Pubdate: Thu, 15 May 2003 Source: Kingston Whig-Standard (CN ON) Copyright: 2003 The Kingston Whig-Standard Contact: http://www.kingstonwhigstandard.com/ Details: http://www.mapinc.org/media/224 Author: Ann Lukits Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Bookmark: http://www.mapinc.org/prison.htm (Incarceration) Bookmark: http://www.mapinc.org/find?143 (Hepatitis) HEP C IN PRISON 'AWESOME' PROBLEM Local News - A Kingston physician who conducted two landmark health studies of intravenous drug users in two area prisons is calling for a national public debate on the epidemic of hepatitis C among federal inmates. Dr. Peter Ford, director of the HIV clinic at Kingston General Hospital, said the high rate of hepatitis C infections among prisoners is a serious public health problem that will place enormous stress on the health-care system in the next decade. "Unlike SARS, which kills you in a couple of weeks, this takes 20 years to do it," he said. "The burden of cost to the health-care system from all these folks is going to be awesome." Ford said a public debate is needed on how to manage the epidemic and how to find more appropriate methods of punishing drug-addicted offenders. The potential for savings in law enforcement, prison costs and personal property is phenomenal, he said. "They're sending a lot of people to prison for drug offences who should go into rehab and shouldn't go to prison at all," Ford said in an interview yesterday. "Drug use is an illness. These people are addicted. They're just as sick as if they were alcoholics but we don't provide them with adequate treatment or the wherewithal to behave safely." Ford said many inmates start using drugs for the first time after they're behind bars. They do so, he said, to cope with the "mind-numbingly boring" and often dangerous environment inside prisons. "It's boring, it's dirty, it's smelly and, on occasion, it's really scary," Ford said. "If you're in there for five or six years, what are you doing to do? You'll do anything to alter your state of consciousness." Ford told The Whig-Standard there's nothing new in a recent report by the Correctional Service of Canada that found almost one in four inmates are infected with hepatitis. The high rate of infection among intravenous drug users has been known for years, he said. In 1994, Ford led a Queen's University study that examined the prevalence of hepatitis C and HIV in two Kingston prisons, Joyceville and the Prison for Women. HIV or human immunodeficiency virus is the organism that causes AIDS. The study found that 27 per cent of Joyceville inmates were infected with hepatitis C and one per cent had HIV. The incidence was higher in the Prison for Women, where 40 per cent of inmates had hepatitis C and one per cent had HIV. Prison for Women is now closed. The findings were "a real jolt" and were shared with the Correctional Service, solicitor general and the public, Ford said. Four years later, the researchers retested the Joyceville inmates and found that 33 per cent of the prison population was infected with hepatitis C and two per cent with HIV. The Prison for Women had closed by that time. The Correctional Service abruptly shut down a third study planned in 2002 without providing any reason, Ford said. "This [CSC report] is not news to anybody who's in the business," he said. Ford, who is also a consultant for the Correctional Service, and his colleague, infectious disease specialist Dr. Wendy Wobeser, hold regular monthly HIV clinics at every prison in the Kingston area. Ford said that inmates talk to him during his visits and express concern about the widespread use of intravenous drugs. It's common knowledge, for example, that syringes are shared by as many as 20 to 30 inmates, he said. "That's really scary," Ford said. "That means the chances of that syringe having hep C in it is 100 per cent." Injection drug use is the common means of transmitting the hepatitis C virus, which causes an inflammation of the liver that can lead to cirrhosis or liver cancer. The virus is also spread by direct contact with the blood of an infected person and other bodily fluids. Ford criticized the Correctional Service for its refusal to introduce a needle exchange program in federal penitentiaries. The fact that HIV infections are dropping among drug users outside prison is proof that needle exchanges work, he said. "HIV rates are going down in the drug-using community because of needle exchange schemes but almost certainly going up in the prisons because there is no needle exchange," Ford said. "These folks are going to get out and when they get out they're going to go on doing what they were doing when they were in - and do it with different people. "They're going to spread disease. And we need a public debate on how to handle this." Ford said he agrees with the refusal by federal prison officials to introduce mandatory infectious disease testing in prisons. "Mandatory testing would be against the whole human concept of human rights and a complete bloody disaster," he said. "There would be riots." Statistics compiled earlier this year by the area health unit indicate the infection rate of hepatitis C in the Kingston region is nearly double the provincial rate. An estimated 97 people of every 100,000 have the disease. Health Canada estimates that 57 of every 100,000 Ontario residents have the virus. When the infection rate of inmates is included in the Kingston figures, the rate of infection is roughly quadruple the provincial average. Tina Knorr, hepatitis C strategy co-ordinator at the Street Health Centre on Montreal Street, said yesterday that she occasionally receives calls from inmates who have contracted hepatitis C and want more information about the disease. The centre hands out about 1,000 needles a day to drug users from all over southeastern Ontario. Needle exchanges have proven to reduce the risk of HIV and hepatitis infections, Knorr said. She noted that young people who are intravenous drug users have lower rates of HIV and hepatitis C than older users because they are more aware of "harm-reduction" techniques. Knorr added that the Street Health Centre is often accused of "enabling or increasing" drug use by handing out free needles but "it's obvious people are getting infected if they are not using" [clean needles]." - --- MAP posted-by: Jay Bergstrom