[Recorded by Electronic Apparatus]
Wednesday, May 3, 1995
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[Translation]
The Chairman: Welcome to the subcommittee on HIV/AIDS of the Standing Committee on Health. Our first witness this afternoon is from the McGill Centre for Medicine, Ethics and the Law, Professor Norbert Gilmore. Good afternoon, Mr. Gilmore. You have about 10 to 15 minutes for your presentation, and after that we'll have our members ask you questions.
[English]
Professor Norbert Gilmore (Professor of Medicine, McGill Centre for Medicine, Ethics and the Law): Thank you very much. First, on behalf of the Expert Committee on AIDS and Prisons, I'd like to thank the subcommittee for the opportunity to appear before you today. I will briefly introduce myself before speaking and also mention something about the committee. I've been a physician in the faculty of medicine at McGill University since 1975. I'm presently professor of medicine at the McGill Centre for Medicine, Ethics and Law; associate director of the McGill AIDS Centre; and senior physician at the Royal Victoria Hospital.
I've been involved in responding to the problem of HIV infection in Canada since 1981. This has included teaching, providing clinical care, and carrying out research. I was chair of the National Advisory Committee on AIDS between 1983 and 1989; a co-founder, past president and director of the Canadian Foundation for AIDS Research; and chair of the Expert Committee on AIDS and Prisons.
In June 1992, the Solicitor General announced that an expert committee would advise the commissioner of the Correctional Service of Canada on the problem of HIV infection and AIDS in federal correctional institutions. The committee consisted of four members: myself as chair; Dr. Christiane Richard, a Montreal physician who has provided medical services to Quebec provincial prisons and is a member of the Correctional Service of Canada's external Health Care Advisory Committee; Dr. Lee Seto Thomas, who has taught at Carleton University, been a member of the Native Council of Canada and brought invaluable expertise regarding aboriginal issues to ECAP, or the Expert Committee on AIDS and Prisons; and Mr. Donald Yeomans, former commissioner of the Correctional Service of Canada.
The committee consulted widely, visited federal correctional institutions, reviewed Canadian and international prison policies, solicited input through submissions and questionnaires, and communicated through a newsletter, a working paper and presentations at numerous conferences and meetings. Its final report was released in March 1994. Having completed its mandate, the committee disbanded. Nevertheless ECAP members continue to meet informally and recently published a letter to the editor of The Globe and Mail.
ECAP identified and studied 15 issues and made 88 recommendations. These are discussed in great detail in the committee's final report, so I shall not comment on most of them. The Correctional Service of Canada is responding to them, and the commissioner of the Correctional Service of Canada will appear before the subcommittee following my presentation to address these responses.
However, I do want to address two of ECAP's more controversial recommendations, namely, those relating to sexual activity and drug use among federal inmates. Responding to them has been troubling and problematic for the Correctional Service of Canada. I shall begin by providing some background information about these issues, including ECAP's views of them.
First, ECAP has taken a strong public health approach to the problems of HIV infection and drug use in prisons. The most important tool in responding to HIV infection is prevention, both inside and outside prisons. Prevention does not stop, nor can it stop, at prison gates since inmates come from and return to their communities. Preventing infections is essential since reducing the prevalence of infection in prison, thereby reducing exposure to infection, will protect the health of inmates, staff and the public.
Second, ECAP has taken a strong harm-reduction approach to HIV infection and drug use in prisons. The committee sought ways by which the harms from HIV infection and drug use can be reduced or avoided. Sometimes this meant choosing the least harmful alternative among possible responses. Whenever people engage in sexual activity or drug use, it is essential they do so safely so that they do not harm others or themselves by these activities.
This cannot, nor should it be, interpreted as encouraging or promoting these behaviours. It is clearly aimed at discouraging unsafe behaviour. Moreover, there is a great risk that attempting to suppress sexual or drug-using activity in order to prevent harm such as HIV transmission, rather than trying to prevent the harms themselves, may be more harmful when sexual activity and drug use cannot occur harmlessly, or in a harm-reducing manner.
Third, ECAP was guided by the mission statement of the Correctional Service of Canada. This includes rehabilitation as the goal of imprisonment and that inmates retain their rights and privileges except for those necessarily removed or restricted by incarceration. This means the availability, access to, and acceptability of services and efforts to prevent infection and to care for, and I think importantly to care about, inmates who are affected should be equivalent to those available in communities outside a prison.
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Fourth, the committee saw that behaviour change is necessary if the spread of HIV infection in prisons is to be stopped. This in turn requires that inmates have realistic opportunities to change their behaviour such that the risk of HIV transmission is avoided or reduced.
The committee has made several recommendations whereby these opportunities may be enhanced. Among them are strengthening educational activities and access to condoms, bleach, and methadone. Suppressing behaviour that can transmit infectious diseases has seldom been effective. Often it has been counter-productive, driving people underground, where they furtively engage in these behaviours, often in an unsafe manner.
Enlisting the cooperation of people, enhancing their autonomy and self-esteem, while providing them with genuine opportunities to act safely, are prerequisites to effective prevention. This is a difficult and sometimes frustrating challenge, which is even more challenging in prisons.
Nonetheless, as ECAP members recently stated in The Globe and Mail, HIV infection is preventable. This means everyone, especially inmates, must have both the opportunities and the means to protect themselves and others. They need them today, not tomorrow or later. Preventing HIV infection in Canadian prisons is essential for inmates, staff, and the public, no matter how controversial, offensive, or unpopular these prevention efforts may be.
Supporting the Correctional Service of Canada so it can address these problems is essential. This includes public support, for example by the leadership and support of the Standing Committee on Health, so the Correctional Service of Canada will continue to have both the resources to respond effectively and expeditiously to the committee's recommendations and the public commitment, encouragement, and accountability to respond decisively. This support would also be likely to have impact at a provincial level, where these problems appear to be no less pressing and complex.
Fifth, ECAP undertook its work as a process of working with Correctional Service Canada so changes the committee sees as necessary would be possible. Importantly, the committee's aim is not to blame anyone. Rather, it is to strengthen efforts by which the health of inmates and staff of federal correctional institutions, and therefore of the public, may be promoted and protected.
