1. P-HSJCC Webinar Series: Family Support for Prisoners with Hep C
March 15th, 2018 Moderator: Tasha Rennie, Network Engagement and Communications Officer, HSJCC Secretariat

2. HSJCC Webinar
We will have a Q&A period at the end of our webinar. To ask a question, please type your question in the chat box.
This webinar will be recorded. The recording and power-point presentation will be ed to you following the webinar.
Please complete the brief evaluation survey following the webinar.
Trevor

3. About the HSJCC Network
HSJCC Network is comprised of:
42 Local HSJCCs
14 Regional HSJCCs
Provincial HSJCC
Each HSJCC is a voluntary collaboration between health and social service organizations, community mental health and addictions organizations and partners from the justice sector including crown attorneys, judges, police services and correctional service providers.
Trevor

4. Presenter
Lindsay Jennings, Provincial Hep C Program Coordinator, Prisoners with HIV/AIDS Support Action Network (PASAN)
Trevor

5. HCV In-Reach Ontario Jails and Penitentiaries

6. Prisoners’ HIV/AIDS Support Action Network (PASAN)
PASAN is a community-based organization in Toronto that provides support, education and advocacy services related to HIV/HCV, harm reduction and overdose prevention with the prisoner and ex-prisoner populations within Ontario

7. Prisoners’ HIV/AIDS Support Action Network (PASAN)
Providing prisoners with prevention and transmission information and support for HIV/HCV and related issues within a prison context
Providing support and advocacy for HIV/HCV-positive prisoners to ensure they are receiving the healthcare that they are entitled to
Promoting an integrated approach to healthcare within prisons to tackle wider public health issues, both through improvements in health care in general and through improvements in general prison conditions, policies and management
Increasing community-based agency capacity through training and consultation to effectively meet the needs of HIV-positive people who are affected by incarceration

8. Goals
We strive to ensure that prisoners living with HIV/HCV are receiving the healthcare and support that they deserve and are entitled to; as well, to facilitate continuity of care when people are returning back into the community.

9. High Risk Activities or Harm Reduction Practices?

10. Drug Use Institutional offense
Zero tolerance drug policies contribute to the creation of high risk environments
Used as currency
Elevated risks due to lack of experience
Lack of withdrawal management
Self-medication, pain management
Re-use of insulin needles
Bleach is suggested to use to clean utensils, but bleach is not always 100% bleach in the intitutions
Nail clippers
Razors

11. Sexual Activity Institutional offense Consensual sex, homophobia
Sex as currency/coerced sex, sexual assault
Condoms, dental dams and lube
Federal vs. Provincial
Men’s vs. Women’s institutions
Mens vs womens– different needs, womens general health- pap smears, bladder infections, experiences with doctors
Federal vs provincial- have to ask for tampons and pads in provincial, institutionally gay

12. Tattooing and Piercing
Institutional offense
Lack of sterile equipment and training
Hep C lives in dried blood for up to 3 days
Tattoo ink
Staples, paperclips (provincial), poking is popular.

13. High Risk Activities
Prison inmates are at greater risk of HCV exposure than the general population because inmates tend to engage in a variety of high-risk behaviours

14. Prison Routines Nail clippers are shared amongst the range
Razors may be hoarded or shared amongst the range
Makeshift speed bags, punching bags
Stigma and discrimination from prisoners and prison staff
Lack of clean up talk:
how to clean self harming tools
how to clean tattoo guns
Proper clean up after violence on range
Advocate for proper hygiene procedures
Share information with prisoners on how to advocate for themselves or healthy procedures, but also HIGHLIGHT the possible consequences for speaking up.

15. HCV on the “INSIDE” HCV prevalence*: CSC= Federal
Among women offenders, the highest HCV prevalence was observed among (38.4%) and (38.0%)
male inmates of Indigenous ancestry the highest HCV prevalence was observed among (51.1%) and (50.9%) age groups.
Among women offenders of Indigenous ancestry, the highest HCV prevalence was observed among (61.5%) and (59.8%) age groups.
and highest among male inmates years of age (40.1%) and (37.5%)
Federal stats*
-provincial numbers would be higher, due ot the remand population which is 80% of provincial prisoners
-less programs, less HR practices to utilize

16. Treatment
Provincial
If a prisoner initiates treatment within the community, corrections will continue treatment upon incarceration
Provincial prisoners are on a case by case basis- have to prove the worthiness of treatment inside- superintendent of the jail will have final decision
Loss off ODB status for OW/ODSP prisoners
Ontario Trillium Application

17. Treatment
Federal
There will be a vast increase in spending on treatment for the estimated 2700 federal inmates infected with Hepatitis C virus (HCV). Correctional Service Canada (CSC) has a treatment budget for of $16.5 million, nearly four times the amount budgeted in 2010
“Needle exchange programs and addiction treatment should be viewed as crucial components of the HCV treatment program,” said Farley. “Otherwise, reinfection will be its Achilles heel.”

18. How to support; Family/Worker

19. Family Member
Understand and learn about HCV-transmission and prevention, and treatment options.
LISTEN to the experiences from “inside”, Believe the stories
Reach out to PASAN; we can act as the middle person, supports for both sides
Be assured, Treatment is 100% available upon release; work with PASAN to set up linkage to care upon release

20. Service Provider

21. Social Determinants of Health
“social injustice is killing people on a grand scale.”
(World Health Organization’s Commission)
This is where you should operate from.
Understand the lifestyle of individuals
What led them to this point of incarceration
And understand everything else that is going on, is treatment the 1st thing on their list

22. The 14 social determinants of health in this model are: Housing
early life income/income distribution
Education
Race/aboriginal status
Employment/working conditions /unemployment and job security
social exclusion( HIV, HepC, homeless, mental health, race)
food insecurity
social safety net- who are ones supports
health services – (health card, proper ID, fear, access to services)
Each of these social determinants of health has been shown to have strong effects upon the health of Canadians.
Source: Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives

23. Build Trust Outline your boundaries if they are not all encompassing
Always do what you say you’re going to do
Don’t be afraid to express yourself
Earn trust. If you lose it, it is almost impossible to get back
Ask culturally specific questions; which name and pronoun they prefer & how the prison refers to them

24. Things That Are Non-Conducive to Building Trust
Asking a Prisoner what they are doing time for
Breaching confidentiality
Asking a Prisoner about another Prisoner
Seeking advice from prison authorities
Making promises you can’t keep
Reinforcing penal authority
Rationalizing punishment
Accepting prison staff reports about a Prisoner’s behaviour without listening to the Prisoner’s perspective in privacy
Speaking down to a Prisoner
Imposing your views or moral standards

25. Keep Yourself in Check
Understand yourself and your motivations for involvement
Be realistic but maintain a strong focus. It is most unlikely that you could help any Prisoner in all areas of need. Concentrate on the things that can be changed
Recognize when you are in over your head
SELF CARE!

26. Conclusions
Prisoners have had a series of events that lead up to them being incarcerated (social determinants of health)
People need community waiting for them so they don’t have to go back in to find it
When working with incarcerated populations, use a trauma-informed framework
Prisoners will be released at some point, so lets prepare them

27. HepC Treatment is a justice issue
HepC Treatment is a justice issue! There is no reason why people should not have access to the cure

28. Prisoner health is Community health