Canadian prison inmates need access to needle-exchange programs in the fight to control HIV infection, a B.C. study says.Fred Lum/The Globe and Mail
Needle-exchange programs and increased access to HIV treatment are essential to curb infection rates among Canadian prisoners, says the lead author of a new study calling for immediate action.
Dr. M-J Milloy of the B.C. Centre for Excellence in HIV/AIDS said other jurisdictions, including some American states, have reduced HIV rates among inmates and protected public health in the communities they return to when they're released.
"We are really in favour of collaborating with the prison system to try and find better ways to deliver harm reduction – whether that's supervised injection, a needle exchange, improved access to methadone," Milloy said on Monday.
"We think scientifically there's a good argument for these sorts of things and what happens next, I think, is a political question and a question that should best be answered by the people who are in charge of our prison system."
The study, published in the journal BioMedical Central Infectious Diseases, was conducted between May, 1996, and March, 2012, involving interviews every six months with 657 inmates who were HIV-positive and used injection drugs.
Milloy said it found that HIV could be detected in a prisoner's bloodstream 83 per cent of the time, meaning they're more likely to pass on the infection.
But when those same people were not behind bars, the study found the infection rate fell to 62 per cent because they received treatment.
Milloy said that although some inmates chose not to disclose they were HIV-positive to prevent being stigmatized, others could not access specific medications they'd started before they were incarcerated or experienced delays in getting their prescriptions filled.
He said institutions in Rhode Island, Connecticut and Washington D.C. have been successful in reducing HIV rates, but the strongest case for change comes from Switzerland, which pioneered needle-exchange programs 20 years ago before that prevention strategy was adopted by other countries including Germany, Spain, Iran and central Asia.
Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, said it's long been known that the sharing of drug-injection equipment by illicit drug users in prisons causes the spread of blood-borne infections but policies have not changed to protect their health.
"So far, governments in Canada are unwilling, despite repeated calls from all over the place, to act to introduce access to sterile injection equipment in prisons," said Elliott, adding HIV rates are 10 times higher in jails and prisons.
In September, 2012, the network launched a lawsuit in Ontario Superior Court against Corrections Canada, along with several groups including the Canadian Aboriginal AIDS Network, the Prisoners with HIV-AIDS Support Action Network and an individual who allegedly contracted hepatitis C while incarcerated.
"It's not a lawsuit for damages," Elliott said. "It's a lawsuit seeking constitutional remedies, seeking recognition that there are constitutional rights that are being violated here when the government withholds an essential evidence-based health service from people in prison."
Infectious disease specialist Dr. Wendy Wobeser, who treats current and former HIV inmates in Ontario, said it's clear that in the past, Corrections Canada acknowledged the use of illicit drugs in jails and prisons by setting up bleach programs to clean needles.
Wobeser, who is also an associate professor at Queen's University in Kingston, said she's not holding out hope for any change in policy on the federal level.
"I'm not sure the current government can even accept the phraseology 'harm reduction,' " she said. "But it would be hopeful that the authorities could have an open mind about what is needed to adequately care for people with HIV in prisons, particularly those who have drug-use challenges."
No one from Corrections Canada was immediately available to comment on the issue.