Many of these changes, the committee sees, are inevitable, and the sooner they are implemented the better. At the same time, one must not underestimate the complexity of the problems and their potential solutions which HIV/AIDS and drug use in prisons present.
It should be apparent that with regard to the transmission of infections within prisons, the committee saw unsafe sexual activity and unsafe injecting practices as the most serious threats to the health of inmates. ECAP was concerned that as long as consensual activity remains an institutional offence, inmates would be unlikely to take the time to practise sexual activity safely.
Consequently, ECAP recommended that consensual sexual activity should not be considered an activity that would jeopardize the security of the penitentiary and that it should removed from the category of institutional offences. This should not be seen as encouraging sexual activity but rather as discouraging unsafe behaviour.
ECAP saw this recommendation to be an important one. Many Canadians disapproved of it. The Correctional Service of Canada decided it could not implement it, stating that CSC, or the Correctional Service of Canada, disagrees with ECAP's proposal to remove current prohibitions against sexual activity between inmates; that CSC is concerned with the significant legal and security implications of this recommendation in the manipulative environment of correctional facilities; and that the recommendation will at a minimum require more extensive examination before revisions of current policies are considered.
The committee also examined three controversial issues relating to drug use, namely inmates' access to bleach, to sterile injection equipment, and to methadone treatment. The committee recognizes the commitment and the major efforts Correctional Service Canada undertakes to prevent drug use in its institutions. Notwithstanding this, it is unrealistic to presume that drug use in prisons will stop or that drug injecting will cease.
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Consequently, the committee found that the only way to prevent or reduce the transmission of HIV infection and other infectious diseases in prisons by drug injecting would be for inmates to always use clean injection equipment when injecting drugs. While recognizing the difficulties this presents for Correctional Service Canada, ECAP strongly believes that the use of clean injection equipment will not only prevent transmission of HIV infection among drug injectors but will also protect other inmates and staff. There will be fewer infected inmates in institutions and consequently less risk of exposure to HIV.
ECAP recommended making bleach available in prisons. This is consistent with the recommendations of many organizations, including the parliamentary ad hoc committee on AIDS. This response is a public health necessity and it should not be seen as encouraging drug use but again as discouraging unsafe injection behaviour.
Correctional Service Canada's response to this controversial recommendation illustrates just how difficult it is to respond to such recommendations. It will make bleach available in its institutions in order to prevent the transmission of infections by injecting drug use and tattooing as soon as employees agree to the change.
ECAP saw that bleach is a necessary but not a sufficient response to the risk of HIV transmission in prisons. As the committee stated, making sterile injection equipment available in prisons will be inevitable; however, it is not possible to make it available at this time. In part, the reason for this is that making it available would not be acceptable to prison authorities, staff, inmates, or the public. Another reason is that how to make it available in a safe and confidential manner is not known. Research is needed on this issue.
Consequently, the committee recommended that research be undertaken, including a needle distribution pilot project. Correctional Service Canada agreed to undertake research on risk-producing behaviour relating to injection drug use but, perhaps understandably, it has not pilot tested needle distribution in any of its institutions.
Methadone treatment is not available in federal penitentiaries, but worldwide its use is being adopted in a number of prisons. The committee examined this issue not as a means to treat opiate dependency but as a treatment option that would help to reduce injection drug use, thereby reducing the risk of infections from drug injecting. Consequently, the committee recommended that the options for the care and treatment of drug users include access to methadone.
There is a growing appreciation of the dangers of inmates sharing needles. This includes an appreciation that the risk of transmission increases as the prevalence of infection among inmates increases, that a scarcity of needles promotes sharing, and that bleach is not always effective in cleaning injection equipment. Despite this, there is a widespread reluctance to distribute clean needles, and often a counter-reaction of actively searching for and confiscating them.
It is surprising that there should be such resistance to implementing recommendations such as these, which for some inmates will be life saving, when providing condoms to federal inmates and providing bleach to provincial inmates in British Columbia has been so uncontroversial. Moving on such recommendations will require public support, and the support of the subcommittee would be extremely helpful to see that these recommendations are fully and quickly implemented.
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There were also issues that the committee did not address because addressing them was beyond the resources of the committee or its mandate. The committee saw them as extremely important since they underlie, predispose to and often complicate many of the problems that HIV infection and AIDS raise in Canada and its prisons. Among them are drug use outside of prisons, the trust of inmates in health care providers, violence in correctional facilities, and the vulnerability of women and aboriginal inmates. I would like to speak briefly about three such issues.
Firstly, there is an urgent need to address the increasing number of people who are being incarcerated in Canada. This is not only a growing public expense, but it also leads to overcrowding, constrains already scarce resources that are needed to rehabilitate and reintegrate inmates into society, jeopardizes working conditions of correctional staff, and helps to spread HIV infection. I would point out that the annual reports of the Correctional Investigator Canada for 1993 and 1994 reaffirms this. I won't read it out, but it's here in the text if you wish to see it.
In my opinion, one of the important determinants of this problem is drug use outside prisons. For example, a recent editorial in The Globe and Mail pointed this out when discussing cocaine use in Canada. If cocaine isn't inherently dangerous, if it isn't a threat to law and order, why make it a criminal offence? At best, we compound a problem; at worst, we actually create one.
First, we make criminals of those who have committed a victimless offence. Second, we instruct police to find and arrest offenders. Third, we ask courts to try them and we ask the prisons to incarcerate them. At every stage there is a cost to society. We stigmatize people, divert resources from other law enforcement needs, and clog the justice system. Having better or bigger prisons can be considered little more than a band-aid solution for this problem. Correctional Service Canada clearly needs greater resources to meet the problems brought about by an expanding prison population, and importantly, it needs them now.
Over time, the wisest solution for Canada will be to prevent the conditions that lead to imprisonment. Preventing crime, and thus preventing imprisonment, is an investment in Canadians. Ignoring these problems, thereby contributing to them, is a tragic and potentially avoidable expense. Canada does not need more criminals and prisons to hold them. It needs more help for people who might otherwise engage in crime.
