Thank you, Mr. Chair and members of the standing committee, for giving us the opportunity to share some of our research on prison and HIV/AIDS.
I'm a senior policy analyst with the Canadian HIV/AIDS Legal Network. We're a human rights organization based in Toronto. We're a national organization that promotes the human rights of people living with and affected by HIV/AIDS. We do this through research and education, legal and policy analysis, education, and community mobilization.
We've studied the issue of HIV in prisons for many years now. More recently, we've focused on the issue of prison-based needle and syringe programs. In 2006, we released what was the most comprehensive international report on the evidence from prison-based needle and syringe programs around the world.
What the research demonstrates, as one of the last witnesses from CSC reinforced, is that there is no prison in the world where drugs do not exist. In spite of the many efforts of prison systems to prevent drugs from entering, drugs do come into prisons, and people use them. In our interviews with people who were formerly incarcerated, they often mentioned the availability of drugs and the fact that in some prisons, there are more drugs inside than what they have witnessed on the street. There's rampant addiction inside prisons. People inject drugs in prison, and they share needles because of the scarcity of sterile needles and syringes inside.
In 1995, CSC conducted a survey of drug use inside federal institutions. Thirty-eight percent of the people interviewed reported having used a drug since entering the institution, and 11% reported injecting a drug. This is quite an old study, as you can see. It's from 1995. We believe that the evidence today probably would indicate a much higher rate of injection drug use and needle sharing, given our interviews with people in prison. It's unfortunate. A 2007 study undertaken by CSC looked at risk behaviours and HIV and hepatitis C prevalence in federal prisons. It's about to be released in a week or so. If we were to have that information before us, I'm sure that it would reveal much higher rates of hepatitis C, HIV, and injection drug use.
As in many other countries, the rate of HIV and hepatitis C is much higher in Canadian prisons than it is in the population as a whole. I know that you've already heard from other witnesses that the HIV rate is at least ten times higher in the federal prison system. Hepatitis C is at least 30, close to 40, times higher in federal prisons than it is in the population as a whole. That rate has increased significantly in the last ten years. In 1999, the reported hepatitis C rate was 20%, and now it's close to 30%.
We studied prison needle and syringe programs around the world to see what the evidence would reveal, how they were working, and whether they were effective in reducing syringe sharing and infectious diseases.
These programs were first instituted in 1992 in a prison in Switzerland. They exist in over 60 prisons in at least 11 countries around the world. Most recently, in January 2010, Kyrgyzstan announced a pilot program.
These prisons are in western Europe, in Asia, and in well-resourced and less well-resourced systems. They're operating in civilian prison systems and in military systems, in women's and men's prisons, in prisons of all security classifications and sizes, and in institutions with drastically different physical arrangements.
They've used various methods to distribute syringes. Some prisons use automated dispensing machines, where you have a one-to-one exchange with the machine. Some use health care units to distribute the syringes and needles through either the prison nurse or the physician. In some cases, peer health workers distribute them in a one-to-one exchange. And in some cases, external NGOs or external practitioners--health professionals--distribute the needles and syringes inside the prison.
Based on the programs that exist around the world, there have been a number of systematic evaluations of these programs, including by the Public Health Agency of Canada in 2006, as a member previously mentioned. What this evidence shows is that these programs reduce risk behaviour and disease, do not increase drug consumption or injecting, and do not endanger staff or prisoner safety. In fact, there's been no single case of a needle or syringe from these programs being used to attack a staff member--not a single case since 1992, when these programs were instituted. They have other positive outcomes for people in prison, including referrals to drug addiction treatment programs.
What's interesting, as well, is that in spite of resistance from correctional officers in some of these countries--Germany and Switzerland, specifically--they have come to learn that their own security is protected when these programs are instituted, because they're less likely to come across a needle that's been hidden in a prisoner's cell and be accidentally pricked. If they are accidentally pricked, for whatever reason, it's less likely that the needle has been distributed among many people and is infected with HIV or hepatitis C.
We feel that by refusing to implement prison needle and syringe programs, CSC is unnecessarily placing those individuals with the most severe drug dependence at risk of severe HIV and hepatitis C infection. Needle and syringe programs have been operating in the community for many years now. In 2001 there were 200 needle and syringe programs operating in Canada, with support from all levels of government--municipal, provincial, territorial, and federal. Many of the people who are entering prison are realistic. They are using these needle and syringe programs in the community, and when they're entering prison suddenly they're denied access to them.
Denying prison needle and syringe programs also discriminates against people in prison who embody many of the characteristics upon which discrimination is prohibited. We've heard, I think, from previous witnesses for the standing committee about the disproportionate representation of aboriginal people in prisons. They're disproportionately represented in federal prisons, disproportionately represented in the community among injection drug users and as people living with HIV.
It also has a disproportionate impact on women. I guess the last witness mentioned the fact that many women entering the federal system have a history of injection drug use, more so than the men incarcerated. They come with a history of trauma. A history of injection drug use is consistently found more frequently among women than men in Canadian prisons. The Canadian Human Rights Commission actually recognizes this, and I provide a quote from them, which reads:
Although sharing dirty needles poses risks for any inmate, the impact on women is greater because of the higher rate of drug use and HIV infection in this population. This impact may be particularly acute for federally sentenced Aboriginal women.
Conversely, prison needle and syringe programs benefit not only the people who use drugs in prison, but also other prisoners, prison staff, and the public as a whole. With increasing rates of HIV and hepatitis C, society bears the cost of treatment for those who are infected. According to CSC, treating one person in prison for hepatitis C costs $22,000 and treating one person with HIV in prison costs $29,000 a year. So this is a lifetime cost. It is far more effective to provide sterile needles and syringes than to treat someone for HIV and hepatitis C infection.
I'm going to conclude with another statistic from CSC. In 2006 over 2,000 people were released into the community with hepatitis C and over 200 people were released into the community with HIV. Prison health is public health. There is no reason to treat prisoners who are struggling with addiction differently from people in the community who have access to needle and syringe programs. By reducing the risk of HIV and hepatitis C infection among people who use drugs in prison, all Canadians face fewer risks of becoming infected with HIV and hepatitis C.
That's my presentation. I'll take questions now. Thank you.