Advocating for Prison Needle Exchange Programs

Target Population

• Population: Inmates in Canadian Federal Prisons (incarceration for at least two years) who are IV drug users and currently lack access to sterile injection equipment.

• These individuals are at a higher risk for HIV infection and transmission than the general population despite incarceration in part due to the lack of sterile injecting equipment

Concern Prompting Health Advocacy Initiative

• A part of Corrections and Conditional Release Act (CCRA) mandates that imprisoned persons must be provided with essential health care conforming to professional practices.1

• The World Health Organization has released prison standards indicating that incarcerated people are to be provided with measures to prevent disease transmission.2

• Lack of access of Canadian prisoners to clean injecting equipment represents a concern to their health that violates guidelines, and further poses a risk to the general population upon their release by increasing the prevalence of affected individuals in the population

Background information regarding the population concern and health advocacy initiative

Injectable drugs continue to be found in Canadian prisons despite control measures to prevent this. Drug users can therefore continue their injecting habits while in prison with some modification, one being the lack of access to sterile injecting equipment. In studies done from 1995 to 2003 it was found that as high as 92% of injecting drug users shared equipment while in Canadian prisons.3 This contributes to the unfortunate fact that the prevalence of HIV in Canadian prisons far exceeds that of the normal population, with some estimates going as much as 10 times higher. The increased prevalence has been in part attributed to needle s...

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...r base level of HIV prevalence then in some cities in this study.

While not the primary concern of this advocacy initiative there may also be an increased level of the mental health of prisoners. While a concern raised was that finding needles could potentially harm staff incidentally, it is also possible that there may need to be less hiding of needles occurring with the NSPs in place, and an increase in the level of trust between staff and prisoners. This was noted to have occurred in an international review on the topic, which no adverse health outcomes being noted for staff in locations where NSPs where implemented.10 This increased level of trust was also associated with increased awareness of transmission and behavioral risks associated with drug use. It is hypothesized that these benefits could improve the mental and physical health of Canada’s prisoners.