PENS AND NEEDLES

Prison population growth has cranked up the risk of infectious disease
transmission

"A lot of addicts in any prison share needles," says Jean-Marc. "They don't
care. They even ask to share with inmates they know are sick."

We are sitting in a room off the chapel in Kingston Penitentiary, a federal
maximum security institution for men. Most inmates are serving a minimum of
10 years at this hard-core facility.

Despite its age, the 160-year-old Kingston pen is not as daunting as you
might expect. Adjacent to Olympic Harbour Park on Lake Ontario, the
impressive limestone buildings are in the last stages of a seven-year,
$55-million retrofit that's included everything from doors and windows to
air exchange systems. The central courtyard feels somewhat like a
university quadrangle, but without the bustle of students and professors.

On the way to the interview, John Oddie, KP's assistant warden of
management services, says the pinkish-grey stone was quarried from a nearby
field where Queen's University's football stadium now stands. Oddie lets me
interview the inmates alone.

Jean-Marc is a member of the inmate committee that deals with prisoners'
issues. Also with us is Jack (again, not his real name), another committee
member, who is serving a long sentence for a shooting. The door is locked.

"We're surprised that we're allowed to talk to you alone," says one. "We're
surprised the warden isn't sitting right there."

"The situation is not getting better ­ it's getting worse," says Jack,
referring to the prison health risks. He is apparently not a drug user.
"They've got to open their eyes sooner or later. What are they going to do,
wait for 30 or 35 people to die here?"

He pauses. "Public safety is at risk. People are going back out to the
streets."

The two inmates estimate 70% of the inmates at Kingston pen use drugs. Some
are "weekend warriors," meaning they shoot up or "snort a line of heroin"
once a week at the beginning of the weekend. That's to avoid being caught
in the random urinalysis testing run by Correctional Services of Canada, a
federal department. Urine testing is only done on weekdays, they say. By
Monday, traces of heroin should have left the system.

Another inmate, Steven Wayne Zehr, has already told me he thinks the
urinalysis program is actually responsible for an increase in the use of
hard drugs. As Olympic snowboarder Ross Rebagliati knows, cannabis is
detectable in the bloodstream for rather a long time. "Urinalysis is one of
the main reasons offenders switch from joints to speed," says Zehr.

A recent report made by the solicitor general's office denies this trend.
It says that urine testing shows a decline in drug usage.

"You may come in here with no drug habit and no diseases, and still get
sick," says Jean-Marc. He describes the grim cycle of boredom that leads to
the first shot. "Then you get hep B, then C, and then HIV. You go to the
hospital twice a day for painkillers."

There is no doubt CSC and its provincial counterparts face immense
challenges. Their health care decisions are complicated by ethical and
security concerns that don't exist in other environments.

"We don't condone drug use," says Oddie. "But if it's evident it's going
on, we don't want to contribute to the spread of disease."

Health care costs are another issue. Last year, CSC's health-care budget
was more than $80 million out of a total budget of more than $1 billion.
Cumulative provincial and territorial budgets are similar.

The triple drug therapy, the cocktail, for AIDS patients costs about $1,200
a patient a month. Alpha-interferon, the only known treatment for
hepatitis C, costs about $4,000 a year. "People must recognize that
prevention is cheaper than treatment," says Ralph Jurgens, author of a 1996
report, HIV/AIDS in Prison.

The growth in prison populations has made the situation worse.

CSC's report for the period ending March 31, 1997, says, "The potentially
adverse impact of prolonged crowding in institutions is widespread,
including increased security risks, increased tension among inmates, and
higher risk of infectious disease transmission."

There are about 14,500 offenders in federal prisons today, 70% more than 20
years ago. More than 100,000 pass through the provincial systems annually.
Provincial prison populations are much more transient because their inmates
have sentences of less than two years.

Many felons entering prison are already carriers of one disease or another.

"To a degree, prison is a mirror of the community," says Alan Sierolawski,
manager of health services operations policy for CSC. Many inmates come
from the high-risk population of street drug users and continue to
participate in high-risk activities while in prison, he says.

"We don't get the cream of the crop from society ­ that's for sure," says a
corrections officer wryly. "They're not known for their positive choices in
life. Their lifestyle on the street carries over here."

It's hard to pin down the number of HIV and hepatitis carriers in Canadian
prisons because testing is voluntary. Last year, 173 or more than 1% of
federal inmates tested HIV-positive ­ at least 10 times the rate outside.
By comparison, only 14 federal inmates tested positive in 1988.

