Thomas Kerr is a professor in the Department of Medicine, UBC, and a senior scientist at the BC Centre on Substance Use
In our efforts to eliminate hepatitis C (HCV), HIV and other blood-borne infections, Canada is dragging its feet on the health of a particularly important but often forgotten group: people in prison. The World Health Organization tells us that it’s possible to reduce global rates of HCV by 90 per cent by 2030. But this can only happen if every country commits to making evidence-based decisions in pursuing these elimination goals. Sadly, as the 2018/2019 report from the Office of the Correctional Investigator highlights, Canada is not even close to being on track.
A critical step to eliminating HCV and HIV as public health threats is to prioritize the health of prisoners. Most people in prison do not stay there forever; they return to their communities after serving their sentence. And all too often, they return carrying the burden of HCV, HIV or another needless infections acquired behind bars.
Peer-reviewed findings by researchers at the British Columbia Centre on Substance Use have revealed high rates of unsafe injecting within prisons in the province, as well as challenges in accessing treatment for infectious diseases such as HCV and HIV.
Yet the federal government is using our tax dollars in court to fight a former prisoner, who was infected with HCV while incarcerated, and several health and human rights organizations who justifiably want prisoners to have easy, confidential and effective access to a prison needle-and-syringe program.
While not a politically palatable idea for some, the science doesn’t lie. Exposure to HCV is approximately 40 times higher among people in custody than in the general public, and nearly a quarter of prisoners in Canada have a past or current HCV infection.
The high rate of HCV in prisoners is not surprising given that Canada criminalizes personal drug use. This means that people who inject drugs are over-represented in the prison population, and while in prison, they have poor access to harm reduction programs or treatment for substance-use disorder. Drug use always has and will be a part of prison life, including by injection – just as it is in our communities. The main difference is that our governments permit and fund needle and syringe programs outside prison, precisely because they are effective, evidence-based public health programs. But prisoners are denied this same health service, forcing them to use and share non-sterile equipment to inject drugs.
Yet the prison environment proffers a unique setting to allow for voluntary, confidential HCV testing, education and counseling, the initiation of treatment, and the expansion of harm-reduction options such as a needle-and-syringe program. If we fail to act, these effective health interventions are nothing more than missed opportunities.
Needle-and-syringe programs have been available in prison systems in multiple countries for more than 25 years. Every review of the evidence shows that accessible programs lead to reduced needle-sharing. The evidence also shows they don’t lead to increased drug consumption, nor do they result in any security problems.
Such programs have been endorsed by the World Health Organization, the United Nations Office on Drugs and Crime, the federal prison system’s own Correctional Investigator and the Public Health Agency of Canada, among others. Canada’s own “Blueprint to inform hepatitis C elimination efforts in Canada,” published by the Canadian Hepatitis C Network, calls for prison needle-and-syringe programs that are accessible, confidentially available, and consistent with good public health practice.
Yet an effective needle-and-syringe program remains largely unavailable in Canadian prisons. The first program was only introduced in 2018 and is still in just a handful of prisons. The Correctional Investigator’s newly released annual report reinforces the arguments being made in court that in the federal government’s program, prisoner uptake is very low because “too much of what should be an exclusively health and harm-reduction program has been shaped by security concerns.”
Indeed, Canada’s program has been met with major opposition from some quarters, including from the Union of Canadian Correctional Officers (UCCO) – despite all the evidence. In fact, prison needle-and-syringe programs also make prisons safer for staff; because there is no need to hide makeshift injection equipment (that is also likely to have been used by multiple people since injection equipment is scarce), this reduces the risk of accidental needle-stick injuries for guards when searching cells.
A prison needle-and-syringe program is a matter of public health, backed by a great deal of evidence. But during last year’s election, the Conservative Party vowed it would cancel the program. A court decision confirming that people in prison have a right to the same health services as those outside prison is essential to protecting this evidence-based health program as a government obligation.
Meanwhile, it is profoundly disheartening that a government that claims to make evidence-based decisions is delaying full roll-out and also resisted changes proposed by experts working on prisoner health designed to make the current program more accessible and effective. Prison health is public health.
Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.