Pubdate: Tue, 30 Jan 2007
Source: Canadian Medical Association Journal (Canada)
Copyright: 2007 Canadian Medical Association
Contact:  http://www.cmaj.ca/
Details: http://www.mapinc.org/media/754
Author: Wayne Kondro, CMAJ
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

CONSERVATIVE GOVERNMENT SCUTTLES NEEDLE EXCHANGE

Rejecting the findings of a Public Health Agency of Canada (PHAC) 
review that indicated needle-exchange programs for injection drug 
users in prisons reduce the need for health care interventions, the 
Conservative government says sterile syringes aren't needed to 
control the spread of AIDS and hepatitis C in cellblocks.

Although a Prison Needle Exchange Program (PNEP) has long been 
advocated as a means of reducing the spiraling incidence and cost of 
treating infectious diseases within the prison population, Public 
Safety Minister Stockwell Day has decided a needle-exchange program 
is fiscally unjustified.

"We prefer to educate inmates about the dangers of using drugs in 
prison. Tolerance zero," says Day spokesperson Melissa Leclerc. "We 
will move ahead with some concrete [educational] initiatives when we 
review the corrections system."

But a recently-released risk--benefit review of PNEPs, conducted by 
PHAC for Corrections Canada, found that PNEPs reduce the sharing of 
dirty syringes. The report, Prison Needle Exchange: Review of the 
Evidence, crafted by a 9-member panel also indicated that PNEP's 
yield higher participation in drug treatment programs, a decrease in 
health care interventions related to injection-site abscesses, and a 
decrease in the number of overdose-related deaths.

PNEPs have no effect on the extent of injection-drug use or on the 
incidence of needle-stick injuries as there's no evidence syringes 
are more widely used as weapons against staff or inmates, the report 
adds. As well, "prison staff attitudes and readiness to accept PNEPs 
shifted from fear and resentment to acknowledgement that PNEPs 
represent an important and necessary addition to a range of harm 
reduction services and health and safety interventions -- many staff 
advocate strongly to safeguard the ongoing support and delivery of 
the programs."

The report also indicates that infectious diseases have become an 
enormous public health problem within Canada's prisons. In 2004, some 
25.2% of 13 107 federal inmates were infected with hepatitis C and 
1.4% with HIV, compared with 0.8% and 0.2%, respectively, within the 
general population. Those stats become even more alarming for inmates 
with a history of injection drug use. For those, the hepatitis C 
prevalence rate is 73% and the HIV rate is 3.8% (men) and 12.9% (women).

Studies cited in the report show that roughly 11% of inmates inject 
drugs while incarcerated and roughly 30% of those share dirty needles.

Information about post-PNEP bloodborne virus rates internationally 
was generally unavailable, except for Spain, where evidence indicates 
there's been significant decreases in hepatitis C (from 5.1% to 2.0%) 
and HIV (from 0.6% to 0.2%) seroconversion rates.

Among those who have urged the adoption of PNEPs are the Ontario 
Medical Association, the 1994 Expert Committee on AIDS in Prison, the 
Standing Senate Committee on Social Affairs, Science and Technology, 
and the Canadian HIV/AIDS Legal Network. 
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MAP posted-by: Richard Lake