This is an immense challenge. One of the ways to meet this challenge, in my opinion, and I suspect in that of many other Canadians, would be for Canada to review and revise its laws and policies relating to drug use. A second way would be to attack the roots of crime, in particular the social context in which disrespect for persons and institutions, including the law, arises.
A second issue is the terrible impact of the stigmatization of, scapegoating of and discrimination against those who are incarcerated. If AIDS has taught us anything, it has taught us again that whether inside or outside prisons stigmatization, scapegoating and discrimination have to be stopped or prevented, and people have to be protected from these reactions. People cannot otherwise respect each other, trust and help each other, or participate in decision-making that affects them.
It is not surprising, therefore, that discourse on AIDS so often includes references to protecting and promoting human rights. AIDS has also shown us that some of the strongest counter-responses to stigmatization, scapegoating and discrimination are advocacy, activism and community support. In it's work, ECAP repeatedly emphasized the importance of inmate peer education and participation to HIV infection and AIDS in prisons.
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Third, all too often social, educational and economic inequity or disadvantage predisposes to poor health, crime and imprisonment. This situation is not unique to Canada, yet it urgently needs to be addressed in Canada, as it does elsewhere.
One example of this impact was shown in a recent study of the survival of people living with AIDS in British Columbia. In the context of prisons, this is perhaps most evident among women and aboriginal inmates. That contemporary social, health, educational and community development programs sometimes fail and people end up incarcerated does not mean these programs are failures; rather, it may indicate that even more has to be done to prevent such failures.
In conclusion, Canada is fortunate that the prevalence of HIV infection in federal correctional institutions is still relatively small. Nevertheless, it is at least ten times higher than that among Canadians in general. AIDS has repeatedly and forcefully shown us that there is no room for delays, inertia or complacency in responding to it. Responding to AIDS in prisons means not only responding within prisons but outside of them, and before and after people are incarcerated.
Much has been done to respond to this threat. Correctional Service Canada deserves recognition for what it has done. Nevertheless, more needs to be done. There must be public recognition and acceptance of the problems brought about by infections in prisons, and the difficult choices necessary to prevent further infections must be made. Rancorous debate, political posturing, and public and private denial or disregard of this risk and responses to it are inexcusable. Most importantly, there must be a climate in Canada in which necessary changes are possible at individual, institutional and public levels.
AIDS has taught us many lessons that are relevant to Canada's prisons. These lessons reinforce this conclusion. There are few, if any, simple solutions or quick fixes. Risk-producing activity is all too often rooted in low self-esteem and vulnerability. Genuine opportunities to act safely are essential. Denial, delays and inertia in responding to these issues are far more costly than acting now, and sustaining safe behaviour is a never-ending challenge.
In closing, through the subcommittee, I ask Parliament to support Correctional Service Canada so that it can and will respond effectively to the threat of infections in its penitentiaries, and so that it has the resources, determination and accountability to decisively respond to this threat.
I also ask you to consider the broader issues that the committee was unable to address and that so often underlie, predispose to and seriously complicate the problem of HIV infection and AIDS in Canadian prisons. Responding to AIDS in prisons, just as outside of prisons, may appear to some people to be controversial, offensive or unpopular, but doing anything less would place the lives of inmates, staff and the public at risk - a risk that is preventable.
Thank you.
The Chairman: Thank you very much, Dr. Gilmore. We're going to start on our questions.
[Translation]
Mr. Ménard, please.
Mr. Ménard (Hochelaga-Maisonneuve): Good morning Mr. Gilmore.
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Is it possible to have a quantitative indication of the number of persons with HIV in our Canadian prisons? At the beginning of our proceedings, Dr. Catherine Hankins has pointed out to this particular problem.
I understand that we have already taken a big step by allowing condoms in Canadian penitentiaries. A second step would be to decriminalize or not to sanction sexual activities between consensual inmates. In your report, you make a difference between consensual inmates and between non-consensual inmates. But I think that you had a few difficulties in the application of this particular recommendation. We will have the opportunity to talk about this with the Correctional Service of Canada whose representatives, as you know, are our next witnesses.
Could you give us some numbers and can you tell us what are the chances to convince the Correctional Service of Canada? How do you explain this reluctance? Could you tell us in concrete terms how inmates can have sexual relations? It is a reality. You seem also to establish a link between the fact that the inmates can be in individual cells and the fact that this implies a certain promiscuity. Give us a better idea in this regard and I'll ask a few more questions afterwards.
[English]
Prof. Gilmore: With regard to your first question about the quantification of the number of inmates who may be infected and the risks of infection inside the prisons, we do not have accurate data on that, just as we do not have it outside of prisons. It's extremely difficult. The concern has been raised that inmates will feel threatened if they are known to be infected with HIV, and this is the same outside. Many people who are infected do not want to express this to others for fear of things like stigmatization and discrimination.
In a closed community such as a prison, it is very difficult to keep information very quiet and confidential. As a result, many people do not want to be tested, so we cannot easily find the information.
Studies have been done in British Columbia and Quebec that give us some indication of the number of people infected. There will be more such studies, I believe, going on and perhaps the commissioner can address more specifically the more recent results. But 1% to 2% of prisoners may well be infected. We don't know the precise number, how quickly this is increasing, or if it is increasing.
The second question you brought up was the difficulty in determining consensual from non-consensual sex within prisons. This is a serious concern and one of the most difficult concerns. The concern, though, of the committee was that if sexual activity is seen to be in any way illegal or illicit within an institution, the inmates would not take the time required to practise sex safely, and this would contribute to the transmission of disease infections. It's not only HIV we have to concern ourselves with but other sexually transmitted diseases as well, including hepatitis.
I don't know a solution for how to tell when sex is truly consensual and when it is non-consensual, or forced in any way. This is a problem outside of prisons as well. I expect within the environment of the prisons people become familiar enough to be able to see this at times, but to develop policy on it is an extremely difficult issue.
Our concern, though, was that if this were not to happen, we would see further transmission of HIV, and this was the least harmful way to go about it. There may be a risk of non-consensual sex occurring, but it would be balanced, hopefully, by less infection because people would be practising safer sex all the time.
