhance the “safety” and security of correctional institutions (CSC, 2014), including the safety of prison staff.

We selected our interview subset based on the interviews’ readiness; they had already been processed and were ready to be coded. CSC facilitated participant recruitment by allowing us to advertise our project to all CO recruits and conduct interviews during training, as well as by providing a private space for the project team to conduct interviews in-person. However, participation in our project was voluntary. Further, CSC had no access to research data, interview voice recording or transcripts. Lasting about 60 min, interviews were recorded and transcribed verbatim afterward. All participant identifying information were anonymized; the participant's name was replaced with an identification number in the larger CCWORK dataset. Our research protocols received approval from the Research Ethics Board of the Memorial University of Newfoundland (File No. 20190481).

When coding the interviews with recruits for the broad CCWORK study, we realized that most participants had voluntarily presented infectious diseases and contagion risks as an occupational concern (i.e., fear of exposure), even though our interview guide had no explicit question about infectious disease and contagion. Conversely, questions about the Prison Needle Exchange Program (PNEP) may have indirectly prompted participants to touch on the topic of infectious disease. Launched in 2018 in federal prisons, PNEP takes the existence of illicit drugs in prison for granted and intends to prevent the sharing of needles among prisoners to curb the spread of infectious disease (CSC, 2019). To mitigate the chances of needle sharing, PNEP swaps the dirty needles of program participants for clean ones, which they can use outside of staff supervision.

We analyzed these interviews in a three-phase coding process using a semi-grounded and constructed approach (Charmaz, 2014; Glaser & Strauss, 1967) using NVivo software. First, we applied axial coding to classify the interview information according to the themes covered in the interview guide. All interview excerpts used in this article were initially coded under the code “PNEP,” a code in our broader coding scheme. Second, we applied open coding to identify and organize the excerpts under PNEP thematically. Through this process, we identified the topics explored in the “findings” section: fear of contagion, sources of spread, and contagion risk mitigation strategies. Such topics were present in every interview, meaning that 10–15 interviews were already enough to achieve “thematic saturation” (Saunders et al., 2018) during open coding, but we opted to code and use all interview available to strength the quality of our analysis. Lastly, we used MS Excel to tabulate participant's demographic information.

The interview subsample comprises 38 males and 33 females, ranging from 19 to 54 years old. More than three-quarters were aged 19–34 years old. Approximately three-quarters of recruits identified themselves as white (77 percent or 55 individuals), while the remaining (21 percent or 15 individuals) reported to be Asian, Indigenous, and Black; one participant provided no ethnic information. About half of the participants were single, while about 40 percent had a marital relationship. Nearly a third were parents. More than two-thirds had post-secondary credentials (e.g., diploma/degree), while about a third completed only high school. Professionally, about a quarter of participants had worked in correctional services before, being familiar with the job and the prison environment, and over half had worked as public safety personnel (e.g., firefighters, public safety communicators, provincial correctional services).

Findings

All CORs in our sample, regardless of past correctional work experience, reported they fear infectious diseases, with about a quarter of them (17 participants) stating that contagion is their “biggest” fear. Participants listed substance use, needles, and bodily fluids as the primary sources of contamination.

Fear of contagion

Fear of exposure to incurable or hard to cure infections was the most emphasized theme by participants. For instance, P229 told us what “concerns” him “most” is to “come into contact with” HIV/AIDS, hepatitis C, and tuberculosis. Also emphasizing “horrifying” diseases one “can never get rid of,” a participant identified as P16 shared that the “possibility” of “getting cut” or “getting something from some inmate” is the “only thing that's ever concerned” her. She added: “Freak things happen, I’m sure it's happened to COs,” reflecting on the topic. In the same fashion, P91said that his “biggest fear” in prison “is getting, contracting HIV or hepatitis.” Like P229 and P91, numerous participants used the expressions “most” concerning and “biggest fear” to represent their feelings about infectious diseases. Participants were especially concerned about incurable diseases because of the risk they pose to quality of life (i.e., morbidity) and life expectancy.

Most participants grounded their fear of contagion in their families. They viewed contagion risks as posing a direct threat to their family members, especially partners and children. Five participants in our sample summarized their concerns as fear of bringing infectious diseases “home.” P113 said: “It's not like I’m single and don’t have to worry about anyone but myself. I have a husband and two kids at home.” Her previous experience and familiarity with the job elevate the significance of her concerns, which resonates with the unnerving work vulnerabilities that officers face daily.

Unmarried young men too shared concerns around infections; they feared infectious diseases could curb their “dreams” of having a family. For instance, P9 told us that his “only concern” about pursuing a career in correctional services was “coming into contact with STIs.” He told us that “running into” an STI would prevent him from fulfilling his “dream.” His comment suggests that fear of infectious diseases represents a factor determining recruitment and employee turnover in addition to job satisfaction in correctional services.

Reflecting on the consequences of infectious diseases on people's lives, P97 outlined the emotional side of “bringing infectious diseases home.” Discussing HIV/AIDS, he alluded to the stress of having to treat himself with a “weird” drug cocktail. His remarks also included the idea that of having to distance himself physically from his hypothetical family: “[You] can’t kiss your kids, can’t hug people, I don’t know how it works, but it's definitely something…” His remarks reveal the COR's fears, as well as the emotional toll that marks the occupation. Conversely, his belief that seropositive people cannot “hug people” and “kiss” their family members is unsound, suggesting that some CORs were misinformed about the transmission of infectious diseases.

Sources of fear

Participants especially feared two sources of contamination, namely needles and bodily fluids.

Substance use and needles

Participants described illicit drugs use in prison as a factor contributing to the spread of infectious diseases, voicing the perception that prisoners may share needles. CORs were especially concerned about prisoners’ abilities to conceal needles. Concealed needles can “prick” COs during cell or body searches. P170 outlined his fears as follows: “…that needle is tiny, and they can hide that on them very easily. And that's, the safety aspect of that, if they use that needle ten times, they have AIDS, they have hepatitis….” P158 shared a similar concern, saying that she feared coming “across [a] sort of needle or whatever,” and further elaborated on the relationship between needles and the high rates of infectious diseases in prison: “I would hate to frigging contract something. I know how high, um, what kind of prevalence rate or whatever there is of weird disease and stuff.” As a cautionary strategy, she suggested that she would avoid any kind of contact with prisoners: “I’m like ‘don’t breathe on me, don’t touch me. I don’t wanna get liquids anywhere.’” However, using avoidance as a strategy might not feasible, given the nature of the job and the circumstances involved in the care, custody, and control of incarcerated persons.

Needles pose a threat because they can surprise and harm COs during searches and because needles can be used as weapons. Cognizant and fearful of the problem that needles represent, about 40 percent of participants opposed clean needle programs. Their concerns revolved around prisoners “passing needles around” (i.e., sharing them) and using them as a weapon against officers and staff. P49, a recruit with approximately six years of correctional experience, stated: “It doesn’t matter how many clean needles there are, it's still going to be passed around…” Her remark suggests that PNEP per se does not stop prisoners from sharing contaminated needles. Echoing P49, P385 said: “Exchanging needles. I don’t think it's too helpful. I feel like diseases are gonna get passed around even if you give them clean needles cause someone's just not gonna follow the rules.”

About ten recruits voiced concerns about prisoners using needles as weapons, often using the words “stab” to describe an attack on the job. P261 illustrated the concern: “Well I know, I know a thing for me would be needles. But, for me, it's not even the needle part. It’d be like knowing, ah, like know in, ah, let's say like an offender were to stab you with a needle…” P170 used the same expression: “If they’re going to come up behind somebody, an officer, anybody, and they’re going to stab them with it, you know high chances of the spread…” Several other participants commented on the same concern. P384 said: “Whether they’re exchanging it … [needles] can still be a weapon they can still use it in some type of grievous act…” Making her concerns clearer, she explained what she perceived prisoners could do: “Intentionally going to put that needle in someone who is infected with something and use it to stab us.” Meanwhile, another recruit presented her interpretation, explaining the idea to provide needles, identified as possible weapons, to people who have a history of breaking the rules saying that needles, when provided “to the wrong people, it can be dangerous.”

Some CORs presented PNEP as an opportunity for prisoners to harm COs. P61said: “…At that point, you’re giving them a weapon, you’re giving them something that they can stab you with, and also something that they can reuse…” Thinking about factors informing her perspective, she added: “Yeah, if it's controlled then I would see the benefit, my attitude would shift… I wouldn’t want to get poked with it.” Nonetheless, she remained dissatisfied with the program.

