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On Point: making prison needle and syringe programs work in Canada

On Point: making prison needle and syringe programs work in Canada. January 23rd, 2014 Sandra Ka Hon Chu Canadian HIV/AIDS Legal Network.

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On Point: making prison needle and syringe programs work in Canada

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  1. On Point: making prison needle and syringe programs work in Canada • January 23rd, 2014 • Sandra Ka Hon Chu Canadian HIV/AIDS Legal Network

  2. Governments have a moral and legal responsibility to prevent the spread of HIV among prisoners and prison staff and to care for those infected. They also have a responsibility to prevent the spread of HIV among communities. • Prisoners are the community. They come from the community, they return to it. Protection of prisoners is protection of our communities. • (UNAIDS, 1996)

  3. HIV and HCV in Canadian prisons • HIV & HCV prevalence in prison at least 10 and 30 times higher than in the community as a whole. • 1 in 6 people in federal prisons reported having injected drugs in the previous six months in prison. • Of those people who injected drugs in prison: • 1/2 used someone else’s used needle& • 1/3 shared a needle with someone with HIV, HCV or unknown infection status.

  4. Global research on injection drug use in prison: • Estimated that up to 75% of prisoners with a history of IDU continue to use drugs in prison. • Up to 25% of people who inject drugs begin injecting while in prison.

  5. For over 25 years, needle and syringe programs (NSPs) have operated in Canada as a key component in a comprehensive response to the risk of HIV and hepatitis transmission among people who inject drugs. • In Canadian federal prisons: • Bleach: in 3 discreet locations in each prison, in order to “promote public health … as a harm reduction measure against the transmission of HIV and other infectious diseases.” (CD 821-2) • OST: methadone, both continuation and initiation (CD 800) • Condoms, dental dams and lubricant: in discreet and accessible locations (CD 821) • But NO prison-based needle and syringe programs (PNSPs)

  6. Federal government’s rationale for rejecting PNSPs? • Does not want to be seen as condoning drug use in prison (CD 585 (2007): “A safe, drug-free institutional environment is a fundamental condition for the success of the reintegration of inmates into society as law-abiding citizens.”) • Will lead to an increase in violence and the use of syringes as weapons against prisoners or staff; • Will lead to increased drug use; and • Will not work in Canada.

  7. Where do PNSPs exist? • PNSPs have been introduced in more than 60 prisons in at least 8 countries: Switzerland Germany a Spain Luxembourg Moldova Tajikistan Romania Kyrgyzstan

  8. Results

  9. Feared negative consequences have not materialized: • No increase in drug use or drug injection • No increase in institutional violence • Not a single documented case of a needle from PNSP being used as weapon • No increase in needle-stick injuries

  10. Conclusions about PNSPs: • feasible and affordable across a wide range of prison settings; • decrease syringe sharing among prisoners who inject drugs, thereby decreasing risk of HIV & HCV transmission between prisoners and from prisoners to prison staff; • contribute to workplace safety; • lead to a decrease in abscesses, and facilitate referrals to and use of available drug dependence treatment programs; • can employ several different methods of needle distribution successfully in response to staff and prisoners’ needs; • can successfully coexist with other drug prevention and treatment programs.

  11. Documentation • Action on HIV/AIDS in Prisons: Too Little, Too Late — A Report Card (2002) • Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience (2006) • Hard Time: HIV and Hepatitis C Prevention Programming for Prisoners in Canada (2007) • Needle and Syringe Programs and Bleach in Prisons: Reviewing the Evidence (2008) • Clean Switch: The Case for Prison Needle and Syringe Programs in Canada (2009) • Under the Skin: A People’s Case for Prison Needle and Syringe Programs (2010)

  12. Advocacy: lobbying • Ministerial Council on HIV/AIDS • Parliamentary Committees: • House of Commons Standing Committees on Public Safety and National Security (2009 & 2011) • Senate Standing Committees on Legal and Constitutional Affairs (2009 & 2012) • Members of Parliament • Resulting in recommendations for PNPS from: • Ministerial Council on HIV/AIDS & Parliamentary Committee reviewing addiction and mental health in prisons.

  13. Advocacy: media • Ongoing media to keep issue of PNSPs before public: • articles in correctional magazines; • press release to highlight HIV/HCV rates behind bars; • letters to the editor critical of government bills to incarcerate more people who use drugs in inhumane conditions; & • media interviews (print, radio, television, web).

  14. Advocacy: public education • a video advocacy series featuring partners, family members and other loved ones of prisoners & their views on PNSPs (www.prisonhealthnow.ca); • Publications in journal articles; • Presentations & workshops at conferences — local and international; • Public events in partnership with activists and academics (U of T, Ryerson U).

  15. PNSPs: domestic & international support • Domestic: • CSC’s Expert Committee on AIDS in Prisons • Health Canada Task Force on HIV/AIDS and Injection Drug Use • CSC’s Study Group on Needle Exchange Programs • Ministerial Council on HIV/AIDS • Canadian Human Rights Commission • Ontario Medical Association • Correctional Investigator of Canada • Canadian Medical Association • Canadian Centre on Substance Abuse • Public Health Agency of Canada International: • World Health Organization • UNAIDS • UN Office on Drugs and Crime • UN High Commissioner on Human Rights

  16. Federal government’s possible rationale for rejecting PNSPs: • Does not want to be seen as condoning drug use in prison • Will lead to an increase in violence and the use of syringes as weapons against prisoners or staff • Will lead to increased drug use • Will not work in Canada

  17. Constitutional challenge In the face of the government’s refusal to implement PNSPs • a man formerly incarcerated in a federal prison in Ontario, Canada • Canadian HIV/AIDS Legal Network • Prisoners with HIV/AIDS Support Action Network • CATIE • Canadian Aboriginal AIDS Network • initiated a lawsuit in September 2012 against the federal correctional service to compel it to introduce PNSPs. • The applicant was infected with HCV after using injecting equipment that had been used by a fellow prisoner with HCV. His infection was entirely preventable had there been a PNSP in place.

  18. Thank you • Canadian HIV/AIDS Legal Network • 1240 Bay Street, Suite 600 • Toronto, Ontario M5R 2A7 • Phone: +1 416 595-1666 • Fax: +1 416 595-0094 • Email: schu@aidslaw.ca • Website: www.aidslaw.ca

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