The question about why it is so difficult to move on this could be illustrated in three ways. First, we have to recognize the political reality that people do not look nicely upon many prisoners or inmates.
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Second, when we put forward a working paper there was discussion in the press about safer sexual activity among inmates. The Solicitor General received correspondence based on this showing striking disapproval. To my knowledge, most of the people who wrote to the Solicitor General did not have access to the working paper we had produced.
However, the committee sent out almost 1,000 copies of the working paper and the replies we received were positive, for the most part. These people had read the report and understood the logic behind what we were saying.
So we have a political dimension in which it is seen to be very difficult to move. That's why I was referring in my talk today about the need to support Correctional Service of Canada in a strong and public way, so it would have the power to move forward.
I think the third point is the microcosm of the prisons themselves, including the staff, prisoners, administration, and the public outside. One has to be very cautious that this does not lead to difficulties in labour relations, and difficulties and concern in running the prisons. So there has to be a natural political process within the microcosm of moving things forward. That is a difficult and real problem that the commission could perhaps address as well.
How can we just move this forward faster? I don't have a simple answer to that, but I could suggest that public support, demands for further action, and accountability on movement of things that are happening would be very helpful. Hopefully, public disapproval would not be able to withstand the political will to see this done.
Finally, you asked why there was sexual activity among prisoners and what could be done to deal with that in general terms. That's very difficult. People are incarcerated. We have family visiting privileges, which are used as an incentive for good behaviour in the prison system. But at the same time, I guess it's human nature. People want sex when they want it and however they can get it, and we do find there will be sex between prisoners.
I must say, I found the activities of the Solicitor General in response to AIDS to be very courageous. To just announce and impose upon the prisons that condoms would be available is wonderful. The subsequent actions of the Correctional Service Canada in the committee has brought this issue forward, so people are now talking about it and starting to address these issues. I think we will see a healthier sexuality in the prisons as a result of all of this.
[Translation]
Mr. Ménard: Obviously, I am having some difficulty understanding this. We're making condoms available, but we know that most of the time condoms have very little to do with self-eroticism. Being a condom user myself, I believe I understand human reality and one might think that the next step would be taken quite naturally.
You seem in favour of introducing a needle exchange program in the penitentiaries, a program similar to what we have in some communities. At that level the results seem to be quite disappointing. Presently, it is impossible to get unsoiled material inside our establishments and there is absolutely no control.
Before our Chairman gives the floor to someone else, I have two questions for you. How do you go about evaluating all this matter of needles and access to clean equipment? If you had to rate your satisfaction with A, B, C, D or E, as they do at UQAM, as to the follow up on the recommendations made by the Correctional Service, what grade would you award, and why?
[English]
Prof. Gilmore: That's a difficult question but I'll be happy to try to answer it.
[Translation]
Mr. Ménard: I know you can answer.
[English]
The Chairman: You could say B plus.
[Translation]
Mr. Ménard: Or less.
[English]
Prof. Gilmore: Maybe I could say an incomplete grade and we'll go back to the next opportunity.
First, about the access to needles and syringes, personally - and I think it's reflected in the committee's statement - we recognize the reality that making needles and syringes available in the prisons would probably be unacceptable in Canada. The question is how can we move this process forward? We recommended things like research and pilot projects in slowly moving this forward.
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The second is that, in my own opinion, it's a very important issue. First, you will hear that the Correctional Service is trying to address in a firmer, stronger way the problem of drug use itself in prisons. That will help if people aren't using drugs. But as long as people are sharing, there is this risk of infections, and the fewer needles there are around, the more people will have to share them, because they do not have their own.
I think over the next year or two you will see more and more movement in prisons in other countries to try to make needles and syringes available.
In my own way, I would like to see Canada take the leadership in the action to see this done. It is not in any way saying that we approve of drug use. It is not saying that we approve of injecting drugs. Rather, it's saying that if people are going to do this, then they'd better do it safely.
This is exactly what is going on outside of prisons, and we have a great difficulty. People outside of prisons have access to needles. They go into prison and they don't have access. They go back out.
It is a difficult problem because it sounds as if we're sending all the wrong messages to people: that we can't control drug use in the prison, that the drug use is going to go on, that we can't outlaw needles and syringes, and so on. But the reality of it is that as long as it does go on, we're going to have problems.
So I would much prefer to see us come to the reality that we have had to do on the streets across the Canada, to say you can get needles and syringes easily. Let's face it. Let's try to convince these people they don't need to use needles and syringes. They may not need to use drugs. That's where the emphasis needs to go. In the meantime, let's not let this become the problem we have to deal with.
In rating satisfaction, I would say a B or a B plus. Many of the recommendations they have moved on very well. In those I would give them As. You will hear a report that says this.
Some of the recommendations we made, such as those relating to sexual activity, needles and syringes, they have not been able to move on. I am not blaming anyone here. Please understand. We want to try to encourage the cooperation of everybody to get them to move forward further, and that's very important. But they haven't done well on those. We understand that and we recognize it. We're pushing. We hope that they'll be pushed and in turn we'll move.
So I guess that overall they deserve a good solid B plus maybe. I'm happy with many of the things. You'll see documents. You will see directions going inside the prisons. You will see things such as prisoners being educated about how to be peer counsellors and health promoters in the prisons. In documents, you will see the testing issue being slowly resolved, confidentiality issues being resolved. A lot of good things are going on. The momentum is building, and this is very good.
The question is, can we continue it and sustain it and can we make sure that the resources are there, the support is there for it?
Ms Bridgman (Surrey North): Thank you for your presentation. My apologies for being a bit late.
It almost sounds like something that could be happening in a community somewhere. The same kinds of needs are there. Yet we're talking about prisons. I'm not very familiar with this environment. It's there. If you do something wrong, then you go to prison. I really don't know the process when one is in there. It sounds to me as if there's certain degree of freedom in which people have access to belongings; i.e., needles or drugs or whatever.
I really get a bit shaky when I hear your comment about it being unrealistic to presume that drug use in prisons will be stopped. This is a controlled environment. This is a place where theoretically we're supposed to be sending people who cannot cope with society, for whatever reasons, etc. Then they give us an excuse to incarcerate them.
