Why don't harm reduction strategies in prisons include needle exchange programs?

By Arielle Piat-Sauvé - Published on July 5, 2016
The push for prison-based needle and syringe exchange programs has been happening since at least 1999.

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Steven Simons blames the federal government for his hepatitis C infection. Simons, who was an inmate from 1998 to 2010 at Warkworth Institution, a medium-security prison outside of Peterborough, says he was infected after another prisoner used his personal drug injection equipment. In 2012, two years after his release, he teamed up with the Canadian HIV/AIDS Legal Network and others to sue the federal government for failing to provide the kinds of harm-reduction programs that would prevent such infections.

“When I was in prison, I would see people passing one homemade needle around and sharpening it with matchbooks,” says Simons in the press release announcing the lawsuit. “The needle would be dirty and held together with hot glue.” Simons is one of many fighting to prevent the spread of HIV and hepatitis C in prisons. His first court hearing is scheduled with the Ontario Superior Court for the fall of 2017. In the meantime, public health advocates continue to call for all levels of government to implement needle and syringe exchange programs in its prisons.

Pushing for prison-based needle and syringe exchange programs has been an ongoing debate in Canada since at least 1999, when the healthcare advisory committee of Correctional Service Canada first reported significant benefits to implementing these needle exchange programs. Seventeen years later, no federal or provincial prison in Canada offers any safe injection initiatives.

Now, some 250 organizations across Canada are petitioning both the federal and provincial governments to implement these programs immediately.

“People who inject drugs would have access to sterile injection supplies which would reduce the transmission of HIV, Hepatitis C and other blood born pathogens,” says Shaun Hopkins, manager of needle exchange at Toronto Public Health. “Needle and syringe programs have been introduced in more than 60 prisons around the world,” she says. Spain, Germany and Switzerland are a few of the countries that have already implemented such programs.

The most recent statistics from Correctional Service Canada are close to a decade old, but broadly point to 10 times higher HIV rates and 30 times higher hepatitis C rates in federal prisons compared to the general population.

Current harm reduction strategies in federal prisons include methadone treatment, the distribution of condoms to inmates, and providing bleach for disinfecting needles and syringes.

“The funny thing is they provide bleach to help clean needles,” says Sandra Ka Hon Chu, director of research and advocacy at the Canadian HIV/AIDS Legal Network. “So there’s an acknowledgment that injection drug use is happening — they just stop short of needle syringe programs.”

In 2006 the Public Health Agency of Canada participated in an extensive international study of prison-based needle and syringe exchanges. The report found that these programs resulted in decreased needle-sharing practices among prisoners and more drug treatment programs—similar results to the 1999 research. The programs did not lead to an increase in institutional violence, an increase in drug use or needle-stick injuries, the study found.

“Every time this issue was studied, they found positive health outcomes,” adds Ka Hon Chu. “There just hasn’t been the political will.”

Despite large investments in detection and interdiction of illegal contraband drugs in prisons, the Correctional Investigator of Canada of Canada believes there hasn't been a decrease in the rate of positive urine testing of inmates, meaning prisoners are still obtaining and using drugs while incarcerated.

“This tells us that drug use is somewhat constant and that there are diminishing returns in spending more and more money just on enforcement and interdictions,” says federal correctional investigator Howard Sapers. His office acts as an ombudsman for federally sentenced offenders.

For others like Stephanie Massey, the provincial hepatitis C program coordinator at the Prisoners’ HIV/AIDS Support Action Network, perspective should be shaped from what is seen and heard on the ground in prisons — data that researchers and organizers currently don’t have . The last research she has from provincial prisons was conducted 10 years ago, and was only a small sample size study from the University of Toronto.

She says a similar picture can be painted in provincial prisons, although with less injection drug use in the institutions themselves. According to Massey, the prevalence of HIV and hepatitis C at the provincial level tends to be high because a large number of people who use drugs get incarcerated. But even then, there are actually no reliable provincial numbers to back this up.

Massey says it’s challenging to do research in provincial settings in part because the average stay can range anywhere from 18 to 90 days. Getting prisoners to share their infection status is another challenge.

“The HIV stigma is quite high in the prison system, so many people will not disclose that they are living with HIV and that can impact how they access medication or care,” Massey says.

Massey, much like her recent petition co-signers, argue the failure to properly introduce harm-reductions services in prisons doesn’t allow inmates to manage their own health and as a result introduces more risk in their lives.

This risk is even greater in provincial prisons because of the comparatively limited access to substance support programming for prisoners. Massey explains how more than half of people in a provincial institution in Ontario are in what is called remand, or pre-trial detention. And prisoners are only allowed access to addiction program or treatment once they are sentenced.

Those pushing for prison-based needle exchange programs say it’s not only a matter of prison health, but also of public health and guaranteeing the human rights of prisoners. Still, a mix of operational and security concerns continue to be raised.

The Ontario Public Service Employees Union, which represents correctional officers in Ontario, has yet to endorse the need for such programs. While its officers agree that providing better healthcare in prisons is an ongoing issue, its focus remains on detection of contraband substances.

“From our perspective, by keeping these drugs out, we keep the inmates safe as well as our staff,” says Monte Vieselmeyer, the chair of the corrections division for the union and a provincial correctional officer for 25 years.

Vieselmeyer believes there’s a crisis in correctional institutions — something he argues is partly tied to a provincial hiring freeze that has been ongoing for three years. This has led to more inmate lockdowns and growing tensions.

But calling for more staff is the opposite of what organizations like Prisoners’ HIV/AIDS Support Action Network want to see happen. Massey says too many people are already being incarcerated when they should in fact be treated for their substance abuse problems and mental health issues.

As groups try to move the prison needle exchange debate to the front of the government’s agenda, Simons’ court challenge is still waiting on a timeline. With still more than a year to go before the case’s first court hearing, those advocating for prison-based needle exchange programs are meeting with Liberal cabinet ministers in the hopes to enact change now, rather than wait through court procedure.

“I would encourage the government to keep an open mind, to look at that body of evidence again and see whether or not there is a practical and safe way of implementing a prison-based needle exchange,” says Sapers, Canada’s prison watchdog. 

“An ounce of prevention is worth a pound of cure.”

Arielle Piat-Sauvé is a Toronto-based television producer and freelance writer with a focus on social justice issues.

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