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World Hepatitis Day Oration HCV and prisons

World Hepatitis Day Oration HCV and prisons. Michael Moore AM. Ngunnawal people have always lived here. In this place we sang and danced and laughed. Young men became wise men. The sky and the earth gave us food and water. Then others came. Public Health.

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World Hepatitis Day Oration HCV and prisons

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  1. World Hepatitis Day OrationHCV and prisons Michael Moore AM

  2. Ngunnawal people have always lived here. In this place we sang and danced and laughed. Young men became wise men. The sky and the earth gave us food and water. Then others came

  3. Public Health A Global Charter for the Public’s Health • Basics / Services • Protection, • Prevention, • Health Promotion • Enablers • Good governance • Capacity building • Accurate Information • Advocacy

  4. The issues -1a Hep C - 2006 /2014 Estimates & Projections • General Community • 2006 estimated there are 197,000 people with chronic hepatitis C infection • 2014 estimated there are 230,500 people with chronic hepatitis C infection • 25% of those living with chronic hepatitis C in Australia have moderate to severe liver disease • 15% (35,000) unaware (2006 = 39,00) • National rates of hepatitis C in prison entrants • 2006 = 34% for males and 50 to 70 percent for females

  5. The issues -1b ACT 2010 HCV Prevalence on prison entrance Australia ACT 2013 Dolan et al AIVL Needs Analysis (2017)

  6. The issues-2 • New breakthrough direct-acting antiviral medicine were made available on the PBS from 1 March 2016.  • These new medicines offer a cure for between a 90-95%  of people living with hepatitis C. • Is this as an excuse? • Treatment is important • Prevention is better than cure • And cheaper

  7. The issues-3 International • The United Nations 1990 General Assembly Resolution on the Basic Principles for the Treatment of Prisoners (Article 9) states: • “Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation”. • World Health Organization view • “All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination” WHO 1993 • Being denied an international right is a denial to justice

  8. The issues- 4 ACT Human Rights Act, 2004 Sections 19 (1) • “Anyone deprived of liberty must be treated with humanity and with respect for the inherent dignity of the human person.” • Human Rights Commissioner Dr Helen Watchirs • Audit of Prisons ACT Correctional Facilities Aug 2007 • Over 100 recommendations including a Needle and Syringe Program • Being denied right under Human Rights Act is a denial to justice

  9. The issues-5 Increasing incarceration • The number of people in Australian prisons has increased for the sixth consecutive year, according to figures released today by the Australian Bureau of Statistics (ABS). • 41,202 prisoners on 30 June 2017, • 6 per cent increase from 30 June 2016 • 51 per cent increase from 30 June 2007. • 2016-17 increased in every jurisdiction except the NT and the ACT (compare prior AMC)

  10. The issues - 6 The AMC • Mar 2009 - Sep 2014 = 51 HCV notifications • Likely to be underestimate • Universal opt-in testing for HCV • approximately 70% uptake • 2009-10 = 117 prisoners treated • Financial cost to community $7million • And re-infection??? • Cause • 2016-17 = 740 prohibited items interdicted • Drugs, syringes, mobile phones

  11. The current NSP in the AMC • Prisoners own NSP • 2016-17 = seized 59 syringes • Unregulated access • High risk spread Hep C and HIV • 64% of men and 40% of women have been exposed to HCV • Compared to 2% of in general community

  12. Countries with Prisons with NSPs (2006) Switzerland 1992 7 Germany 1996 1 (6 closed following political decision) Spain 1997 38 Moldova 1999 7 Kyrgyz Rep. 2002 11 Belarus 2003 1 (as of 2004) Luxembourg 2005 1 Isl. Rep. of Iran 2005 1 to 6 Armenia 2004 3 Ukraine 2007 2 pilot projects due start September 2007 UK (Scotland) 2007 pilot study approved to start in 2007 Portugal 2007 implementation by 2008 SURELY IT IS POSSIBLE IN THE ACT Wodak 2008

  13. Women’s Penitentiary – Berlin, Germany (JVA Lichtenberg) • Women need to volunteer • Machine used one for one exchange • Single wing of prison • Counselling to other options • pharma & abstinence Reichstag building Women’s Prison – East Berlin

  14. Luxembourg -Schrassig Penitentiary • NSP originally opposed by officers • Prisoners largely refugees (1st & 2nd generation) • Prison health authorities run the exchange • Like AMC - full range of prisoner classifications

  15. Geneva, SwitzerlandChamp-Dollon Penitentiary • Dr Hans Wolff • Overcrowded • Emphasis on evidence • As many options as possible • Distribution • Care • Counselling Internet images Compare to Solithurn Prison

  16. Valencia Penitentiary – Spain Valencia Railway Station • Distribution by Drug and Alcohol Workers from FSIC • Arms length from prison officers • Users in a specific wing • Monitoring by prison authorities • Initial objection then strong support Madrid Madrid

  17. NSP in IRANJuly 2008 – May 2010

  18. NSP in Canada - 2018 • Globe and Mail May 14 2018 • “the union representing Canada’s correctional officers says the move condones illicit drug use and allowing prisoners to possess needles puts officers in danger” • New Brunswick and Kitchener Ontario in June • Best practices learned at these two locations will inform a national rollout in January, 2019 • Spokesperson for the service, Ms Stephanie Stevenson • prison needle-exchange programs are not associated with increased attacks on prison staff or inmates. 

  19. Royal Commission into Aboriginal Deaths in Custody • There are an estimated 22,000 Aboriginal and Torres Strait Islander people with hepatitis C • In 1991, the Royal Commission into Aboriginal Deaths in Custody • Looked at such issues of organisation, culture and policy, security issues, access to health care, domestic politics and the system in the communities to which people return after incarceration • Now twenty years since the start of the Commission • More aboriginal people in custody • Health threats from hepatitis C and from HIV/AIDS

  20. Royal Commission – a success? • The Royal Commission provided a road map – but ... • Aboriginal and Torres Strait Islander peoples now make up 24% of the total prison population • an increase from 14% in 1992 • They make up less than 3% of the total Australian population Memorial for John Pat in front of the prison walls of the decommissioned Fremantle Prison. It was erected in September 1994 "in memory of all Aboriginal people who have died in custody in Australia"

  21. International Incarceration Rates Aboriginal Incarceration Rates Aboriginal Australians 2,434 / 100,000 Victorian Sentencing Advisory Council From 30 June 2017, the Aboriginal and Torres Strait Islander imprisonment rate increased by 4%, from 2,346 to 2,434 prisoners per 100,000 Aboriginal and Torres Strait Islander population. The non-Indigenous rate also increased by 4% over the same period from 154 to 160 prisoners per 100,000 non-Indigenous population. (Table 20) (Aust Bureau of Statistics)

  22. Report to the ACT Govt on NSP in AMC • Recommendations • Recommendation 1: Requirement Under Law • The ACT Corrections Management Act 2007 be amended to require the establishment of a needle and syringe program at the AMC • Recommendation 2: Rules, Procedures and Protocols • A clear set of rules, procedures and protocols be established through an appropriate process guided by the ACT Corrections Management Act • Recommendation 3 :Implementation through a Flexible Contingency Approach • Adopt a contingency process for the implementation of appropriate model/s for a needle and syringe program at the AMC. If the initially preferred model does not meet the needs of stakeholders the procedure should be to move to the next preference (next slide) • Recommendation 4: Aboriginal Health Worker • Recruitment of a dedicated Aboriginal Health Worker position in NSP and related service provision would be worthy of consideration • Recommendation 5: Secure Syringe Disposal Bins • The installation of secure syringe disposal bins would further reduce the potential for accidental needle-stick injury and be worthy of consideration even without the implementation of an NSP • Recommendation 6: Retractable Syringes Technology • Future developments in retractable syringe technology will need to be considered as part of the ongoing development of NSPs in custodial settings Moore, M & Walker M, Balancing Access and Safety

  23. The main block in the ACT • Prison staff – we need to engage differently • Claim it is because of fear of needles as weapons • This has been managed in Spain, Switzerland & elsewhere • Truth • It is moral issue for prison warders • In some prisons they are part of the supply chain • Some health staff adopt attitude of prison officers • Action • Change the law and follow up. Who should manage health? • Politicians – we need to engage • Either law and order themselves or others’ campaigns

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