Correctional Service of Canada must do better

Needle exchange programs work. The science bears this up, with studies confirming that such programs drastically reduce the risk of HIV, hepatitis C, and other serious infections, and of overdose. Crucially, they also facilitate prisoners’ access to drug treatment and other health care. But when they are designed to limit access, none of these benefits will be realized. Last month, the Office of the Correctional Investigator’s annual report was tabled in Parliament, and outlines how Canada is failing to provide adequate health care to federal prisoners, especially incarcerated Indigenous people, including women. Importantly, the Correctional Investigator Ivan Zinger found that the Correctional Service of Canada’s (CSC) prison needle exchange program is not actually benefiting prisoners because “ecurity-driven practices and a zero-tolerance approach to illicit drug possession and use behind bars severely erodes confidence and limits participation in what should be an exclusively harm reduction and health-focused prison needle exchange program." The result is that few prisoners are accessing the program and are continuing to share and re-use needles. Put simply: the current system is not working and must be fixed. The Canadian HIV/AIDS Legal Network and the Native Women’s Association (NWAC) have observed these flaws since the program was introduced in 2018. As the correctional investigator noted, “CSC has a legal obligation to ensure reasonable access to essential health care in conformity with professionally accepted standards of practice.” Access to sterile injection equipment is essential health care for people who inject drugs in and out of prison, and best practices in public health require such a program to protect prisoner confidentiality. Yet, prisoners who apply to the program not only have no guarantee of being approved but are forced to ‘out’ themselves as a person who uses drugs—a highly stigmatized and penalized activity—to the very people who are responsible for enforcing the law against drug use behind bars. As the past year of protests by correctional officers has shown, security staff have been extraordinarily hostile towards this program as well as towards the people who risk participating in it. Incarcerated Indigenous women have expressed their fear of being further stigmatized to NWAC staff. They are also targeted for harassment, additional surveillance, or disciplinary action from guards. Moreover, those who do apply to participate in the needle exchange program are forced to wait months for approval. The few participants who are accepted to the program have difficulty accessing sterile injection equipment because opportunities to replenish equipment are scarce. The model that CSC implemented for the needle exchange program is unlike models used in other countries in that it violates prisoners’ confidentiality by embedding security staff in the delivery of this health service and imposes other barriers to participation. The United Nations Office on Drugs and Crime stresses that prisoners should have easy and confidential access to sterile drug injecting equipment, syringes and paraphernalia. The Correctional Investigator also notes in his report, “Harm reduction strategies can only be successful if there is uptake on the part of users.” It is a fact that Indigenous women’s vulnerability to HIV, HCV, and incarceration is intimately linked to poverty, housing insecurity, mental health, substance use, adverse childhood experiences, racism, and intergenerational trauma. The connection between trauma and substance use within the Indigenous population cannot be understated. A prison needle exchange program can only succeed if implemented in a way that is culturally safe and trauma-informed—and, of course, if prisoners can trust the program because access is easy and confidential. The continued denial of essential health care to people in prison—who are among the most marginalized in our communities—is unconscionable. Denying access to a needle exchange program flies in the face of human rights and the spirit of the recommendations posed by both the Truth and Reconciliation Commission and the National Inquiry on Missing and Murdered Indigenous Women and Girls Inquiry. The Correctional Service of Canada must do better. Sandra Ka Hon Chu is director of research and advocacy for the Canadian HIV/AIDS Legal Network. Lorraine Whitman is president of the Native Women’s Association of Canada. The Hill Times

Correctional Service of Canada must do better

Denying access to a needle exchange program flies in the face of human rights and the spirit of the recommendations posed by both the Truth and Reconciliation Commission and the National Inquiry on Missing and Murdered Indigenous Women and Girls Inquiry.

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