1 On Point: making prison needle and syringe programs work in Canada January 23rd, 2014 Sandra Ka Hon Chu Canadian HIV/AIDS Legal Network

2 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)

3 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.

4 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.

5 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)

6 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.

7 Where do PNSPs exist? PNSPs have been introduced in more than 60 prisons in at least 8 countries: SwitzerlandGermanya SpainLuxembourg MoldovaTajikistan RomaniaKyrgyzstan

8 Results PrisonIncidence of HIV/HCVNeedle SharingDrug UseInjection Am Hasenburg--Strongly reducedNo increase BasauriNo seroconversionStrongly reducedNo increase Hannoversand--Strongly reducedNo increase HindelbankNo seroconversionStrongly reducedDecreaseNo increase Berlin (Lehrter Strasse et Lichtenburg)No HIV, but HCVStrongly reducedNo increase Lingen 1No seroconversionStrongly reducedNo increase RealtaNo seroconversionSingle casesDecreaseNo increase VechtaNo seroconversionStrongly reducedNo increase VierlandeNo seroconversion Little change or no reduction No increase

9 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 Feared negative consequences have not materialized:

10 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.

11 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)

12 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.

13 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).

14 Advocacy: public education  a video advocacy series featuring partners, family members and other loved ones of prisoners & their views on PNSPs (  Publications in journal articles;  Presentations & workshops at conferences — local and international;  Public events in partnership with activists and academics (U of T, Ryerson U).

15 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

16 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

17 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.

18 Thank you Canadian HIV/AIDS Legal Network 1240 Bay Street, Suite 600 Toronto, Ontario M5R 2A7 Phone: Fax: Website: