Pubdate: Thu, 28 Oct 2004
Source: Globe and Mail (Canada)
Copyright: 2004, The Globe and Mail Company
Author: Christie Blatchford
Bookmark: (Harm Reduction)
Bookmark: (Hepatitis)
Bookmark: (Needle Exchange)


Soaring Rates Of HIV, Hepatitis C Among Inmates Threaten Citizens,
Ontario Group Says

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

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

"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

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

"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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