I have troubles with the unrealistic aspect. I have lost hope here in some way. I would like to see that it's realistic to assume this, but it's going to be very difficult, in making a direction that way, to not condone or even to imply that drug use is something we will tolerate.
On the other hand, it's like a threat to me. I'm hearing: ``If you don't provide me with the correct needles, then you're going to get infected, or I'll infect somebody when I get out''. I don't like being put in that position.
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What percentage numbers are we talking about in the prison population that are actually involved in drug taking? Is there anything we can do to control this, other than band-aiding it as we go along with supplying the needles or the bleach or whatever?
Prof. Gilmore: The first one is that there are statistics available as to the estimates of the numbers of people who may use drugs. I couldn't quote them to you right now, but I think we could get them for you if you wish. Perhaps the commissioner may have access to them here and his staff may have them, but that's just the quantitative point.
Ms Bridgman: Could you just give me an idea? Are they big numbers, big percentages?
Prof. Gilmore: It's very difficult to know. I'm being very clear here; what I'm really referring to here would be injection drug use, but there are different ways of taking drugs. You can take them by mouth, you can inhale them, smoke them, various things, but shooting up is the major concern we have here. I'm not certain of the precise numbers.
Again, to get the answer to whether this is an accurate number, you would have to be inside the prisons and probably monitoring this all the time, but we've heard at times that there are as many as twenty prisoners who would share the same needle on a weekend, that type of situation. So I'm not sure of the precise numbers.
As to the idea of the unrealistic part of it, I would say that the way to look at this and the way we came to that conclusion was to say that yes, prisons could be made drug-free, that prisoners could never use drugs in certain environments. But the trouble would be that the security and the effort involved in that would be so stringent that anyone going into the prisons would have to be thoroughly searched, that any packages getting in would have to be thoroughly searched, single rooming of prisoners perhaps, thorough searches of their quarters all the time, so that any needles and syringes would be found all the time and so on.
The difficulty with that is it would be very difficult to try to rationalize that process with attempts to try to rehabilitate people so that they can get out of prison and back into society. That's the difficulty, the balancing of it. How can you run a prison that would allow people to be rehabilitated and reintegrated into society and certainly to have their esteem and so on and at the same time keep it totally drug-free?
There is a variety of approaches. Drug testing is one of them, for instance. Education programs are going forward about this and when people are brought into the prison they are counselled and educated about drug use.
There is the politics within the prisons themselves. Drugs and so on are a commodity and people will sell them for power, for money, for other resources. That is being addressed very strongly and firmly by Correctional Service.
So you have to balance out the realities of trying to live a more normal life inside a prison so that people will be able to progress towards being released from prison and the difficulties then that drugs and so on can slip into prisons. I think the difficulty is trying to reach a balance in which you can have incentives for people to get out prison and stay out against having no drugs in prison. That's the difficulty.
We saw that it would be very unlikely that this would occur now because the balance is that drugs could get into prisons despite the hard work of trying to keep them out and so on.
The second one is that, the same as outside of prisons, we have to look at the reasons people use drugs. We don't fully understand. Alcohol, tobacco, cocaine, heroin, all of these things fit into that same category. We can't figure out the best ways to stop people from using them outside of prisons and so we still have that problem inside, particularly when you have people in there for long periods of time. They may see themselves as being bored, frustrated, and so on, and this is an opportunity perhaps to have different experiences than they would have.
There's a variety of reasons, and the other side of it that we have to see is that the drive to use drugs may be there very strongly at times.
Ms Bridgman: Thank you. I still have this reservation in my mind that since it is a prison, for example, I really don't have too much of a problem with suggesting that you don't get a choice when you go. You may have a choice when you're within society, the programs are available and such, but when I violate society in some way that I have to go to prison, I don't get a choice any more. That's how I will leave it.
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Prof. Gilmore: I understand. That's one of the reasons why I tried to address the bigger issue of how we prevent so many people going to prison. That's the major one. If we didn't have people in prisons, we wouldn't have the problem. That is certainly, I think, a very important issue. It's one that we felt we couldn't address; it's so big that it goes far beyond us.
The other issue, of course, is how do we address the drug issue in general? That, I think, is one of the very serious problems. I don't think it's simply by saying we have stronger laws to force things along that the problem will be solved. I think we have learned over the years that if we can enlist the cooperation of people to do the right things, great progress is made. The way to go is to give people a sense of the value and the power of drug-free life, a life in which they don't need these things and can get on better without them or, if they're going to use them, they use them in such a harmless way that they're not harming themselves or others.
I think it's one of the very important lessons we have learned from AIDS. There are ways and possibilities if you empower people. If you give them the strength to make good decisions, give them the opportunities, maybe they'll do the right thing.
Ms Bridgman: Thank you very much.
[Translation]
The Acting Chairman (Mr. Ménard): Thank you. We have two questioners on the government's side, Mr. Culbert and Ms Fry.
Mr. Culbert (Carleton - Charlotte): Thank you, Mr. Chairman.
[English]
Good afternoon, Mr. Gilmore.
I guess I have some philosophical problems with what you've been saying. I suspect you, like me and I believe everyone here, would agree that the HIV/AIDS virus is a very serious infection and one that can indeed end in death. I strongly believe that people do have to take some responsibility for their own actions in addition to whatever we as a society may demand legally or morally. I guess I have some real hang-ups about the suggestion that proper or sterilized needles, syringes and so on be made available, I assume at the cost of taxpayers.
The other part I want to follow up with - and I can understand what you're saying in terms of an end result - is that in your recommendations regarding the institutions you're basically saying that testing should be voluntary, with the express consent of the inmate. I also see that there is concern among the prison workers who wish to have that information provided to them since it is a very harmful infectious disease that indeed can cause death to them. So I can understand their concerns as well.
Then when move into your recommendations you are also talking about confidentiality. You might want to touch on that from the perspective of your expert team that was put together to bring this report forward. I take it from reading your notes that in many cases you have examples showing that confidentiality was not there in the past and you don't see any possibility of it being there in the future. Therefore, if the testing is done, it's going to be out there in the prison population and therefore it puts the person in danger.
I would completely concur with your last comment about education - education before a person may need it in prison, an education out there for everyone. Do you have any suggestions, ideas or input on that? I'm sure everyone here is all ears on how to address that, how it could be done better or differently.
So there are quite a number of things, Mr. Gilmore, but perhaps you could touch on them.
[Translation]
The Acting Chairman (Mr. Ménard): Would you ask a question from the witness so that we can hear the Commissioner? We are already quite late and I would like to give some time to Ms Fry.
.1620
[English]
Ms Fry (Vancouver Centre): I just wanted to congratulate you if you were done. But I'm sorry, you're not finished.
Prof. Gilmore: I'll be very brief.
The first thing is I don't know what really works for education. I think primary school...from birth upwards, we're still searching things out. Kids in school, people in prison, in the workplace: it doesn't matter...the big issue. I do think, though, what we saw was when we educate people we have to give them an opportunity to act appropriately. They have to have realistic opportunities to do the right thing. That's very important.
The second thing is that the confidentiality issue and the question about, for instance, whether staff need to know is a very important issue. We tried to address that not only in the report but in the longer document in the background papers to the report.
As Mr. Yeomans, the former commissioner of the Correctional Service, likes to say, detection is not protection. You sometimes know people are infected, but when you don't know you still have to make the assumption that everyone is infected. This goes on in the hospitals, for instance. It goes on now in the Correctional Service as well. You just assume everyone is infected. Therefore you are taking the appropriate precautions all the time.
It's the same message we give when we talk about safer sex, safer drug use. You always assume your partner is infected. Therefore you do the right things. If you say only I know this person is infected, I'll take precautions here, but I won't do it over here, because I don't know or I don't believe or something, you run into problems.
The basic idea is that underneath that confidentiality, from the inmate's point of view, was a deterrent to being tested. It was a deterrent to going forward and seeking counselling and help. So what we wanted to do was see stronger respect for confidentiality so people would feel they could go forward to the health care system, could go forward for counselling, could go forward for testing or whatever other purpose they needed, without fear of being discriminated against, disadvantaged in any way, or feeling threatened. It is their perception. They live in that world where there is a fear. It's not that confidentiality isn't strong, but they live in that fear that it might not be there. So we don't see it.
What we're trying to do in most of our efforts is to get people to do the right thing. So we tried to make recommendations that would see that happen.
I hope that answers the issue. But the bottom line is that people, when they have more and more experience - and that was certainly our experience as we went around the prisons - when there was more and more awareness of AIDS, more experience with it, people relaxed. They learned how to work in that environment of dealing with it.
For instance, a very good example was in Kingston. One prisoner there was widely known to be infected. Everybody was protective of him. They knew he had the virus and he was liable to get sick at some point and needed extra help.
We see the same thing in the health care system. The first patient comes in and everybody wants to run away. We've heard of cases of discrimination and refusal of care and so on. But today in most institutions where there are plenty of patients around...let's get on with it, let's get you the care you need, let's get you the support you need, let's get you the help you need. Everybody learns how to put on their gloves, take care of themselves, protect themselves appropriately, but - importantly - such that they can give the care and service and so on that need to be given.
Mr. Culbert: I guess where I have difficulty with it is the perception that the individual obviously has wronged society, according to our laws, in order to be in the institution to start with. I guess it's my personal feeling that some of those rights were perhaps given up when that wrong was done, because as I said before, we all have to take some responsibility for our actions.
Prof. Gilmore: If I could go back and say it in a different way, sir, perhaps it's the old argument of spare the rod and spoil the child, as one side. But the other part of it we probably all around this room know is that in regimes which are too disciplinary people rebel, they hide, they refuse, and so on. So the question we're doing is how do you get people to cooperate? It's a balancing act.
It's the same thing with responding to drugs in prison. You can clamp down on almost any situation you want. But you may lose and find it's counter-productive in the end. Rather, I would like to see it - and I think so many people with AIDS have learned this...if you give people their self-esteem, their respect, and say, you're a good person, do the right things, I think you'd see that happening.
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Ms Fry: Thank you. Professor Gilmore, nice to see you again.
Prof. Gilmore: Thank you.
Ms Fry: I want to congratulate you on your report. I think it's an excellent report. I think it has been a long time since these things have needed to be talked about, and it has been a long time coming. I know Dr. Roy, who is at the back of the room, has been fighting for this for many, many years.
But there is one thing I don't think you addressed in the report that is specific to the work of this committee and that I wanted to ask you about. What did you find out, and can you tell me anything about discrimination within the prison population itself of those who are HIV positive and of those who are in a high-risk category? Is there a great deal of discrimination amongst inmates, and how do you think one can deal with that, understanding confidentiality?
Prof. Gilmore: I understand. There is some reference, not necessarily very quantitative, to it in the report. We have, for instance, the report of one of the inmates who spoke in British Columbia at the B.C. AIDS conference and expressed some of the things, and we went around and met other inmates who also expressed this.
The problem with it is, just as outside, how do you actually get some estimation of how much and how severe it is? I imagine the human rights commissioner would have the same problem trying to express to you. We know things happen, but to get them in such a formal way that we can quantify them is difficult. That's the first point.
The second one is, we do recognize, though, that people perceive this to be a problem inside, and they are acting as if that does occur and does occur frequently. That was one of the things we repeatedly heard, that people were afraid to go forward and talk about things.
The third one, I think, is that yes, probably a variety of incidents have happened that could be found or talked about or discussed, and so on. The difficulty, though, as again outside of prisons, is that when one complains that they have been discriminated against or they've been put down in some way, this requires a certain, as it were, strength to go forward and say that and seek out some way to redress or correct that problem. This in turn is an admission that they have a problem. Others will then know more about it, and it puts them at greater risk. So you have this awful circularity, exactly, that when you try to defend your rights you make yourself more vulnerable, and it's a very difficult issue.