P97 suggested PNEP fails to align the prisoner's well-being with the officer's, instead the program prioritizes the prisoner's health over the officer's safety: “…it's a huge officer safety thing because these people have communicable diseases like AIDS and all that kinda stuff.” Recruit P29 shared a similar interpretation: “I get the purpose, and like I get it, and it's important, but with reducing that risk for them [prisoners], it increases a huge risk for us.” She followed up by explaining PNEP makes officers depend on their “luck” to avoid infection in case prisoners weaponize their needles: “They’ve already injected themselves with that and used it as a weapon, now you have like a 90% chance of getting it, I mean you’re really lucky if you don’t get it….” Another participant, P90 presented his concerns about needles as a “family concern:” “Can you imagine coming home and telling your spouse that you were pricked by an HIV needle?” The few participants who prioritized the harm reduction goal of PNEP also expressed concerns about its unintended consequences. For instance, P173 reported preferring prisoners to have “clean needles than dirty needles because you can get so many illnesses spread to the rest of the prison, like hepatitis, HPV…” However, she still feared for the safety of staff and prisoners. Overall, recruits believed that PNEP does little to reduce the spread of infectious diseases but much to compromise the staff and officer occupational health and safety.

Despite their critical perspective on the PNEP, several participants reported that their training effectively taught them how to be cautious about drugs and needles. On this matter, P115 said: “I mean… we’re trained, I think very well, to be as cautious as possible and to assume that [there are always drugs]…” P117 suggested that training made her feel safe. However, concerns about needles were “always” “in the back” of her mind: “I know there's always that threat, and I’m slightly concerned about pricking myself and getting a disease or whatever, but again there’re precautionary measures we take for a reason.” Our findings demonstrate that the problem of illicit drug use in prisons involves not only the prisoner's well-being but also the prison employee's health and safety.

Bodily fluids

Exposure to bodily fluids emerged as a concern among our research participants. A survey with 200 COs in British Columbia, Canada, indicated that three-quarters of officers had had contact with the prisoners’ feces, saliva, or urine (Boyd, 2011). In another Canadian study, interviewees explained that bodily fluids can be even more effective than needles as sources of potential contamination because prisoners can engage them from longer distances (Ricciardelli & Power, 2020). Concerned about infectious diseases, P109 described being more concerned about “getting blood thrown” at him than being stabbed or punched. To explain his position, he implied that infectious diseases may have life-long consequences: “I mean someone's going to shank me up quick and I die fast that's one thing, but to have AIDS that's a different story.” Likewise, P109 was also more worried about exposure to bodily fluids than being physically attacked. Some participants, like P112 even named bodily fluids as the most challenging aspect of correctional work. Following up, she added: “I’ve never had certain things throw in my face or [been] spit on or anything like that, so I think that’ll be a big challenge.” Despite being aware that COs may be exposed to bodily fluids, P112 said she was not ready to be attacked.

Others, like P86 mentioned bodily fluids when explaining the cautionary measures that she learned in training: “You could be spit on or thrown stuff at …I just have to learn better techniques to approach those things, right?” Despite acknowledging that there are techniques to manage bodily fluids, recruits still were concerned about bodily fluids due to the unpredictability of human nature. For example, P270 said: “Say I arrest and control him, get him down and stuff, I’d have to be conscious of like positions I’m in, and he was in because I wouldn’t want to be like face-to-face with him because then he could spit in my eyeball, and I could be exposed.” Overall, participants worried about contact with bodily fluids, worries intensified by the possibility of contagion. CORs describing bodily fluids as having potential morbidity and mortality implication revealing the inherent health and safety that underpin the correctional officer occupation.

Contagion risk mitigation strategies

Confronted with a contagion risk, a strategy of safekeeping commonly voiced by CORs, although riddled with challenges around prisoner confidentiality and privacy, is knowledge of who carries infections. According to CSC guidelines, prisoner health records are confidential and only to be disclosed to third parties on a need to know basis (Corrections and Conditional Release Act (S.C. 1992, Sections 85–89). Therefore, excluding exceptional cases, COs do not know the health/infection status of prisoners. Recruits reported they would feel safer or “fine” if they knew about the prisoner's medical condition as P261 indicated: “OK, me knowing whether the person has any kind of infections or conditions. I think that's the only thing. I think, mentally, I would be fine if that was disclosed to me. If that was able to be disclosed…” P199 added that COs only learn about the prisoner's health condition after the fact; when they have already been involved in an incident: “We don’t get to know they’re [prisoners] infected unless we’re dealing with that case specifically, but when you get pricked, and they have an infectious disease of any sort, that's with you now…” As COs cannot secure health knowledge of the prison population under their care, they have limited opportunities to take a proactive approach to protect their occupational health and safety. To mitigate contagion risks, COs relied on the protocols and strategies they learned during CTP, particularly the use of PPE and dynamic security (e.g., rapport with prisoners). They often relied also on ad hoc strategies such as physical distancing.

