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

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Needle Exchange Programs Should Be Implemented in Prisons in Canada Needle exchange programs recommended since 1992 As presented in detail above, the rate of HIV infection in Canadian prisons is estimated to be at least 10 times that of the general population, and the rate of HCV infection is approaching 30%. The results of numerous studies clearly indicate the need for programs that reduce the risk of HIV and HCV transmission among injection-drug-using prisoners. Indeed, the results of numerous studies indicate rates of HIV and HCV infection and injection drug use equal to or higher than those in countries that have already implemented prison needle exchange programs. In Canada, since 1992 numerous reports have been produced by both governmental and non-governmental bodies that have explicitly called for the provision of sterile needles to prisoners in Canadian prisons (federal and provincial/territorial). These include: • 1992 – HIV/AIDS in Prison Systems: A Comprehensive Strategy, Prisoners’ HIV/AIDS Support Action Network 247 • 1994 – HIV/AIDS in Prisons: Final Report of the Expert Committee on AIDS and Prisons, Expert Committee on AIDS and Prisons, Correctional Service of Canada 248 • 1996 – HIV/AIDS and Prisons: Final Report, Canadian HIV/AIDS Legal Network and the Canadian AIDS Society 249 • 1997 – HIV, AIDS, and Injection Drug Use: A National Action Plan, Task Force on HIV/AIDS and Injection Drug Use 250 • 1998 – HIV/AIDS in the Male-to-Female Transsexual/Transgendered Prison Needle Exchange Programs Should Be Implemented in Prisons in Canada 57
Population: A Comprehensive Strategy, Prisoners’ HIV/AIDS Support Action Network 251 • 1999 – Final Report of the Study Group on Needle Exchange Programs, Study Group on Needle Exchange Programs, Correctional Service of Canada 252 • 2002 – Action on HIV/AIDS and Prisons: Too Little, Too Late – A Report Card, Canadian HIV/AIDS Legal Network 253 • 2003 – Unlocking Our Futures: A National Study on Women, Prisons, HIV, and Hepatitis C, Prisoners’ HIV/AIDS Support Action Network 254 • 2003 – Protecting Their Rights: A Systemic Review of Human Rights in Correctional Services for Federally Sentenced Women, Canadian Human Rights Commission 255 In addition, two reports from House of Commons committees have called for CSC to allow incarcerated offenders access to harm-reducing interventions in order to reduce the incidence of bloodborne diseases in a manner consistent with the security requirements within institutions: • 2002 – Policy for the New Millennium: Working Together to Redefine Canada’s Drug Strategy, Report of the Special Committee on Non-Medical Use of Drugs 256 • 2003 – Strengthening the Canadian Strategy on HIV/AIDS, Report of the House of Commons Standing Committee on Health 257 Taken together, these 11 reports plus this report (Prison Needle Exchange: Lessons from A Comprehensive Review of International Evidence and Experience) present evidence of the effectiveness of needle exchange programs and provide ample evidence of the need for such programs in Canadian prisons. In light of this body of evidence and informed opinion supporting the introduction of needle exchange programs in Canadian prisons, it is not credible for elected and prison officials in Canada to claim that they are unaware of the health risks associated with injection drug use in Canadian prisons, or of the existence of a proven-effective means to reduce those harms – namely, needle exchange programs. Despite the support for needle exchange programs from groups and individuals who speak with credibility and authority on the issue, governments and prison officials in Canada have failed to take decisive action to reduce the harms known to be associated with injection drug use, including HIV and HCV transmission. All of the above-noted reports are from credible sources and contain important evidence to support prison needle exchange programs. However, three are exceptionally significant because of the confluence of processes and people involved in the evidence gathering, production, and publication of each. Governments and prison officials in Canada must take decisive action to reduce the harms known to be associated with injection drug use, including HIV and HCV transmission. Expert Committee on AIDS and Prisons The 1994 HIV/AIDS in Prisons: Final Report of the Expert Committee on AIDS and Prisons by the Expert Committee on AIDS and Prisons (ECAP) was published by the Correctional Service of Canada. In 1992 ECAP was established at the direction of the Solicitor General of Canada to assist the federal government to promote the health of federal prisoners and to protect CSC staff, and to prevent the transmission of HIV and other infections within federal correctional facilities. Committee members were a clinical immunologist, researcher, and ethicist; a physician and member of CSC’s Health Care Advisory Committee; a social work 58 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience
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Prison Needle Exchange: Lessons fro
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In memory of Andréa Riesch Toepell
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Spain 29 Summary 29 HIV/AIDS, HCV,
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Prison Needle Exchange: 2006 update
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Sample Evaluations of Prison Needle
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initiatives occurring in local comm
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ings on the feasibility and efficac
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Executive Summary This report exami
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• do not endanger staff or prison
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Prisoner Health Is a Public Health
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Methodology The evidence for this r
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HIV and HCV Epidemics in Prison Pre
Page 28 and 29: injection drug practices and unprot
Page 30 and 31: Many prisoners, whether in pretrial
Page 32 and 33: while in holding cells before incar
Page 34 and 35: While harm-reduction policies do no
Page 36 and 37: • Additional Protocol to the Amer
Page 38 and 39: fit from medical treatment under th
Page 40 and 41: Review of International Evidence of
Page 42 and 43: History of the response to HIV/AIDS
Page 44 and 45: in drug consumption, and there were
Page 46 and 47: lence rate of approximately 0.1% in
Page 48 and 49: ic acid, filters, plaster, and sodi
Page 50 and 51: harm-reduction measures and declare
Page 52 and 53: injection drug use, HCV infection r
Page 54 and 55: the jurisdiction of the government
Page 56 and 57: punished by prison staff for access
Page 58 and 59: changed to a peer model, which has
Page 60 and 61: the prisoners who were injecting, a
Page 62 and 63: Kyrgyzstan 218 Summary Kyrgyzstan i
Page 64 and 65: of 20% to 40%. However, these treat
Page 66 and 67: working place, it is interesting to
Page 68 and 69: These findings demonstrate that the
Page 70 and 71: grams strongly reduced syringe shar
Page 72 and 73: proven effective in barracks-style
Page 74 and 75: • Prison has opportunity to maint
Page 76 and 77: staff, is also an indication of the
Page 80 and 81: professor of Aboriginal ancestry; a
Page 82 and 83: contained and standards presented i
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Page 86 and 87: • do not increase drug consumptio
Page 88 and 89: the case in countries, including Ca
Page 90 and 91: 15 Central and Eastern Europe Harm
Page 92 and 93: 67 R Keppler, F Nolte, H Stöver.Tr
Page 94 and 95: 121 Australian National Council on
Page 96 and 97: 180 Delegación del Gobierno para e
Page 98 and 99: 245 Ibid at 14. 246 This analysis i
Page 100 and 101: Bibliography International instrume
Page 102 and 103: Byrne A, K Dolan. Methadone treatme
Page 104 and 105: 2000). Elementos Clave para la Impl
Page 106 and 107: Landry S et al. Étude de prévalen
Page 108 and 109: Shapshak P, RK Fujimura, JB Page, D
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