But certainly, I think, this is the reality of the world the people live in. They see discrimination as a problem. They see it as they cannot trust and that they are afraid to go forward, and this is what we were trying to address - to change the entire milieu of the environment, as has had to occur outside of prisons, particularly in communities such as the gay community, amongst prostituted women, amongst youth and homeless people, the drug users. You have to get them to trust you, get them to come forward and see that it's better for them somehow or other to behave appropriately, to act appropriately, to see themselves as persons.
Ms Fry: You said that very well in that qualitative part of the thing. What I really wanted to know is whether there is any quantitative assessment on whether that discrimination is greater or less in a prison population, or equal to the ones in the population outside.
Prof. Gilmore: I would say it's greater, but the difficulty is that I'm not sure I could substantiate that with factual information at the moment. But my impression would be, and I think the committee would go along with that, that it probably is greater. You have a group of people who are in prison, more often than not because of things like violence and breaking the law, and so on. So you have that to start with. It's a tougher world of people out there.
The second is that you have a very closed community in which power relationships get more focused, amplified, magnified between, for instance, prisoners, staff, administration, and so on, and that can lead very quickly....
I think the third one is that this implies behaviour that sometimes may not be easily accepted by some parts of the prison, and we have to recognize that - sex between men, sex between women, use of drugs, injecting drugs, and so on. So we have all of those aspects of it that I think fit in.
So my feeling would be that, yes, it's much greater because you simply can't leave and find new neighbours, new friends around, and you can't hide. It's like living in a very small town and, say, being gay, or being engaged in prostitution, or using drugs, and people hear about it. We know there's likely to be problems. It's too small a community. That's why I would say it's greater. But again, I have no facts.
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[Translation]
The Acting Chairman (Mr. Ménard): Thank you. Mrs. Ur wishes to have the floor. Go ahead.
[English]
Mrs. Ur (Lambton - Middlesex): Thank you, Mr. Chair.
Is the education program within the prisons readily accepted by the inmates? Are they willing to participate?
I like to think I'm optimistic and not pessimistic. If we cannot make progressive steps in education and prevention in such a concentrated environment within the prisons, I think we've lost the battle.
In part of your statement you said the climate in Canada was not proper to make the necessary changes. Could you expand on that as well?
Prof. Gilmore: Yes. With the last point, let me turn it around. I wasn't so much saying that the climate was not proper, but rather that we must ensure the climate is there to allow the changes that need to be made.
Mrs. Ur: What is the climate?
Prof. Gilmore: The climate would be one where if Correctional Services see if something is the most beneficial thing for prisoners, staff and the public, Correctional Services can do it, whether that would be needles and syringes, sex education, condoms, more after-care, anonymous testing within the prison system, and whatever they may decide. I just want to make sure this is the type of thing, and that, for instance, all the recommendations we've made could be carried out.
Some of these things may be seen to be very unpopular. They may be seen to be unnecessary. I think we've heard discussion here today about some of them. That's the climate I want. It's a supported climate. It's a climate that says, you people got advice, you people have the expertise, and you people have the opportunities now to do the right things. So there's that side.
By the way, this applies equally outside of prisons, where we've recognized that putting needles and syringes out there - again at public expense - for people to use is preventing infections. It's costing the health care system less. There are fewer people who are going to be sick, suffering and dying because of it. We'll have fewer transmissions to the sexual partners of drug users. There are benefits to be seen for every investment we make.
Now I'll go to that next step and say that the climate needs to be one where action, not negotiation, is the word. We're seeing this. Not to bring up something that is now before a commission and perhaps many cases in the courts, but a good example is the concern and the scrutiny we're seeing about whether blood was screened early enough in Canada. The question we come back to is whether enough was done soon enough, actively enough, and dynamically enough. Whether we like it or not, did we act quickly enough? Otherwise the consequences can be seen as tragic or devastating or extremely costly.
One of the things I think we have certainly learned through AIDS is that acting quickly now is important, though I would want to make sure that climate is there for people, not so much to seek out tremendous consensus and negotiation or permission or to have to face political furore and so on, but rather to say these are problems that we know we need to get on with, let us get on with them, and let's address the bigger issues outside that because we'll have the resources to do it.
Mrs. Ur: You can provide all the climate you want. If there isn't a willingness to change your lifestyle....
Prof. Gilmore: I think we recognize that. Just being incarcerated is an example of an almost in-state problem.
I think we certainly saw that the problem has to be addressed and dealt with in the prisons. It's as if your house is on fire and you need a fire department. There is no way around that. The bigger thing is that it would be much nicer if we could prevent the fires from happening. That is the real challenge that is posed, not only by AIDS but by the need for and existence of Correctional Services. Undoubtedly, we will always have - I hate to say this - people who will need to be in prison. I guess that's human nature, unfortunately. We probably will.
To go a little bit further, the question is what can we do to make that problem smaller? How can we make Canada have people who respect the law, respect the institutions, and respect each other, so that we don't have the crime? That is the real challenge.
I think it does go right back to the fundamental views of what we are talking about with education. How do we educate our children? It may well be something where we will not see success today or tomorrow for what we're doing now; it may be years from now.
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One of the concerns I personally have is that as we start the change in modifying our social net, which includes economics and social and health support systems in Canada, are we going to see the consequences of that not now, not next year, but 10 or 20 or 30 years from now? It's a very difficult problem.
Turned around, if we start to try to change people and we can have success at times, I do believe - and I want to leave the subcommittee with this - that there have been changes in the correctional services because of all of the activities of Correctional Services Canada and the committee. We want to make sure that they continue and momentum builds and grows just the same. Education may not change very many people. For every one it does change, that's great; but we have to keep trying, because the alternative is terrible. That's the difficulty.
[Translation]
The Acting Chairman (Mr. Ménard): One last question from the majority, if Ms Bridgeman agrees. Ms Augustine, please.
[English]
Ms Augustine (Etobicoke - Lakeshore): Dr. Gilmore, I'm not a usual member of the committee - I'm sitting in today for a regular member - but I want to compliment you on the thrust of the report and also to say to you that looking to prevention and education as the way forward is really the way in which we have to go.
We need to work also on society's view of the inmate and what we need to do with the inmate we have in our hands for x amount of time. The whole issue of rehabilitation and a series of other things come to mind as I listen to your presentation.
