Harm Reduction in Prisons: Prisoners’ Rights are Human Rights Rick Lines, MA Executive Director, Irish Penal Reform Trust December 11 th 2003

“Why Harm Reduction?” High rates of HIV and HCV seroprevalence are evident in in many prison systems internationally, including Ireland. High risk behaviours for the transmission of HIV and HCV are widespread in prisons across the world, including Ireland. HIV and HCV are PREVENTABLE infections HIV and HCV infection in prisons has broader implications on public health Prisoners have a right to health, including preventive measures

Prisoners’ Right to Health: International Law Universal Declaration of Human Rights and the European Convention on Human Rights prohibit “cruel, inhuman or degrading treatment or punishment” International Covenant on Civil and Political Rights sets forth the right of “persons deprived of their liberty” to be treated with “dignity” and with “respect for the inherent dignity of the human person” Covenant requires all the rights and freedoms it sets out to be respected for “everyone”, including persons deprived of their liberty by process of law

Prisoners’ Right to Health: International Rules, Standards, Guidelines “Except for those limitations that are demonstrably necessitated by the fact of incarceration, all prisoners shall retain the human rights and fundamental freedoms set out in the Universal Declaration of Human Rights, and … the International Covenant on Economic, Social and Cultural Rights, and the International Covenant on Civil and Political Rights … as well as such other rights as are set out in other United Nations covenants” UN Basic Principles for the Treatment of Prisoners, Principle 5

Prisoners’ Right to Health: International Rules, Standards, Guidelines Numerous declarations and covenants provide that “[e]very person has a right to the highest attainable level of physical and mental health” Article 25, Universal Declaration of Human Rights Article 12, International Covenant on Social, Economic and Cultural Rights Article 11, European Social Charter Article 16, African Charter on Human and Peoples’ Rights

Prisoners’ Right to Health: Standards of Health Care “Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.” UN Basic Principles for the Treatment of Prisoners, Principle 9 “Everyone has the right to access preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices.” Charter of Fundamental Rights of the European Union, Article 35

Prisoners’ Right to Health: Standards of Health Care “Health policy in custody should be integrated into, and compatible with, national health policy. A prison health care service should be able to… implement programmes of hygiene and preventive medicine in conditions comparable to those enjoyed by the general public.” Committee of Ministers to Member States Concerning the Ethical and Organisational Aspects of Health Care in Prison

Prisoners’ Right to Health: HIV/AIDS and Harm Reduction “All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination…with respect to their legal status.” Principle 1, WHO Guidelines on HIV Infection and AIDS in Prisons “general principles adopted by national AIDS programmes should apply equally to prisons and to the general community.” Principle 2, WHO Guidelines on HIV Infection and AIDS in Prisons

Prisoners’ Right to Health: HIV/AIDS and Harm Reduction “With regard to effective HIV/AIDS prevention and care programmes, prisoners have a right to be provided the basic standard of medical care available in the community.” UNAIDS

Prisoners’ Right to Health: HIV/AIDS and Harm Reduction “Whether the authorities admit it or not – and however much they try to repress it – drugs are introduced and consumed by inmates in many countries…Denying or ignoring these facts will not help solve the problem of the continuing spread of HIV.” UNAIDS (1997)

Our Government’s (non) Response 80. Mr. Boyle asked the Minister for Justice, Equality and Law Reform if the Government will commit to providing bleach to prisoners as a HIV prevention measure, as is standard practice in at least 11 of 23 EU jurisdictions, as well as in all Canadian federal prisons. [23434/03] Minister for Justice, Equality and Law Reform (Mr. McDowell): I do not intend to make arrangements in prison which are premised on the tolerance of intravenous injections of hard drugs. Parliamentary Question, 14 October 2003

Harm Reduction Challenges Dominant Policy Harm reduction accepts the reality of drug use. Harm reduction does not necessarily seek to reduce the amount of drug use. Harm reduction seeks to reduce the harms to the individual and to society. Harm reduction recognizes and values the human rights and the health expertise of drug users.

Challenges to Ourselves Harm reduction asks us to adopt a political understanding of the effects of drug use and social marginalization. Harm reduction asks us to defend the human rights of drug users and prisoners. Harm reduction asks us to question our own assumptions – and often our own training – about drug use. Harm reduction demands that we challenge our own prejudices about people in prison and people who use drugs.

Our Government’s Toleration of HIV and HCV in Prisons NO condoms or safer sex measures WHO (1991) – 23 of 52 prison systems surveyed provided condoms to prisoners EMCDDA (2001) – 18 of 23 prison systems in the EU proving condoms 11 of 14 Canadian jurisdictions (2002) Ukraine, Moldova, Estonia, Turkmenistan, Romania (pilot), some parts of Russian Federation Recommended in two Trinity College studies in 1999 and 2000

Our Government’s Toleration of HIV and HCV in Prisons NO bleach or disinfectants EMCDDA (August 2001) – Bleach provided in 11 of 23 EU prison systems. UNAIDS (1997) – Provided to prisoners in prisons in Europe, Australia, Africa, and Central America. Canada – 52 federal prisons, 20 British Columbia prisons, and some Quebec prisons. Turkmenistan, Kyrgyzstan, Moldova, some parts of Russian Federation, Uzbekistan (pilot) Recommended by Group to Review the Structure and Organisation of Prison Health Care Services (2001) Identified as a concern by the European Committee for the Prevention of Torture (2003)

Our Government’s Toleration of HIV and HCV in Prisons NO provision of sterile syringes Successfully implemented in over 40 prisons in 6 countries Recognised as best practice Recommended by Trinity College study in 1999 National Drugs Strategy 2001—2008 – “review the exisiting network of needle-exchange facilities with a view to ensuring access for all injecting drug misusers to sterile injecting equipment”

Our Government’s Toleration of HIV and HCV in Prisons LIMITED access to methadone Dublin area prisons Only available to those on methadone prior to incarceration Rarely provision to initiate methadone while in prison

Barriers to Harm Reduction in Prisons Zero-tolerance/abstinence based approaches often more entrenched Admission of failure Discrimination against prisoners Criminal laws and punishment Lack of legal framework Staff safety concerns

Advocating for Policy Change Zero-tolerance/criminalization has failed Evidence-based Cost-effective Promote legal, ethical, human rights Collaboration Between drug users/prisoners and health professionals Between organizations Between countries

Legal & Ethical Responsibility of Governments There is no doubt that 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