Making prison needle exchange programs work in Canada – Part 3

This is the third of four unique perspectives on prison needle and syringe programs. It explains why such programs are essential, what is happening in Canadian and international prisons and how such a program can work. All were part of a panel discussion in support of prisoners’ rights and justice at Toronto’s Ryerson University.

Human Immunodeficiency Virus and Hepatitis C Virus in prisons: The facts behind the constitutional challenge to implement needle and syringe programs in federal prisons

By Sandra Ka Hon Chu

Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) prevalence in Canadian prisons is at least 10 and 30 times higher, respectively, than in the general population.

Furthermore, one in six people in this country’s federal prisons reports that he or she has injected drugs in the previous six months in prison. Of those people who injected drugs in a Canadian prison:

  • half injected the drugs with someone else’s used needle
  • one-third shared a needle with someone with HIV, HCV or unknown infection status.

Global research on injection drug use in prison supports these statistics. An estimated up to 75 per cent of prisoners with a history of intravenous drug use continue to use drugs in prison. Up to 25 per cent of people who inject drugs begin injecting while in prison.

Harm reduction programs in Canada and internationally

Some measures have been available in Canadian prisons for over 25 years, such as:

  • Providing bleach in three discreet locations in each prison; it is to be used to “promote public health … as a harm reduction measure against the transmission of HIV and other infectious diseases”
  • Opioid Substitution Treatment: continuation or initiation to methadone
  • Condoms, dental dams and lubricant: in discreet and accessible locations

None of these is adequate, but the federal government rejects supporting prison-based needle and syringe programs because:

  • it does not want to be seen as condoning drug use in prison
  • it misguidedly believes that prison-based needle and syringe programs will lead to the use of syringes as weapons against prisoners or staff and an increase in violence, and
  • it also thinks needle and syringe programs will lead to increased drug use; and will not work in Canada.

The truth about these programs

Twenty years of evidence demonstrate that these concerns are not based on fact.

Prison-based needle and syringe programs have been introduced in more than 60 prisons around the world. These include prisons that are well-funded and severely underfunded; are civilian and military; have drastically different physical arrangements for the housing of prisoners; are for men and for women, and of all security classifications and all sizes.

What they have in common is that they all distribute syringes. Prisoners receive syringes directly from nurses and/or the prison physician, from prisoners trained as peer outreach workers, or from external NGOs or other health professionals, or access them via one-for-one automated syringe dispensing machines.

At least 10 research projects at these prisons systematically evaluated the effects of prison needle and syringe programs on risk behaviours and their overall effectiveness in prisons. Their findings:

  • Needles and syringe programs are feasible in a wide range of prison settings. All prisons studied effectively employed different methods of needle distribution.
  • When provided, people who inject drugs in prisons readily accept sterile needles.
  • There has been no increase in drug use or drug injection, no increase in institutional violence and no documented cases of a needle from one of these programs being used as a weapon.
  • Most important of all, sterile needles and syringes contribute to a significant reduction of syringe sharing over time, thereby reducing HIV and HCV transmission and improving the health of prisoners. The five prisons whose evaluation included blood testing found no new cases of HIV or HCV infection, a decrease in fatal and non-fatal heroin overdoses, a decrease in abscesses and other injection-related infections and the facilitation of referral of users to drug dependence treatment programs.

What we can conclude

The negative consequences feared by the federal government have not materialized.

We can reasonably conclude that prison needle and syringe programs:

  • are feasible and affordable across a wide range of prison settings;
  • decrease syringe sharing among prisoners who inject drugs, thereby decreasing the risk of HIV and 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 be successfully distributed in a variety of ways in response to staff’s and prisoners’ needs; and
  • can successfully coexist with other drug prevention and treatment programs.

Constitutional challenge

In the face of the government’s refusal to implement prison needle and syringe programs, a former prisoner, the Canadian HIV/AIDS Legal Network, Prisoners with HIV/AIDS Support Action Network, CATIE and the Canadian Aboriginal AIDS Network have initiated a lawsuit against the federal correctional service to compel it to introduce prison needle and syringe programs in federal prisons.

The individual applicant is a man who was infected with HCV while incarcerated in a federal prison in Ontario after using injecting equipment that had been used by a fellow prisoner with HCV. His infection was entirely preventable. So are hundreds more across this country.

Go to the Prison Health Now website to hear Sandra’s full presentation.

Sandra Ka Hon Chu

Sandra Ka Hon Chu is the Co-Director of Research and Advocacy at the Canadian HIV/AIDS Legal Network. She works on HIV-related human rights issues concerning prisons, harm reduction, sex work, women, and immigration. For the past six years, Sandra has lead the Legal Network’s advocacy in relation to prison needle and syringe programs, including a lawsuit launched in 2012 challenging the Canadian government’s failure to make sterile injection equipment available in federal prisons.