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. - --- MAP posted-by: Jo-D