Pubdate: Mon, 30 Dec 2013
Source: Province, The (CN BC)
Copyright: 2013 Postmedia Network Inc.
Contact: http://www2.canada.com/theprovince/letters.html
Website: http://www.theprovince.com/
Details: http://www.mapinc.org/media/476
Authors: Dr. Julio Montaner and Dr. M-J Milloy
Note: Dr. Julio Montaner is the director of the B.C. Centre for 
Excellence in HIV/AIDS, the chair in AIDS research and head of 
division of AIDS in the Faculty of Medicine, University of B.C. Dr. 
M-J Milloy is a research co-ordinator at the B.C. Centre for 
Excellence in HIV/AIDS and recipient of the CIHR Frederick Banting 
and Charles Best Graduate Scholarship.) Page: A16

TIME FOR OTTAWA TO FOLLOW B.C.'S LEAD ON HARM REDUCTION, HIV
TREATMENT

We applaud the decision of Stephen Harper's Conservatives to finally
address the long-neglected issue of drug use among people living in
Canada's federal penitentiaries. However, his new Drug-Free Prisons
Act ignores decades of scientific evidence and will be insufficient to
reduce the deadly consequences of drug use behind bars.

The act gives new powers to the Parole Board of Canada to punish
prisoners who fail a urine test for drugs, including the ability to
cancel their release. According to Steven Blaney, the public safety
minister, these new consequences will reduce drug use among prisoners.

Sadly, this is not likely to be the case. It is clear some people in
Canada's penitentiaries use drugs. About one in 10 random urine tests
conducted by Correctional Service Canada are positive for illicit
drugs, a number that has remained stable despite spending over $50
million since 2008 on new interdiction efforts such as ion scanners.

For prisoners, drug use not only impacts their chances of
rehabilitation it means a sharply elevated risk of contracting HIV.
Scientific studies conducted across Canada have identified high levels
of used syringe sharing among incarcerated drug users. This is one
reason the level of HIV in Canada's federal prisons is about 20 times
higher than in the general population and, at an estimated five per
cent of all prisoners, equal to the prevalence seen in some countries
in sub-Saharan Africa.

In light of this clear threat to public health, a number of groups,
including the Canadian Medical Association, have called on the federal
government to implement prison-based needle and syringe programs. The
Conservative government has consistently refused, despite similar and
effective programs in many prison systems abroad. Evaluations have
found no evidence needles and syringes were being used as weapons.
However, they did find lower levels of risky needle and syringe
sharing. As a result, the World Health Organization recommended
countries urgently introduce and expand prison-based needle and
syringe programs.

In addition to implementing these harm reduction programs, Canadian
prison authorities should also expand HIV testing and early initiation
of HIV treatment. This approach is already occurring in some prisons
in the U.S. as a proven means of decreasing HIV-related morbidity,
mortality and further transmission. Effective treatment for HIV
infection puts the disease into remission and at the same time, for no
extra cost, it reduces an individual's risk of passing the virus by
more than 95 per cent. Thus, HIV treatment has become the cornerstone
of global efforts to halt the pandemic.

Unfortunately, incarceration remains a substantial barrier to
effective HIV care. In new research among about 650 HIV-positive drug
users in Vancouver, we found going to prison boosted their risk of
non-effective treatment by 54 per cent. By focusing HIV risk
behaviours and treatment failure, we are seriously concerned Canada's
prisons will help to further perpetuate the spread of HIV and other
blood-borne diseases.

Of note, in B.C. we have seen a greater than 90-per-cent decline in
new HIV cases among drug users, thanks to the wisdom and foresight of
the provincial government and health authorities. They have invested
in evidence-based strategies to curb HIV incidence such as harm
reduction and HIV Treatment as Prevention. Indeed, the province's STOP
HIV/AIDS initiative has shown expanding HIV testing and treatment
among drug users and other vulnerable groups in B.C., has not only
improved their health, it also reduced the number of new infections.

In contrast, the federal government has reinforced its strategy of
criminalizing people who use illicit drugs, further threatening the
health of prisoners and the public health and safety of the
communities to which they return. It is time to embrace the evidence
and work together to decrease the burden of HIV and other blood-borne
diseases in our communities. B.C. has shown the way; it is time for
Canada to jump on board.  
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MAP posted-by: Jo-D