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Alain Beaudet
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Alain Beaudet
2011-03-10 15:46
I would like to thank the committee for this opportunity to discuss the transfers to the Canadian Institutes of Health Research under supplementary estimates (C).
As you have seen, CIHR's grants vote will increase by $10.67 million with approval of the 2010-11 supplementary estimates (C). This increase will bring CIHR's reference levels for the 2010-11 fiscal year to $1.026 billion.
I would like to highlight the potential impact of a few of these transfers on health outcomes and commercialization of health discoveries.
The largest transfer is $9.36 million for the Centres of Excellence for Commercialization and Research. This investment is being used to fund two centres of excellence: the Centre for Commercialization of Regenerative Medicine located in Toronto, and the Centre for Imaging Technology Commercialization located in London.
Regenerative medicine and medical imaging are two areas at the forefront of discovery in health research. They are also two areas in which Canada is world-renowned for its scientific expertise. These two new centres therefore represent exciting opportunities for future breakthrough discoveries with impact on the health of Canadians and the strength of our life sciences industry.
CIHR's transfers, as you just heard, also include a transfer of $1 million from the Public Health Agency of Canada for population health intervention research. With this investment, CIHR and PHAC have succeeded in attracting other partners, including the Canadian Institute for Health Information, the Heart and Stroke Foundation of Canada, the New Brunswick Health Research Foundation, and the Ontario Ministry of Health and Long-Term Care. Together with these partners, CIHR will fund seven major research projects in the area of mental health promotion and the prevention and reduction of obesity, two major priority areas for the health of Canadians.
For CIHR this is but one of many of these very Canadian examples where government investment serves as a catalyst for the engagement of other partners so as to increase the coherence of research funding and maximize its potential for impact.
A third transfer of $800,000 from the Public Health Agency will go to major projects on HIV and AIDS co-infections and other co-morbidities, as you have heard. This research will provide the evidence needed for future programs and policies to prevent or control HIV and AIDS co-infections and other co-morbidities.
Finally, CIHR is transferring out the amount of $700,000 to the International Development Research Centre for an international research initiative on adaptation to climate change. This investment will support multinational research teams to advance a fuller understanding of climate and related stressors on vulnerable populations, resources, and ecosystem health in Canada and in low income and middle income countries.
The purposes of having this knowledge are: to shape policies and practices that help people and vulnerable segments to adapt to climate change; to train highly qualified staff; and, finally, to establish networks that will enhance the ability of governments, of the private sector and of civil society to adapt to climate change and to reduce its effects.
I would like to thank you for your support of CIHR's endeavours and for health research in general.
I'm pleased to take any questions that you may have.
Sandra Ka Hon Chu
View Sandra Ka Hon Chu Profile
Sandra Ka Hon Chu
2010-04-01 16:47
Sure. I have an opening statement, as well.
Sandra Ka Hon Chu
View Sandra Ka Hon Chu Profile
Sandra Ka Hon Chu
2010-04-01 16:47
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.
View Mark Holland Profile
Lib. (ON)
That figure was 2,000 people being released with hepatitis C, and 2,000 with HIV?
View Mark Holland Profile
Lib. (ON)
And what is the annualized cost of treating hepatitis C and HIV/AIDS for prisons?
View Maria Mourani Profile
View Maria Mourani Profile
2010-04-01 17:07
Thank you, Mr. Chair.
Thank you for being here, Madam. I have a few quick questions. You said that 30% of offenders currently have hepatitis C. Is that right?
View Don Davies Profile
Thank you.
First of all, I just want to thank you for the incredibly well-researched document you provided us. I don't think I've seen more footnotes in a presentation in any other thing we've had.
My colleague on the other side asked who would pay for the needles if they were provided. Who pays the $22,000 a year to treat someone with hepatitis C, and $29,000 a year to pay for an inmate with HIV?
Peter Ford
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Peter Ford
2009-11-05 12:28
My name is Peter Ford. I am a physician recently retired from the department of medicine at Queen's.
For the past quarter of a century I have been looking after patients with HIV and associated diseases. Also for about a quarter of a century I have been looking after federal prisoners with HIV, which I do by going into the prisons on a regular basis.
At any one time I have 35 to 50 patients in the eastern Ontario area with HIV. Ninety-five percent of these have hepatitis C, which is, in this particular context, a marker of intravenous drug use.
Because of this high prevalence of hepatitis C in the HIV population, we did some studies back in the nineties--the first one was in 1994--to see what the prevalence of HIV and hepatitis C was in the institutions generally. We looked at a medium security institution in the Kingston area and did an anonymous study, which showed us that 28% of the inmates had hepatitis C and 1% had HIV.
We repeated that study in 1998, by which time 33% of the inmates had hepatitis C and 2% had HIV. With the second study we did a detailed questionnaire, which could be linked to the blood samples anonymously. What we discovered was that almost everybody who had hepatitis C had a history of intravenous drug use. The people who gave a history of sharing injection equipment had the highest incidence of hepatitis C. But the most alarming thing that came out of that study was that there was a group of people who had not injected outside prison but had shared injection equipment in prison, and two-thirds of these people were positive for hepatitis C.
