The interior of a cell is seen during a media tour of renovations at the Central Nova Scotia Correctional Facility in Halifax on Tuesday, May 15, 2018. Inmates’ access to sterile needles in Canadian federal prisons continues to be significantly limited due to the way the program was implemented, according to a report on the program’s performance. THE CANADIAN PRESS/Andrew Vaughan

Few inmates using flawed needle exchange program meant to protect against HIV: report

OTTAWA — Inmates’ access to sterile needles in Canadian federal prisons continues to be severely limited, potentially exposing them to blood-borne infections including HIV and hepatitis C.

A report commissioned by Correctional Service Canada and produced in October 2020 found flaws in the federal prison service’s needle exchange program.

The report, obtained through an access-to-information request by the HIV Legal Network, said it was concerning that most institutions with the program had no active participants.

Canada’s correctional investigator, Dr. Ivan Zinger, said the program’s requirement that participants undergo a risk assessment, coupled with the COVID-19 pandemic, have contributed to very low participation rates.

“The problem we have now is that there’s only so few participants. That suggests to me that there’s probably still a lot of dirty needles out there, and people making bad choices because they are not convinced that the program as implemented by the service is the correct one for them,” Zinger said.

The correctional service announced the program in 2018 and it was put in place in nine federal prisons. The harm-reduction strategy reduces the sharing of non-sterile needles among inmates, which can reduce transmission of blood-borne diseases.

In May 2020, the service paused the process for new implementation of the program, which required extensive consultation and face-to-face meetings, due to the COVID-19 pandemic.

Zinger said when he recently looked at the program, only four prisons continued to operate it, with a total of 42 participants.

Ginette Clarke, director general of health policy and programs at Correctional Service Canada, said the program is available at all nine sites and they continue to receive requests to participate in the program “on an ongoing basis.”

Sandra Ka Hon Chu, executive director of the HIV Legal Network, said she’s concerned about low participation in the program because rates of HIV and hepatitis C are very high in the federal prison system, and injection drug use is one way that people get infected.

“This is not good for prison health or public health or people’s health. We want people to participate and have access to this health service just like they do in the community,” said Ka Hon Chu.

Zinger noted that prisons that have put in place the program have seen a considerable reduction in the spread of communicable diseases.

The report, led by University of Ottawa professor Dr. Lynne Leonard, said low uptake needs to be investigated in order to identify barriers that might prevent participation.

The report showed that three of the nine participating prisons have not received one expression of interest in the program.

A lack of discretion or anonymity for participants was a barrier to program uptake, the report said.

In some prisons, certain aspects of the program have the effect of identifying an inmate as a participant to guards, wardens, and inmates.

The process for exchanging used needles for new sterile needles in some cases opened an inmate to risk of disclosing their participation in the program to guards.

Some participants reported that when they had to present their equipment on request, they had to do so in a loud and vocal way.

Inmates in the program reported being subject to negative and stigmatizing remarks from correctional staff, according to a memo retrieved through an access-to-information request by the HIV Legal Network.

Zinger said the security-focused aspects of the program reflect the fact that the commissioner had to respond to concerns of correctional officers and unions.

This approach is contrasted against one driven purely by health-care, “which is what other jurisdictions have done and has certainly played a role in preventing higher participation,” Zinger said.

While Clarke did not directly answer a question about the tension between the security and health aspects of the program, she said CSC will continue to ensure its services align with community standards and that it provides the “best and most effective services that we can.”

She said CSC is reviewing Leonard’s report and recommendations. The service has already begun implementing some of the recommendations, including updating health promotion materials, it added in a followup email.

Jeff Wilkins, president of the Union of Canadian Correctional Officers, said security measures need to be in place for the program out of a concern that the needles could be used as weapons.

“The needle is in the inmate’s cell. They could use that potentially to inflict harm and assault staff members, they could use it to assault other inmates,” said Wilkins.

The program report found there is insufficient evidence to show that needle stick injuries have increased in prisons where the program is in place.

When needles are given to inmates to keep in their cells without being counselled or monitored by health-care professionals, “it’s on the backs of correctional officers or security officers to run that program, essentially,” Wilkins said.

Ka Hon Chu said she agrees the program should squarely be a health-focused one and that correctional officers should not be running it.

She pointed to models elsewhere in the world where correctional officers don’t run the program, such as Moldova’s peer program, where fellow inmates are trained on harm reduction and distribution of supplies to those who want access.

The model adopted by Correctional Service Canada is unique and “problematic” for that reason, said Ka Hon Chu.

Correctional Service Canada plans to continue to run the programs at the existing institutions, and “when the time is appropriate, taking into consideration COVID-19” to consider implementing the program across all federal prisons, said Clarke.

A major concern for Zinger is that barriers to accessing the program mean people are going to continue to use drugs unsafely.

“Then we’ll see incidents of overdose and perhaps even deaths as opposed to trying to manage a problem that is clearly happening. That will continue to happen.”