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.