So what we're looking at is a problem with a communicable blood-borne disease, which is being imported into the prisons and is proliferating within the prisons. That has some very serious public health overtones, because these folks are going to get out and they're going to go on doing what got them infected in the first place. In addition, hepatitis C can be spread by sexual transmission--just under 10% is spread by sexual transmission--so the risk is going to move beyond the intravenous drug users to their sexual partners.
The long-term health costs of this are very considerable. It costs about $20,000 to treat somebody with hepatitis C. The treatment is not always successful. The treatment is not always possible because the patients don't identify themselves or because they're not suitable for treatment--and there are some reasons why people do not get treated.
The end product of hepatitis C is liver failure. Liver transplantation due to liver failure from hepatitis C is now the largest cause of liver transplantation in North America, and we're only in the early stages of this epidemic. The epidemic of hepatitis C infection has blossomed with the increase in intravenous drug use, but it takes 20 years to get to end-stage liver failure. So the big bulk of this problem is not going to arrive for quite some time yet.
Corrections is going to find itself looking after people with terminal liver failure, and this is a very expensive prospect. As a physician, I am very concerned about the amount of hepatitis C, and to some extent HIV, that is related to intravenous drug use in our institutions.
I have brought with me something that can be passed around, but if it is going to be passed around I would really asked that you don't open this container. This contains a syringe that was brought into our clinic in Kingston by a very frightened guard who had just stuck himself on it while doing a cell search. This syringe was probably the only syringe on the range from which it came. It's probably been used by at least 10 to 15 different people, several of whom would have been infected with hepatitis C and some of whom would have been infected with HIV.
You will see that this syringe, which is made from a ballpoint pen, tape, and a needle that probably came from an insulin syringe, is dirty. It's not possible to clean it. There is no way you can clean this syringe, even with the best intentions. These syringes are not only responsible for transmission of hepatitis C, HIV, and hepatitis B, but they are also responsible for a large number of rather nasty injection site abscesses that I see in the course of my work in the prison. I think this is a problem that also needs to be addressed.
Thank you, sir.
Martine Mangion
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Martine Mangion
2009-10-29 12:37
Good afternoon, Mr. Chairman and members. Thank you very much for inviting the Canadian Working Group on HIV and Rehabilitation to present today. We are pleased to provide input on how Canada's disability income support programs could be improved and better coordinated to create incentives and reduce barriers for increased labour force participation for people living with episodic disabilities.
Everybody knows someone living with an episodic disability. They include conditions such as mental health, arthritis, HIV/AIDS, MS, and some forms of cancer.
There are an increasing number of Canadians living with episodic disabilities. Features that distinguish episodic disabilities from traditional disabilities are their unpredictability and alternating episodes of illness and wellness, both of which can have a negative impact on employment participation and income security. The experience of many people living with disabilities is that while some disability income support programs are essential, many trap them in poverty by creating barriers to staying on the job or returning to work. For people living with episodic disabilities who have periods when their health permits them to work, this is especially true.
For Canadians with episodic disabilities, more flexible disability income support programs would facilitate labour force participation consistent with their capabilities. Both the financial and social implications of partial disability benefits, combined with partial earned income from the workplace, would be a win-win for Canadians with episodic disabilities as well as for disability income support programs as a whole.
Let me give you an example. Jane is a 42-year-old woman who has been working for over 15 years. She has recently been diagnosed with arthritis, which is causing her excruciating pain. Jane begins to get episodes and flare-ups of arthritis; these are unpredictable and last a few days. Sometimes Jane can work for a few months or more without an episode; however, Jane only gets five sick days from her employer. One arthritis episode can use up all her sick days. In light of this, she is forced to disengage from the workforce and go on disability income support, as she needs more sick days than her employer can afford to provide.
Now Jane is out of the workforce on disability income support and not paying employment-related taxes. She does not have as much money to contribute to the Canadian economy and may lose access to her employer's extended health benefits. However, if Jane were able to use employment insurance sickness benefits in a more flexible way and over a longer period of time, instead of the current 15 consecutive weeks or 75 full days, she would be able to stay attached to the workforce, have access to her employer's extended health benefits, and continue to pay income tax and EI premiums.
This is not about more; it's about different. These modest changes to employment insurance sickness benefits would help many people to be employed, as well as result in a more efficient and effective program and better use of resources.
Our first recommendation is to make employment insurance sickness benefits more flexible. Change the EI sickness program to allow people to work part time or intermittently and receive partial sickness benefits for up to 150 half-days as needed, instead of the current 15 consecutive weeks or 75 full days. This would enable people who are or could be employed to remain attached to the workforce by working part time when their health permits, while receiving part-time benefits.
I'm now going to turn it over to John Stapleton.
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