Last month, four AIDS advocacy programs and one former prison inmate took the unconventional, and rather inspired, step of suing the Canadian federal government for not providing a clean needle exchange program to the country’s prison inmates. Their argument, based on the premise that the government must provide prisoners access to the same healthcare services as would be available to them in the community, is unlikely to succeed in Canada’s courts. It does, however, bring to the forefront important public health issue.
Harm reduction has been shown time and time again to be an effective public health measure to curb the prevalence of communicable diseases such as HIV/AIDS and hepatitis C that can be spread via shared needles. The need is there. Prevalence of HIV/AIDS in prisons vary from country to country; however, globally infection rates are consistently higher in prison populations than in the general community. In Canada, estimates of HIV/AIDS prevalence in incarcerated populations are as much as ten times higher compared to the rest of the country. And, remarkably, Hepatitis C infection rates in prison are even worse. Peer-reviewed studies consistently demonstrate that hepatitis C infection rates in prisons ranges from 20 to 40 percent. While these numbers are astounding, they are perhaps not unexpected. According to the Correctional Service of Canada (CSC), approximately 80 percent of people incarcerated have a serious substance abuse problem. So, is it really any surprise that a large percentage of inmates find ways to continuing using injection drugs once they are in prison?
North America has always been squeamish about harm reduction. It is unclear where this attitude originates; both Canada and the United States strive to be progressive world leaders in a plethora of other sectors regardless of “conventional” wisdom. Yet for some reason, these nations have failed to take a leadership stance when it comes to public health. In Canada, there has been a long and disturbing history of the government acting contrary to compelling evidence supporting harm reduction measures. Some of the more notable failures include in 2006, when then federal public safety minister Stockwell Day cancelled an initiative to provide safe tattoos in prisons. This is despite a CSC report stating that the program was found to reduce the health risks of the inmates, prison staff members and the community at large. More recently in early 2012, a study done by the University of Toronto at the city’s request urged that both Toronto and Ottawa implement safe-injection sites in the community, following the example set by their Canadian colleagues in Vancouver. Despite these unambiguous recommendations, the province’s Minister of Health was quick to state that no further action would be taken on the issue.
Not only have governments ignored arguments put forth by public health or social justice advocates, they have also failed to heed the advice of economists. One study estimates that in the United States, a clean needle exchange program would cost approximately 34,278 USD per HIV infection averted, significantly lower than the cost of providing treatment to an HIV/AIDS positive person throughout their lifetime. Though the number of studies done on needle exchange programs in prisons specifically is limited, researchers have shown that clean needle exchange programs in the general community are cost-effective. One Australian study concluded that community needle exchange programs were not only effective, but that they would yield a ten-fold return on their initial investment.
Part of the reason for this seemingly mystifying failure to act is rooted in the common perception that harm reduction measures will encourage drug use. Policymakers also fear that needles given to inmates might be used as weapons, compromising the safety of the prison staff as well as the other inmates. While these are both understandable lines of reasoning, they have both been shown to be unfounded concerns. In programs that have been implemented in several countries, the levels of drug use within the prisons remain consistent at worse, and have even been shown to improve. Moreover, there have been no reports of the needles being used to intentionally to incite violence.
Another common justification against harm reduction measures insists that the government should not take such a “soft” stance on drug users. This attitude equates government action to that of an overly lenient parent failing to discipline an unruly child. Yet the difference in the situation at hand is obvious: by failing to provide a clean needle exchange, the government is actively promoting conditions that put an addict at risk of increased health problems. In no world is drug addiction an easy battle to overcome; only by lowering risk for HIV/AIDS or hepatitis C can addicts increase their chances of breaking of the cycle of drug use and recidivism.
That fact of the matter is that North America is falling behind. To date, there are 60 countries worldwide that have taken strides to implement safe-needle exchange programs in their country’s prisons, including, of all places, Iran. Even in Iran, where freedom of speech is disallowed and where the government does not believe in the Holocaust, policymakers no longer ignore the towering mountain of evidence that supports this pubic health intervention. If they can do it, so can we. The need is there and the evidence is there; all we require now is the will.
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