A 1996 joint Canadian AIDS Society and Canadian HIV/AIDS Legal Network
report says more than 5% of inmates are HIV-positive in some institutions,
especially in Quebec. B.C. figures suggest more than 30% of the
drug-injecting population from the lower mainland area are HIV-positive,
says Dr. Diane Rothon, British Columbia. Corrections' director of health
services. About one-third of B.C.'s inmates are drug users.

Kingston inmates say a high percentage of inmates are infected but refuse
testing for fear of being ostracized or because they don't care.

The quality of medical care offered to infected inmates is another factor,
they say. Jean- Marc tells me of the case of Billy Bell, an inmate who died
of AIDS in the Regional Treatment Centre in Kingston pen in May 1997. Bell
was denied release by the parole board 19 days before his death. He died
alone, triggering a coroner's inquest. According to reports, a prison
chaplain was so upset by the manner of Bell's death he left a note on a
colleague's door stating: "Billy Bell died tonight, like a dog in a back
kennel."

Hepatitis is even more widespread. Up to 40% of the prison population has
hepatitis B or C, says CSC's Sierolawski. Some institutions may have rates
as high as 70%.

The inmates I interviewed believe it's even higher. "I can't think of
anyone here who doesn't have hep C," says Jean-Marc.

Most blood-borne diseases in prison are transmitted by needles ­ either
medical syringes or home-made puncturing equipment made from pencils, pens
or bits of wire. Prisoners rarely seek medical attention for skin
infections caused by primitive and dirty "needles", implements which may be
shared by up to 20 people without cleaning.

Not only intravenous drug users are at risk. Tattooing and body-piercing in
prison ­ which use the same tools and are also prohibited ­ are another
mode of transmission, says Judy Portman, CSC's national HIV/AIDS
co-ordinator. More than 60% of inmates received tattoos or body-piercing in
prison according to provincial inmate surveys.

Hepatitis B and HIV are also passed through sexual contact. A CSC survey
suggests 6% of inmates surveyed have had sex with another inmate.

Inmates infected with blood-transmitted diseases are not separated from the
other prison population unless they represent a specific threat, like
sexual predators, says Sierolawski.

The prevalence of drugs in prison is amazing. "The movement in and out is
very substantial," he says. "It's a community with a lot of visitors. There
are many varied and clever ways to smuggle drugs in."

B.C. Corrections Rothon says rectal and vaginal insertions are commonly
used to smuggle drugs into jails. And Jean-Marc says that authorities will
never be able to stop the drug flow. The network is so good, that inmates
pay street prices for drugs inside.

The number of prisoners in "segregation" is a clue to the extent of
drug-selling in prison, he adds. Inmates often volunteer themselves for
segregation because they can't pay drug debts.

CSC and provincial institutions have introduced programs to combat the
rising tide of infection. However, they have been implemented unevenly,
partly because of lack of co-ordination between the federal and provincial
governments. Progress has been made with the establishment of a federal,
provincial and territorial group on HIV/AIDS.

One of the first federal measures was the condom program, introduced in
1993. "We offer a wide range of lubricated and non-lubricated condoms,
lubricants, and dental dams," says Claudette Lawson, chief of health
services at Kingston pen. "Nobody asks any questions."

Condoms do not address the bigger problem of infected needles in prisons.
The "bleach kit" program launched 1996 was the first serious measure taken
federally. B.C.'s provincial corrections service had introduced it in 1992
and anticipated the federal condom program by many years.

Inmates are given a kit upon admission which includes a one-ounce
refillable bottle of bleach and instructions on cleaning needles. It's a
popular program ­ about 30,000 bottles have been issued within the federal
system's Ontario region alone since September 1996.

Offenders are also offered hepatitis B immunization and confidential HIV
and tuberculosis testing, says Teresa Garrahan, CSC's regional infectious
diseases co-ordinator for Ontario. But there is no vaccine for hepatitis C
which is linked with the development of cirrhosis and liver cancer.

A methadone maintenance treatment program for heroin-addicted offenders was
announced last December by Federal Solicitor General Andy Scott.

"This is the best thing to happen yet," says Jean-Marc, who expects to go
on the program soon. B.C. Correction's program, already in place, has
resulted in a reduction of recidivism, meaning a return to a life of crime,
says Rothon.

Another project focuses on peer education. Piloted in New Brunswick's
federal Dorchester Penitentiary in 1995, the program is designed to train
inmates as health counsellors. A more conventional health education program
counts toward a grade 10 credit. Courses include birth control,
understanding sexually transmitted diseases, family planning, and illness
prevention.

