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HIV spending way up in federal prisons

Interdiction emphasis proving costly and less effective

Credit: Ken Boesom illustration

Over the past five years, the money Correctional Service of Canada (CSC) gets from the Federal Initiative to Address HIV/AIDS for federal prisons has increased tenfold, from $400,000 a year to $4.2 million.

On the surface, CSC lists various programs it funds, including harm-reduction mechanisms like condoms, dental dams, water-based lubricants, bleach for cleaning needles and opiate substitution therapy. But there are some conspicuous absences from the list, including needle exchange programs and, of course, the safer tattoo project the Conservative government killed in 2006.

Then-public safety minister Stockwell Day objected to prisoners getting tattoos on the government’s dime (even though prisoners actually paid for their own tattoos). According to CSC figures, it costs $29,000 per year to treat each HIV-positive inmate. The cost to operate the safer tattoo program at six federal institutions was around $600,000 per year: cost-effective if 21 HIV infections are prevented among those six institutions each year. And that’s just HIV. Clear evidence suggests the tattoo program reduced the incidence of other diseases such as hepatitis C as well.

“It is an unfortunate gap, and it’s a gap that we have said over and over again should be closed,” says Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network. “I don’t think CSC can claim to be engaged as it usually does in a comprehensive response to HIV in prisons when there are two key programs that address known, documented HIV risks in prisons that they’re unwilling to implement.”

Some of the organizations serving HIV-positive prisoners are reluctant to blame CSC for the demise of the safer tattoo program.

“They weren’t the ones that pulled the plug, and they really were getting some good results,” says Anne-Marie Di Censo, executive director of Prisoners’ HIV/AIDS Support Action Network (PASAN). “It was a really good program, and they were spending the money appropriately, but their hands were tied around that one.”

It’s not all bad: according to Di Censo some of the CSC education programs, such as the Reception Awareness Program (RAP), Peer Education Course (PEC), Choosing Health in Prisons (CHIP) programs, and discharge planning are effective, at least to a point.

But then there are needle exchange programs. Easy access to clean needles for injection drug users drastically reduces the chances of HIV transmission.

“We’ve had needle exchanges since 1989 in the community, but we can’t get effective harm reduction, like needle exchange, into the prison population,” says Di Censo. “What you’re doing is incarcerating drug users… It’s even difficult to have a conversation about that because there are unions involved. Prisons are the guards’ workplaces, and it’s a health and safety issue.”

The NDP public safety critic, Don Davies, says when the public safety committee travelled to Europe in 2010, its members learned that prisons in Norway issue clean needles to inmates, which, they say, actually makes it safer for guards because sharps are kept in the open rather than hidden in places where guards may be pricked accidentally. Davies has proposed a medical injection pilot project for Canadian prisons in place of a needle exchange.

“Have them come to the medical dispensary where they can have a safe injection right there,” he says. “That way you won’t have needles around the prison.”

So if the Conservatives have cut or refused these effective harm-reduction programs, where is all the extra money they’re spending going?

Davies says all funds the Conservative government put into addictions last year went entirely to drug interdiction. That is, attempting to stop the drugs trade. That stretched resources, leading to a lack of effective addictions programming.

Liberal public safety critic Mark Holland says the situation is largely a reflection of the government’s ideological position on crime and punishment. But with federal prison populations on the rise – up almost 10 percent during the past five years to 22,827 inmates, according to CSC – HIV rates are likely to get worse.

“Everything I’m hearing is that the system is being stretched near to the breaking point, and [Correctional Investigator] Howard Sapers has made that point clearly,” says Holland. “Any new money going in is essentially being sucked into a black hole because they can’t keep up with the exploding population and the exploding demands. Most of their efforts have centred around stopping drugs entering the prison – this has been highly ineffective.”

Di Censo says the Federal Initiative money also funds meetings for federal, provincial and territorial corrections heads, but the meetings are closed-door, and nobody can be sure what, if any, the outcomes are. There are also annual community stakeholder meetings, which groups like PASAN and the Legal Network attend, that are valuable tools for communication, she adds, but that don’t seem to result in plans for action.

“CSC did a study in 2007, which they just released in March of 2010,” Di Censo says. “In the sample, they found about 4.5 percent of the overall [prison] population are HIV-positive. Those are huge numbers, and when you pull out women, the percentage from their study shows that 7.9 percent of women are HIV positive.”

The survey Di Censo refers to is the National Infections Diseases and Risk Behaviour Survey on Infectious Disease. Read the survey posted here.
But figures from a CSC spokesperson, citing the CSC Infectious Disease Surveillance Report, suggest only 1.7 percent of inmates are HIV positive. Here it is below.Read the survey posted here.

Why discrepancy in the numbers? A CSC spokesperson says there are significant differences in methodology between the two studies.

“First, the survey relied on self-reported testing results at one point in time while CSC’s annual surveillance data relies on documented laboratory results from blood samples taken by healthcare professionals,” she wrote. “Estimates based on self-reporting are less reliable than those based on blood samples. Second, the survey provided estimates for inmates who report ever having been tested either in or outside of a federal penitentiary. In comparison, CSC’s surveillance data only captures testing conducted at a CSC facility. Finally, the survey calculated rates of infection among inmates who had ever been tested, whereas CSC’s surveillance estimates are calculated for the entire inmate population.”

It paints a somewhat confusing picture.

“There still are no statistics on the number of people who are contracting HIV while incarcerated, and that’s a pretty key statistic,” says Holland. “One of the first things that’s got to happen is for all programs implemented within the Corrections Service, we need to have statistics as to their success rates. How can you have an intelligent conversation about the efficacy of the program if you have no statistics with which to base the debate?”

Di Censo believes that perhaps CSC is getting too much money for HIV, believing the organization doesn’t do as much as it should for $4.2 million.

“I really think we need to be talking about this money getting divided up into the community, so that the community can respond to people,” Di Censo says. “People in prison don’t stop being human beings because they’ve been incarcerated. We need to be able to respond to those specific needs, and we can only do that if we are appropriately funded.”