Several participants reported feeling safer from contagion when wearing PPE. The comments by P188, a recruit who had completed a practicum in prison, summarizes the common perspectives among recruits of PPEs and contagion risks: “With the proper like gloves and stuff like that it would make it less likely that something were to happen like that…” Meanwhile, other participants emphasized the importance of physical distancing. Explaining how she mitigates the risk of infection on the job, P158 explained using physical distancing to counter her “biggest fear,” that is the “prevalence rate” of “weird disease and stuff.” However, physical distancing is not always possible, especially in overcrowded prisons. Thus, rapport becomes a central contagion risk mitigation strategy.

Participants often viewed rapport as an effective strategy to ensure their safety. For example, P178 described a situation where good rapport with a prisoner saved an officer from exposure to hepatitis. According to P178, during a confrontation between incarcerated persons, the attacker raised up his hand and told the approaching officer to put on PPE because he had hepatitis C. After telling the story, P178 emphasized that the prisoner only alerted the officer because of their good “rapport”: “[He, the prisoner] let her [the officer] know, just because he has a rapport.” P178's interview describes rapport as a “bridge” enabling the officers to learn about prisoners under their care rather than rely on official need to know based knowledge. Other recruits echoed the value of rapport to ensure the safety of COs on the job. P270 introduced rapport as an effective strategy to avoid being infected: “The other thing is having a good rapport with inmates, if I have a good rapport with inmates, inmates won’t try to plant things [to] try to infect me…” P270's words suggest that the health and safety of COs is perceived as subordinated to that of the prisoners under their care. Further illustrating the CO work vulnerability, P9 presented rapport as the “best way” and an effective strategy to avoid contagion: “The best way to avoid that is to build a rapport…An inmate has no reason to attack you, they’re not going to attack you. They just want to do their time and get out of there, just like we want to work our shift and go home…” Participants, as evinced across the excerpts, valued good rapport with prisoners, revealing that developing and maintaining a good relationship with those in custody diminishes the risk of infection, even encourages honesty about prisoner health status. Rapport welcomes caring, and caring is then demonstrated in that prisoners disclose their health status; their intention is often not to harm the staff member. Trained to value rapport, including for their own safety and to approach prisoners as people, recruits learn that being fair and treating prisoners as people is critical in prison. Despite the multiple layers of formal and informal authority that negate the value of direct, authoritative power, recruits learn to treat prisoners as they would want to be treated if ever in the same situation and, in turn, by doing so, they increase their own personal safety.

Overall, the CORs interviewed consistently reported fear of infectious disease and enhanced perception of contagion risks as an occupational stressor. Participants grounded their fear of infection primarily in the possibility of transmitting incurable diseases to their family member. The stigma that surrounds infectious diseases seem to aggravate their fear, as several participants presented the possibility of reporting to their family that they were pricked by a needle as daunting. The presence of drug-related sharpies in prison was the primary source of fear among recruits who anticipated the following two possibilities: having infected needles weaponized against them and coming across needles inadvertently during cell and body searches. PNEP, which has been implemented in select Canadian federal prisons since 2018, represents a point of contention among recruits, despite their official nature. Participants, including those who agreed with the PNEP's harm reduction objective, argued that having needles in prison increases the occupational risks they experience regularly. In addition to wearing PPE, recruits planned on using good rapport with prisoners as a primary line of defense to manage their fear of infectious disease and perceived contagion risk.