But one of the most controversial proposals for reducing the spread of
infectious diseases is a needle exchange program, something that has proved
successful in some Swiss, German and Spanish prisons. The federal
government, however, has decided against it "at this time."

B.C. Corrections' Rothon visited Swiss prisons with needle exchange
programs and pushed for something similar in B.C. It was included in a
bundle of recommendations made by B.C. Corrections' Harm Reduction
Committee to branch management. "However, we ran up against a veritable
wall in the union that represents security officers," she says. When
presenting the proposal, she was not helped by a rash of convenience store
holdups in Vancouver. The weapon? A blood-filled syringe.

She is looking for a solution which may involve a new type of safety
syringe or dedicated injecting rooms.

Kingston inmate Steven Zehr is discouraged that a needle exchange program
has not been implemented. However, he says some progress has been made.
"The authorities are a bit more liberal," he says. "If you were to talk
about this 15 years ago, they'd think you were crazy."

Not only do security staff fear needles as potential weapons, some object
on ethical grounds. "I wouldn't agree with it," says one. "Officially
speaking there is supposed to be zero tolerance to drugs, which are often
the reasons for crime. I don't see how it could be seen as compatible."

Inmate Jean-Marc feels there is little risk, provided needles are kept in
clear view. He says guards are at greater risk of being pricked by a dirty
needle when searching for contraband.

This happened last October at nearby Joyceville Penitentiary when a guard
was pierced by a needle of an HIV-positive inmate. It was a clear
demonstration that security officers' flimsy latex gloves are inadequate
protection.

In Toronto, a detention centre guard was pricked by a homemade tattoo
needle during a search last November. Oddie says they are searching the
market for puncture-proof gloves. "We want to provide protection for
officers and allow them to do their search at the same time."

These searches aren't easy. In Kingston, where there's no double-bunking,
inmates are separated into 12 cellblocks, called ranges, each with about 38
cells. Individual cells, measuring about four feet by 10 feet, are jammed
with personal possessions and blankets are draped over barred doors for
privacy.

"We are told to treat all inmates as if they are HIV- or
hepatitis-positive," says a guard. "We know that 75% have one or the other
or both."

Fights between inmates is another high-risk situation. "We wait until
someone wins," says the officer. "It may not be policy but it's standard
practice."

She says that protective plastic disposable clothing and medical
disinfectant soap should be more readily available. "If someone is gushing
blood, I wouldn't want to pick him up without protection.

"I don't want to go home to my family and pass on an illness. Where's CSC's
responsibility in that?"

Indeed, liability issues cannot be ignored by prison authorities. Staff
members, infected with serious illnesses contracted at work, might be
expected to launch lawsuits. And prisoners, infected while in prison, will
look to the courts too.

Already, legal actions by prisoners have resulted in important health care
changes in correctional facilities, according to the 1996 joint report by
the Canadian AIDS Society and the Canadian HIV/AIDS Legal Network.

In 1996, an HIV-positive woman petitioned the British Columbia Supreme
Court for methadone treatment denied her by the Burnaby Correctional Centre
for Women. The petition was withdrawn when treatment was provided.

In 1993, B.C. Corrections introduced methadone treatment for pregnant
womenwho were in methadone programs before entering prison. The province
expanded the methadone continuance program to all offenders in 1996. It is
now looking into extending treatment to heroin addicts serving longer
sentences.

Correctional Services of Ontario decided against random urinalysis testing
in anticipation it could be considered a human rights issue, says Dr. Paul
Humphries, the senior medical consultant.

The union representing the province's correctional staff agreed to a condom
program provided bleach and needle exchange programs would not be
considered. Some provinces have not even made condoms freely available in
prisons.

Many prison authorities recognize the need for drastic action and have made
difficult decisions in the past few years. The B.C. Corrections Branch
"has shown true leadership and courage," says its director of health services.

"Although there has been some progress, it's still too slow," says Ralph
Jurgens, co-ordinator of the Canadian HIV/AIDS Legal Network and author of
the 1996 HIV/AIDS in Prisons report. "Liability issues are still there."

A needle exchange program in prison should be considered a public health
measure, he says. More than 80% of prisoners serve short sentences and
return to their families and communities. "We must do everything we can to
protect them. It's both a moral and legal responsibility."

It's pointless to ignore the staggering numbers and pretend sex and drugs
aren't a big part of prison life. Health care decisions should be
paramount; a sentence to prison should not be a sentence to death.

Checked-by: Mike Gogulski