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Rampant HIV and hepatitis C infection in Canadian prisons "constitute a clear and present health risk" -- not just to prisoners and the correctional officers who guard them, but also to ordinary law-abiding citizens on the outside.

So says the Ontario Medical Association, which represents the province's 23,000 physicians and which yesterday joined the chorus of voices demanding the establishment of needle-exchange programs in both federal and provincial jails.

The OMA released a lengthy position paper yesterday showing that soaring infection rates are 10 times higher for HIV and 29 times higher for the extremely contagious hepatitis C among inmates than among the general population.

But while the document is rife with unnerving statistics and the study subjects that produced them, including a small group of male prisoners who started injecting drugs only after they went to jail, the anecdotal evidence is perhaps even more alarming, The Globe and Mail has learned.

Peter Ford, a contract doctor with the Correctional Service of Canada who regularly goes into federal prisons in Eastern Ontario, home to the maximum-security Kingston Penitentiary and medium-security Millhaven Institution, brought to the OMA news conference yesterday a makeshift needle a prison guard had seized and given to him.

Such homemade needles -- in this one, the plunger and casing are refills from a ballpoint pen, and the needle itself is likely from a diabetic syringe -- are regularly "rented" out, Dr. Ford said, and shared among as many as the 30 to 40 inmates on a single prison range.

"You couldn't begin to clean a needle like this," Dr. Ford said later in a telephone interview, adding that, in any case, the bleach available in jails is so weak a person can drink it with no ill effects and thus it is probably ineffective in preventing hepatitis C infection.

Dr. Ford, who has been treating inmates in federal and Ontario jails for 15 years, has concrete examples of how what might appear at first blush to be a prisoners' problem is, in fact, a genuine public-health concern.

"We're just not shipping in a lot [of drug users]" he said flatly, "we're amplifying the problem."

Dr. Ford has seen inmates who enter the prison system as marijuana users switch to harder drugs because they disappear faster from the body and are less likely to show up in random urine tests; intravenous drug users who come into the system never having shared a needle start sharing; and the relatives and visitors of those who run up so-called "drug debts" by renting the makeshift needles being pressed to bring drugs to the jail to pay off the debts.

Most poignant, Dr. Ford told The Globe of two particular patients, a young woman he is treating who was infected with HIV by her former prisoner boyfriend, and a male prisoner, now on a methadone program, who before his admission to that program was injecting himself as many as 80 times a month in jail.

"We'd go in and count the needle holes and find 80 injection sites over the previous month."

Of note is that Dr. Ford was responding to a question about how easy it is in the Canadian penitentiary system for inmates to get hard drugs.

In its formal position paper, the OMA cast the issue as a matter of wide public concern. It said: "Despite their illegality, the penalties for their use and the significant amounts of money and effort spent by correctional services to stop their entry, illegal drugs do get into prisons and prisoners do use them." And prisoners "return to the community and when they do, if they are infected with HIV or hepatitis C, they can and do infect others."

In the words of OMA president John Rapin yesterday: "We should all be concerned about disease spreading through our prison systems because we are at risk."

But Dr. Ford, who is the chair of the OMA committee on HIV infection, also said it is "a refined form of obscenity" that while prisons provide some education about cleaning needles and safe IV drug use, they "don't let" inmates use that knowledge.

The OMA says more than 50 needle-exchange programs have been implemented around the world -- including in Switzerland, Germany and Spain -- and that they have been shown to increase neither drug use nor risks to prison staff.

Needle exchanges, where users can turn in a used needle and receive a fresh syringe, are considered part of a harm-reduction program and are established in most major Canadian cities, where they exist side by side with a larger societal message that drug use is dangerous and illegal.

Dr. Ford sees no reason the same messages can't co-exist in a prison setting.

"Drugs would continue to be illegal. You don't legalize anything." What a needle exchange would do, he said, is make the prisoners themselves, and the guards' workplace, safer.

Health Canada estimates that there is an HIV prevalence rate of 0.18 per cent, or less than one-fifth of 1 per cent, in the general population, while CSC statistics show that as of 2001, there were 223 reported cases of HIV in federal prisoners out of a prison population of about 12,700 -- a prevalence rate of 1.8 per cent, or 10 times higher.

Almost 3,000 federal inmates, or about 23 per cent, are infected with hepatitis C, which, like HIV, is transmissible either by needle-sharing or sexual contact. And a 1995 CSC survey showed that fully 38 per cent of prisoners reported having used illegal drugs since being behind bars.

Drug use, Dr. Ford said, is not something people want to talk about, in or out of prison. In the city of Kingston, where the 64-year-old lives and works, "we have a needle exchange, and we exchange many thousands of needles every month. Many of those who are using are going to end up in prison. So all in all, it's a pretty glum scene."

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