Discussion and conclusion

Despite the prison worker's continual exposure to infectious diseases and contagion risks at work, empirical-based studies on how COs view and perceive infectious disease in prison are rare. The opinions and feelings of prison staff regarding infectious diseases usually appear in studies seeking to identify the predictors of job satisfaction (and dissatisfaction) and job stress among officers (Hartley et al., 2013; Lambert et al., 2017; Lambert et al., 2018; Lambert & Paoline, 2005). The lack of studies dedicated to analyzing infectious diseases from the prison employee's perspective makes our findings a rare window into how correctional workers view and feel about infectious diseases and contagion risks. In addition to corroborating the scholarship that portrays infectious diseases and contagion risks as a source of stress and dissatisfaction (Hartley et al., 2013; Lambert et al., 2018; Lambert & Paoline , 2005), our study advances Correctional Studies by providing information on the following aspects of infectious diseases: the prevalence of fear, the reasons driving fear, the sources of threat, and the strategies that CORs expect to use to stay safe. Our findings and sample size demonstrate that fear of infectious diseases and contagion risks is a real and recurrent feeling among CORs in Canada's federal prison system; this fear is independent of the CORs’ gender, age, ethnicity, marital status, and occupational tenure. Concern for the family and desire to keep family members safe as the primary reasons explaining the fear that CORs have of infectious diseases. Our findings also demonstrate that CORs perceived illicit drug use in prison, as well as the presence of needles in prison—be it authorized (i.e., provided to prisoners through the PNEP) or illicit—and bodily fluid, as other researchers have indicated (Mahaffey & Marcus, 1995), are major risks of contagion. CORs viewed, often based on prior experiences in correctional services, rapport with prisoners and PPE wearing as tools to mitigate their fears and risk of contagion. Our findings have theoretical and concrete relevance to the understanding of correctional work.

First, because reports of fear of infectious diseases and heightened perceived contagion risks were consistent throughout our interview sample, they shall be viewed, analyzed, and addressed as a collective problem (e.g., social problem within correctional services), as opposed to an individual problem. One may argue that the likelihood of contagion by incurable infectious diseases, like HIV or hepatitis C, is low and unpredictable, that prisons are not as dangerous as suggested, and that the fear that CORs experience is exaggerated. Regardless, the fear that CORs and COs feel is real and impacts their occupational and personal lives (Alarid & Marquart, 2009; Mahaffey & Marcus, 1995; McIntyre et al., 1999; McKee et al., 1995). Research on fear (Whalen, 1998) has found that continual exposure to ambiguous threats can intensify the experience of fear and the stress deriving from that exposure. Practically, continual exposure to contagion risk, regardless of degree, shape, or form, pushes individuals into a state of hypervigilance, in which they continuously scan environmental information to identify and assess threats that can lead to mental injuries; this pronged state of hypervigilance can cause mental health injuries and is correlated with stress and PTSD symptoms (Kimble et al., 2014; Whalen, 1998). Thus, correctional work, which is characterized by dangers and threats that never cease, is an aversive stimulus originating such fear and perception regardless of the person's personality or life experiences.

Essentially, fear of infectious diseases and enhanced perceptions of risk are intrinsic collective reactions to correctional work; they are normal emotional manifestation of working under the conditions that underpin correctional work. As such, fear of infectious disease and perceived (high) risk of contagion represent an occupational vulnerability intrinsic to the prison as a work environment that shall be addressed with clear and specific policies in Canada, and, arguably, compensated for as is the norm in several countries (Costa, 2014; Kearney, 2014).

Second, evidence of fear of infectious diseases as a collective reaction to correctional work corroborates the growing scholarship that frames the emotional and psychological symptoms among public safety personnel as an “operational stress injury” (OSI) (Carleton et al., 2018; Carleton et al., 2019; Carleton et al., 2020; Liu et al., 2013; Regehr et al., 2019). Occupational stress injuries refer to any persistent psychological difficulty caused by prolonged stress and fatigue or exposure to traumatic experiences during service as a public safety personnel (Howatt, 2020; Oliphant, 2016). The OSI scholarship represents an overhaul in the understanding of occupational health and safety, which thus far has paid limited attention to the dangers and risks that affect the psyche, as opposed to the body. Based on the research findings outlined, fear of infectious disease and perceived contagion risk are a persistent psychological danger among CORs, that is an OSI.

Third, our portrayal of fear as inherent to correctional work and an OSI does not imply accepting and embracing it complacently; on the contrary. Inspired by previous scholarship indicating a negative correlation between knowledge of infectious disease and the variables perceived risks and attitude towards prisoners (Kamerman, 1991; Rotily et al., 2001), even when that correlation is mediated by other variables (Ferguson, 1997), we call into question the effectiveness of the training by CORs. While preventing contact with bodily fluids is prudent, several recruits seemed oblivious to the fact that the effective transmission of bloodborne pathogens requires a number of conditions that are unlikely to occur together (Fry, 2005; Mast et al., 1995) beyond kissing someone or being spat in the eye. Thus, we join other voices (Hartley et al., 2013) recommending a full-revision of the training modules covering bloodborne illnesses. Ideally, training should detail conditions of contagion and draw on scientific research conducted with professionals who have continual exposure to bodily fluid (e.g., athletes and health professionals; Fry, 2005; Mast et al., 1995) to demonstrate the low likelihood of transmission, as well as mitigate any concerns.

Fourth, our study revealed a new facet of rapport; officers use rapport with prisoners as a safety net, in addition to a mechanism to promote security and safety (e.g., talk a prisoner down), as well as prisoner rehabilitation (CSC, 2014). Participants portrayed good rapport with prisoner as a tool to manage and potentially remedy fear of infectious diseases and perceived risk of contagion. Rapport with prisoners can create a safe space for prisoners to disclose their health information voluntarily, equipping officers with the knowledge they need to protect their safety while performing their occupational responsibilities. However, not all officers can benefit from rapport. Rapport represents a form of “emotional labor” (Hochschild, 1983) that is difficult to define, measure, quantify, standardize, teach, and thus certify (George & Paul, 2002; Payne, 2009). Also, not everyone can perform emotional labor effectively; this ability also requires personality traits (e.g., charisma and empathy) that result from broad socialization processes, beyond training (Hochschild, 1983; Keep & Mayhew, 1999; Payne, 2009). Establishing good rapport also requires pre-disposition on the interlocutor's side. Thus, the use of good rapport as a personal protection tool is not available to every officer. Most importantly, the use of good rapport with prisoners to feel safe inverts the officer-on-prisoner power relation that characterizes prison, potentially increasing the officer's occupational vulnerability to the dangers of correctional work.

Fifth, this study raises awareness to the imperative and continual need to align prisoner's interests and well-being with the interests and well-being of COs, as conditions of employment reflect conditions of incarceration, and vice-versa (Ricciardelli & Power, 2020). For instance, several participants perceived harm reduction programs that promote prisoner health at the potential detriment of the officer's safety, such as the PNEP, as prioritizing prisoners’ rights over the rights of those who watch and care for them. Our study also showed that several CORs interpret the confidentiality of prisoner health status as a hazardous work condition. CORs believe that knowledge of the prisoner's medical condition can shield them from contagion, reduce their perception of danger, and improve job satisfaction, which could potentially benefit prisoners (see also: Lambert & Paoline , 2005; Rotily et al., 2001). However, knowledge of prisoner health status is complicated by the legal need to keep prisoner's right to confidentiality and privacy, as well as the prison administrator's responsibility to protect prisoners from potential discrimination due to their health status. Nonetheless, knowledge represents the foundation of behavior regulation (Bennett et al., 2014; Haggerty & Ericson, 2000; Rose, 1999), particularly in “total institutions” (Goffman, 1961), where “care” and “correction” depends on the continuous scrutiny (i.e., a panoptic vision) of prisoners (Graham & James, 2006). Thus, correctional managers, as well as prison rights advocates, shall work to reconcile the prisoner's right to confidentiality and safety with the employee's right to feel safe at work.

Broadly, the findings outlined reveal that infectious diseases in federal prisons represent a source of structural vulnerability for COs, which underpins the need to approach prison infectious diseases as an occupational health and safety issue; not doing so could risk transforming the work vulnerability that COs currently experience into work precariousness. Addressing the COR's perceived vulnerability against fear of infectious diseases certainly will contribute to improve the correctional environment for both staff and prisoners.

The data supporting this analysis is limited in that the researchers did not set out to learn about infectious disease in prison; instead, the topic emerged during coding. Thus, future research is needed to understand how COs, as opposed to recruits, perceived infectious diseases and contagion risks, as well as if their perception vary according to demographics, including occupational tenure. Such an exploration would be the next necessary step to understand how the life course alters work vulnerability throughout the correctional career. Given the interviews were conducted before March 2020, we could not evaluate how the COVID-19 pandemic impacted the perception of infectious diseases in correctional work, as well as the correctional agencies’ response to COVID-19. Based on our findings, we expect CORs and COs to perceive bloodborne and curable infectious differently from the perspective of fear and risk. COVID-19 fear and perceived risks, unlike those of bloodborne diseases, are likely to be highly influenced by political ideology (Deane et al., 2021). Regardless, explorations of how COVID-19 has informed risk perceptions among recruits and COs are necessary. Understanding how COVID-19 impacted correctional workers, including their perceived occupational dangerousness, concerns, work routine, and stress, will allow correctional scholars and practitioners to assess the effectiveness of the policies and protocols deployed because of COVID-19, better preparing prisons to keep both staff and prisoners safe in case of future epidemics and pandemics.