Prison Needle Exchange: Lessons from a Comprehensive Review ...

HBV and 74.8% were infected with HCV. Furthermore, the authors found that the
number of seroconversions during detention was considerable. Nearly half the women
who seroconverted (20 of 41) had been infected with hepatitis during incarceration. 67
Canadian evidence
Numerous Canadian studies have documented injection drug use and needle sharing in
Canadian prisons:
• In an Ontario study reported in 2003, 11% of all participants (439 adult males, 158
females) in six provincial correctional centres who had a history of injecting reported
injecting in the past year while incarcerated. 32% of those who reported injecting
while incarcerated reported injecting with used needles. 68
• A 2003 study of federally incarcerated women found that 19% reported engaging in
injection drug use while in prison. 69
• A 1998 study at Joyceville Penitentiary in Kingston, Ontario, found that 24.3% of prisoners
reported using injection drugs in prison. This was an increase from the 12%
found in a similar study at the same prison in 1995. 70
• A 1996 survey of prisoners in a federal prison in British Columbia found that 67%
reported injection drug use either in prison or outside, with 17% reporting injection
drug use only in prison. 71
• In 1995, the Correctional Service of Canada’s National Inmate Survey found that 11%
of 4285 federal prisoners self-reported having injected since arriving in their current
institution. Injection drug use was particularly high in the Pacific Region, with 23% of
prisoners reporting injection drug use. 72
• A 1995 study among provincial prisoners in Montréal found that 73.3% of men and
15% of women reported drug use while incarcerated. Of these, 6.2% of men and 1.5%
of women reported injecting drugs. 73
• A 1995 study of provincial prisoners in Québec City found that 12 of 499 prisoners
admitted injecting drugs during imprisonment, 11 of whom had shared needles. Three
were HIV-positive. 74
Harm reduction
Traditionally, concerns about disease transmission via injection drug use have been met with
calls to further entrench the philosophy and practice of “zero tolerance” of drug use.
Increased penalties for drug use, tightened security measures to
reduce the supply of drugs, and heightened surveillance of individual
drug users are often put forward as “law and order” solutions to
public health problems. However, the health risks posed by HIV and
HCV infection through the sharing of needles have prompted many
countries, including Canada, to recognize the limitations of a strict
zero-tolerance approach. This has led to the development and
implementation of community health programs that enable people
who inject drugs to reduce their risk of contracting HIV and HCV while continuing to use
illegal drugs. These harm reduction initiatives, including needle exchange programs and safe
injection facilities, have been enacted as pragmatic responses to injection drug use and the
attendant risks that HIV and HCV infection pose, to the individual and to society as a whole.
Numerous Canadian studies
have documented injection
drug use and needle sharing
in Canadian prisons.
12 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience