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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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)
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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.
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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.
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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)
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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.
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Where do PNSPs exist?
PNSPs have been introduced in more than 60 prisons in at
least 8 countries:
Switzerland
Spain
Moldova
Romania
Germany
Luxembourg
Tajikistan
Kyrgyzstan
a
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Results
Prison
Incidence of HIV/HCV
Needle Sharing
Drug Use
Injection
Am Hasenburg
--
Strongly reduced
No increase
No increase
Basauri
No seroconversion
Strongly reduced
No increase
No increase
Hannoversand
--
Strongly reduced
No increase
No increase
Hindelbank
No seroconversion
Strongly reduced
Decrease
No increase
Berlin (Lehrter Strasse et Lichtenburg)
No HIV, but HCV
Strongly reduced
No increase
No increase
Lingen 1
No seroconversion
Strongly reduced
No increase
No increase
Realta
No seroconversion
Single cases
Decrease
No increase
Vechta
No seroconversion
Strongly reduced
No increase
No increase
Vierlande
No seroconversion
Little change or no
reduction
No increase
No increase
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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
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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.
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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)
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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.
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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).
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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).
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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
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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
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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.
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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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