By Sandra Ka Hon Chu, Director of Policy and Advocacy
International Prisoners’ Justice Day, observed every August 10, is a chance for people to reflect on what it truly means to be incarcerated in our country. Prisoners are not fundamentally different from us and remain members of our communities who are entitled to human rights. In Canada, against the backdrop of the raging overdose crisis and the continued, harmful criminalization of people who use drugs, this day should be full of meaning for us all.
Just imagine, for a moment, having a chronic illness as highly stigmatized as problematic drug use. If others discover your illness, you are the subject of derision and abuse. You could even be thrown in jail for it. But, mercifully, there are proven measures you can take to mitigate the risks associated with your health condition, including the risk of HIV and hepatitis C infection.
Now imagine that you are behind bars, perhaps even because of this illness. Here, the stigma surrounding your health condition is far worse. If others find out, you will be harassed and bullied by prisoners and staff alike. And your health will most certainly suffer because you do not have access to the same health measures that you had outside prison.
This is the reality currently facing federal and provincial prisoners who inject drugs, despite the fact that the Correctional Service of Canada has finally introduced prison-based needle and syringe programs in two federal prisons. The benefits of such programs are many and well-documented, including 25 years of international evidence that they reduce the risks of HIV and hepatitis C transmission, provide a bridge to health care and drug treatment programs for prisoners, and enhance occupational safety because staff are far less vulnerable to accidental needle-stick injuries and less likely to experience such an injury with a needle that has been shared by many people — with no evidence of additional security risks.
But while the federal correctional service has seemingly accepted the overwhelming evidence that prison-based needle and syringe programs work for prisoners and prison staff, these benefits will never be realized if prisoners do not have actual access. The model of prison-based needle and syringe program being introduced in Canada creates significant barriers to access and leaves much to be desired. A course correction is desperately needed.
Under the current model, prisoners’ participation must be approved by prison health services and prison security. This means prisoners’ confidentiality will be compromised from the start. Even if the prison authorities do decide to grant access to sterile injection equipment, a prisoner’s participation would be known to prison security, other prison staff and to the Parole Board, which could lead to additional scrutiny, institutional charges or a delay in parole. It is more than obvious that prisoners will be highly unlikely to participate in a program that poses such risks, including the possibility of prolonging incarceration.
As the United Nations Office on Drugs and Crimes has indicated, medical confidentiality is essential for these programs to be effective. Without strong protections for confidentiality, people will not participate because of the gravity of potential repercussions. When correctional officers and other prison staff know who is participating in a prison-based needle and syringe program, those prisoners are vulnerable to heightened surveillance, institutional charges and a denial of conditional release. When the Parole Board considers a prisoner’s participation in these programs as evidence of continued drug use in prison, participants are punished for taking positive steps to protect both their own health and the health of others, in prison or upon release to their communities.
Prison-based needle and syringe programs are health interventions. In providing health care, the ultimate decision about who can participate should not rest on security staff who seem unwilling to consider years of actual evidence, but with the person seeking access and their health care provider. And as with other health interventions, medical confidentiality should be preserved, especially in an environment where being ‘outed’ for one’s drug use has such drastic consequences. Failing to enact strong protections for confidentiality destines the current program to flounder — all at the expense of the people it was ultimately intended to protect. On International Prisoners Justice Day, let us remember that prisoners deserve a needle and syringe program that works.