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Monday, 9 March 2015

Incarceration, HIV, Hepatitis C and the lack of access to clean drug consumption supplies in Canada

A guest contribution from a health profession trainee.  Extracted from a letter to their professional body requesting advocacy action.  

Incarcerated populations have rates of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection 15 and 39 times greater than the general population, respectively. Sharing of injection equipment can account for a large proportion of the increased rates seen in these populations. Due to the illegality of drugs, there are high rates of incarceration among intravenous drug users (IVDUs). High incarceration rates for IVDUs lead to an increased proportion of people who inject drugs within prisons, and there is evidence showing little change in their drug use patterns once in custody. As there is a scarcity of sterile injecting equipment relative to drug supply and demand, high rates of needle sharing occur.  A 2010 survey of Canadian inmates found that half reported sharing needles. As well, some individuals report initiation of injection use while in prison.

Current policy is to focus on interception of drugs before they enter prisons. There has been less than a 1% decrease in prison drug use during increased efforts to reduce drug entry (1998-2007). A Correctional Service Canada (CSC) survey of prisoners found that 40% reported using drugs since arrival at their current institution. It is evident that the current emphasis on drug interception has not proven effective.

Prison needle distribution programs (PNDPs) have been implemented successfully in several countries, for many years. Switzerland, Germany, Spain, Moldava, Kyrzygstan, Luxembourg, Romania, Portugal, Iran and most recently, Australia, have all implemented some PNDPs. Analysis of the effectiveness of those programs reveals reduced spread of HIV and HCV, as well as reduced needle sharing. There has been no increase in drug use or safety issues for the prisons involved; staff at the PNDP prisons report increased feeling of safety. 

The health of incarcerated individuals rarely comes to public awareness as these individuals are sequestered from society. In reality, the incarcerated population is extremely fluid, particularly in provincial facilities where inmates serve sentences less than two years. Disease contracted in the prison system does not remain confined there; incarcerated individuals are released to the community. Statistics from CSC estimate that between 2000 and 2002, the number of individuals released into community with HIV and/or HCV increased by 60% and 13%, respectively.

The World Health Organization (WHO) recommends that “prison authorities in countries experiencing or threatened by an epidemic of HIV infections among IVDUs should introduce needle sharing programs urgently and expand implementation to scale as soon as possible”. In concert with this recommendation, various national agencies have called directly on the Government of Canada, CSC and the provincial correctional bodies to implement PNDPs, including: CSC’s Expert Committee on AIDS and Prisons, the Correctional Investigator of Canada, Canadian Medical Association and the Canadian Human Rights Commission.

Join in the call - contact your federal and provincial Ministers responsible for corrections.  Clean needles are just one of the adjuncts needed in corrections facilities in order to maintain minimum wellbeing.   

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