By Sean Barry, Community HIV/AIDS Mobilization Project (CHAMP)
NOVEMBER 2006 • Issue 1
Many United States prison and AIDS activists have been inspired by Canada’s relatively long record of providing behind-bars harm reduction and prevention tools. Our Canadian counterparts continue to struggle for the full range of needed interventions, but their victories can offer strategic lessons to activists in other countries.
In 1991, recognizing that the AIDS crisis in Canadian prisons was a result of “government inaction,” activists launched the Prison HIV/AIDS Support Action Network (PASAN). PASAN’s advocacy is driven by the needs of people who are locked up: an informal committee of prisoners identifies campaign issues, while the external “Activist Committee” is made up of prison rights activists and AIDS service providers. Prisoners have actively participated in letter-writing campaigns and utilized a prisoner grievance system that, while not effective at redressing problems, helps “raise the profile” of issues. Prisoner-run health groups, with both formal and informal peer educators, also inform activists of what their constituency needs.
Notably, Canada has a comparatively more equitable health care system and more responsive correctional oversight than in the United States, although advocates point out that the prison system remains a fundamentally inhumane place. PASAN and other groups have used meetings with correctional staff, issued reports on current conditions and recommendations for improvement, and supported prisoners taking action on the inside as tactics for improving conditions.
In 1992, PASAN issued HIV/AIDS in Prison Systems: A Comprehensive Strategy, a report recommending forty specific steps the Correctional Service of Canada (CSC) needed to take in order to improve prevention and care for people living with and at risk for HIV inside federal prisons. Among the bold but practical recommendations were universal education for prisoners and staff, harm reduction programs, and prevention tools — including condoms, bleach kits, and clean needles.
CSC responded to PASAN’s challenge by forming the Expert Committee on HIV and Prisons (ECAP), whose recommendations looked like much of what PASAN had asked for, and which echoed recommendations from the World Health Organization. Framing its commitment in terms of community health and noting that 80% of prisoners in the federal system returned to the community, CSC started providing anonymous HIV testing and counseling, condoms (even though CSC still prohibited consensual sexual activity among inmates), and bleach kits (first as a pilot program, then approved for nationwide use).
Methadone maintenance treatment was also eventually approved, although it was initially limited to those who had already received it before entering the system. PASAN and other prison rights groups have followed up by monitoring enforcement of these policies, documenting continuing problems, and calling for further advances in improving HIV prevention and treatment inside prisons.
A follow-up report sponsored by the Canadian HIV/AIDS Legal Network in 2002 stated that “the proportion of prisoners with HIV is six to 70 times higher than the proportion of all Canadians with HIV” — and as many as one-half or more of prisoners have HCV. Thus, a decade later the government had accepted many of the activists’ demands, prevalence of both HIV and HCV had grown. Does this mean that the interventions themselves do not work?
The 2002 report graded the progress of the federal CSCs and each provincial government in meeting ECAP’s recommendations, concluding that a “piecemeal” and uncoordinated response to HIV behind bars persisted, and that basic HIV prevention tools like condoms, bleach, and basic HIV education “continue to. be denied to prisoners” in many jurisdictions. Thus, it is the lack of full policy implementation – not the policies themselves – that is the problem.
Advocates, who believe jailhouse tats could be a major source of HCV and HIV transmission, have recently won some progress toward safe tattooing. Framing its decision to approve funding for them as a cost-saving measure that will prevent new infections, CSC opened up a limited number of in-house tattoo parlors that use clean equipment. Unfortunately, the pilot sites have been suspended pending an evaluation, and it’s unclear whether they’ll be re-opened and expanded.
Currently, needle-exchange programs are the number one prevention tool prisoners are pushing for. Although many European countries have started syringe exchanges in prison without incident — and despite endorsement from a CSC-convened task force in the late 1990s — not even a pilot program has been approved.
The powerful Canadian prison guards’ union has been an active and politically influential opponent of harm reduction, citing common arguments about safety and suggesting that needles or bleach could be used against guards. The current conservative government may make further improvements in prevention and care in prisons even more difficult.