Transcript Harm Reduction: An Overview of Policy and Practice

Harm Reduction in Prisons:
Prisoners’ Rights are Human Rights
Rick Lines, MA
Executive Director, Irish Penal Reform Trust
December 11th 2003
“Why Harm Reduction?”
High rates of HIV and HCV seroprevalence are evident in
in many prison systems internationally, including Ireland.
High risk behaviours for the transmission of HIV and HCV
are widespread in prisons across the world, including
Ireland.
HIV and HCV are PREVENTABLE infections
HIV and HCV infection in prisons has broader implications
on public health
Prisoners have a right to health, including preventive
measures
Prisoners’ Right to Health:
International Law
Universal Declaration of Human Rights and the European
Convention on Human Rights prohibit “cruel, inhuman or
degrading treatment or punishment”
International Covenant on Civil and Political Rights sets forth the
right of “persons deprived of their liberty” to be treated with
“dignity” and with “respect for the inherent dignity of the human
person”
Covenant requires all the rights and freedoms it sets out to be
respected for “everyone”, including persons deprived of their
liberty by process of law
Prisoners’ Right to Health:
International Rules, Standards, Guidelines
“Except for those limitations that are demonstrably
necessitated by the fact of incarceration, all prisoners
shall retain the human rights and fundamental
freedoms set out in the Universal Declaration of
Human Rights, and … the International Covenant on
Economic, Social and Cultural Rights, and the
International Covenant on Civil and Political Rights …
as well as such other rights as are set out in other
United Nations covenants”
UN Basic Principles for the Treatment of Prisoners, Principle 5
Prisoners’ Right to Health:
International Rules, Standards, Guidelines
Numerous declarations and covenants provide that
“[e]very person has a right to the highest attainable
level of physical and mental health”
Article 25, Universal Declaration of Human Rights
Article 12, International Covenant on Social, Economic and Cultural
Rights
Article 11, European Social Charter
Article 16, African Charter on Human and Peoples’ Rights
Prisoners’ Right to Health:
Standards of Health Care
“Prisoners shall have access to the health services available in
the country without discrimination on the grounds of their legal
situation.”
UN Basic Principles for the Treatment of Prisoners, Principle 9
“Everyone has the right to access preventive health care and
the right to benefit from medical treatment under the conditions
established by national laws and practices.”
Charter of Fundamental Rights of the European Union, Article 35
Prisoners’ Right to Health:
Standards of Health Care
“Health policy in custody should be integrated into,
and compatible with, national health policy. A prison
health care service should be able to… implement
programmes of hygiene and preventive medicine in
conditions comparable to those enjoyed by the
general public.”
Committee of Ministers to Member States Concerning the
Ethical and Organisational Aspects of Health Care in Prison
Prisoners’ Right to Health:
HIV/AIDS and Harm Reduction
“All prisoners have the right to receive health care,
including preventive measures, equivalent to that
available in the community without
discrimination…with respect to their legal status.”
Principle 1, WHO Guidelines on HIV Infection and AIDS in Prisons
“general principles adopted by national AIDS
programmes should apply equally to prisons and to
the general community.”
Principle 2, WHO Guidelines on HIV Infection and AIDS in Prisons
Prisoners’ Right to Health:
HIV/AIDS and Harm Reduction
“With regard to effective HIV/AIDS prevention and
care programmes, prisoners have a right to be
provided the basic standard of medical care available
in the community.”
UNAIDS
Prisoners’ Right to Health:
HIV/AIDS and Harm Reduction
“Whether the authorities admit it or not – and
however much they try to repress it – drugs are
introduced and consumed by inmates in many
countries…Denying or ignoring these facts will
not help solve the problem of the continuing
spread of HIV.”
UNAIDS (1997)
Our Government’s
(non) Response
80. Mr. Boyle asked the Minister for Justice, Equality and Law Reform if
the Government will commit to providing bleach to prisoners as a HIV
prevention measure, as is standard practice in at least 11 of 23 EU
jurisdictions, as well as in all Canadian federal prisons. [23434/03]
Minister for Justice, Equality and Law Reform (Mr. McDowell): I do
not intend to make arrangements in prison which are premised on the
tolerance of intravenous injections of hard drugs.
Parliamentary Question, 14 October 2003
Harm Reduction Challenges
Dominant Policy
Harm reduction accepts the reality of drug
use.
Harm reduction does not necessarily seek to
reduce the amount of drug use.
Harm reduction seeks to reduce the harms to
the individual and to society.
Harm reduction recognizes and values the
human rights and the health expertise of
drug users.
Challenges to Ourselves
Harm reduction asks us to adopt a political
understanding of the effects of drug use and social
marginalization.
Harm reduction asks us to defend the human rights
of drug users and prisoners.
Harm reduction asks us to question our own
assumptions – and often our own training – about
drug use.
Harm reduction demands that we challenge our own
prejudices about people in prison and people who
use drugs.
Our Government’s Toleration
of HIV and HCV in Prisons
NO condoms or safer sex measures
WHO (1991) – 23 of 52 prison systems surveyed
provided condoms to prisoners
EMCDDA (2001) – 18 of 23 prison systems in the EU
proving condoms
11 of 14 Canadian jurisdictions (2002)
Ukraine, Moldova, Estonia, Turkmenistan, Romania
(pilot), some parts of Russian Federation
Recommended in two Trinity College studies in 1999
and 2000
Our Government’s Toleration
of HIV and HCV in Prisons
NO bleach or disinfectants
EMCDDA (August 2001) – Bleach provided in 11 of 23 EU prison
systems.
UNAIDS (1997) – Provided to prisoners in prisons in Europe,
Australia, Africa, and Central America.
Canada – 52 federal prisons, 20 British Columbia prisons, and
some Quebec prisons.
Turkmenistan, Kyrgyzstan, Moldova, some parts of Russian
Federation, Uzbekistan (pilot)
Recommended by Group to Review the Structure and
Organisation of Prison Health Care Services (2001)
Identified as a concern by the European Committee for the
Prevention of Torture (2003)
Our Government’s Toleration
of HIV and HCV in Prisons
NO provision of sterile syringes
Successfully implemented in over 40 prisons in 6
countries
Recognised as best practice
Recommended by Trinity College study in 1999
National Drugs Strategy 2001—2008 – “review the
exisiting network of needle-exchange facilities with a
view to ensuring access for all injecting drug
misusers to sterile injecting equipment”
Our Government’s Toleration
of HIV and HCV in Prisons
LIMITED access to methadone
Dublin area prisons
Only available to those on methadone
prior to incarceration
Rarely provision to initiate methadone
while in prison
Barriers to Harm Reduction in Prisons
Zero-tolerance/abstinence based
approaches often more entrenched
Admission of failure
Discrimination against prisoners
Criminal laws and punishment
Lack of legal framework
Staff safety concerns
Advocating for Policy Change
Zero-tolerance/criminalization has failed
Evidence-based
Cost-effective
Promote legal, ethical, human rights
Collaboration
Between drug users/prisoners and health professionals
Between organizations
Between countries
Legal & Ethical Responsibility
of Governments
There is no doubt that governments have a moral
and legal responsibility to prevent the spread of HIV
among prisoners and prison staff and to care for
those infected. They also have a responsibility to
prevent the spread of HIV among communities.
Prisoners are the community. They come from the
community, they return to it. Protection of prisoners
is protection of our communities.
UNAIDS