I want to ask something that may or may not have been part of your mandate. Did you see any connection between the communicable diseases, like TB and a whole series of other things, and HIV? Was there anything in that?
Prof. Gilmore: Yes. We really focused on HIV, because that was, we saw, the instrument to make change, if possible. A lot of the things you do for HIV you will do for all the other diseases that can be transmitted by sex or by injections or tattooing and things like that. That would include things like hepatitis.
The other one was that we did address the issue of tuberculosis, recognizing that there was already a very good program and policy in place in Correctional Service Canada for this. We recognized that that is a serious concern outside of prisons and it could be a very serious concern inside them.
The general approach was that we were looking at the health of people, which included not only specific infections but also the conditions that led to those that predisposed to them or permitted them to happen. So we really were trying to develop a general health promotion approach that would help protect health and promote health as well.
Every time one sits down and talks about HIV or AIDS, or you talk about tuberculosis or hepatitis, the messages come closer and closer. Care, caution - health promotion messages are continuously going out there, and that there's a health care system that's trying to do a job for you and help you.
You can't really separate one from the other. We didn't see any that really stood out separately. If today I was going to go back and try to do the whole thing again, it might be wiser to broaden it to include all infections. However, the immediate issue we wanted to address was that of HIV, because it's the difficult case, the strong point that needed to be addressed.
[Translation]
The Acting Chairman (Mr. Ménard): This ends the first round. I would now like to thank you in the name of the Committee members for having been with us.
I shall now ask our second witness to come forward, the Commissioner for Correctional Services Canada, Mr. John Edwards.
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Mr. Commissioner, I would now invite you to introduce the people who are with you. We had thought we would reserve some 10 to 15 minutes for your initial presentation and then go on to questions from members of the Committee.
Mr. John Edwards (Commissioner, Correctional Services Canada): Thank you,Mr. Chairman.
[English]
I would like to introduce my colleagues at the table. Dr. Jacques Roy is our corporate advisor on inmate health care; Anne Malo is an expert on AIDS who's been seconded to us from Health Canada and has been working with us for six months; and Irving Kulik is the deputy commissioner for the Ontario region. If there are questions that directly relate to implementation, he is responsible for our largest region, and as a result he should be able to help us share information with you.
In my opening remarks I would like to provide you with a brief overview and perspective on the Correctional Service Canada, from there move on to describe the kind of health care system we have in place now, and then direct some comments specifically to the issue of HIV infection and AIDS within our institutions. This will cover the action we've taken to date - I'll try not to duplicate what Dr. Gilmore has said - and what action we will be taking over the coming months.
Ours is one of the few prison services in the world that is responsible for offenders from the time they receive a sentence to the time their sentence expires. Most services elsewhere have splits in that one part has the parole side and another part has the incarceration side and basically is publicly accountable for the activities related to offenders or the actions by offenders during the time of their sentence.
I don't think it would be an exaggeration, Mr. Chairman, to say that we are seen internationally as being one of the best correction services in the world, partly for the humane policies we have, partly for the quality of our programs, partly for the tools we use in risk assessment, and I should also add for the training of our staff. Our staff correctional officers receive more training than almost any other prison service in the world at the front end, where they get eleven or twelve weeks of intensive training.
As I've indicated already, our basic business is risk management. How do you handle offenders who have broken serious laws and committed serious offences in ways that keep them safe from each other and keep the public safe from their actions as they come in contact with the public?
We have about 23,000 offenders under our jurisdiction. About 14,000 are inside our penitentiaries at various levels of security, and the balance, about 9,000, are out in the community under supervision.
I would like to stress to you the reality of our offender population. They generally are from the marginal side of our society and most have already experienced long periods of alienation and failure. Few have much reason to be optimistic about the future. Most have not held regular employment and the majority are school drop-outs; 65% were functionally illiterate when they came into our institutions after their conviction; that is, they function at or below the grade eight level in both reading and numeracy.
The lifestyles they have led are rarely healthy and often include drug abuse and tattooing; 70% had a substance abuse problem in their past. Indeed, 50% were under the influence at the time of the offence for which they've been sent to prison. Nearly one in ten has suffered from a serious mental disorder.
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Some of them view coming into our prisons as the end of the line, but most see it as an opportunity for a new beginning, one by which they can come out in due course to live a useful life, whatever that means by their estimation. Almost all of them will indeed come out. Eighty percent of our inmates are serving sentences of fixed length, and many of those who are serving indeterminate lengths, such as our lifers, will at some stage be granted a parole condition. Our challenge is to help them become able to return into their communities without a failure after that return.
Since it's relevant to the discussion of AIDS, the fact that our prisons are getting increasingly overcrowded is also a fact that should be shared. We are seeing a large increase in our population, far larger year by year now than we have experienced historically.
I might add in parentheses that I wholeheartedly agree with the general thrust of Dr. Gilmore's comments about the need to examine whether all those people need to be in prison. It is far from obvious to us, as correctional professionals, that non-violent offenders are necessarily best handled through intervention via incarceration rather than through some other program of correction within the community.
Partly stimulated by the ECAP report, much has been said in the past year about the problem of drug use and drug trafficking in federal penitentiaries. There is no doubt that the level of drug abuse among federal offenders is too high. Since we have within our federal prisons some of the biggest drug traffickers, as well as large numbers of drug users, we really shouldn't be too surprised that the drug traffickers will continue to try to ply their trade.
Most people also find it odd that drugs would be available in a prison environment, but the exchange and availability of contraband articles in penitentiary is as old as penitentiaries themselves. More so, today's prisons are not the isolated, enclosed institutions of the past. Many people enter our prisons each and every day - tradespeople, suppliers, friends, relatives, and families of the inmates, as well as countless volunteers who assist in delivering programs and services. Moreover, inmates themselves have access to the community through temporary absences and work releases.
As is the case within society as a whole, drug abuse in federal prisons has existed for a long time. While we've only recently begun to get useful data, we suspect the drug problem has grown significantly in recent years in terms of the amount and types of drugs and the impact this has been having.
The existence of drugs in prison has serious consequences. It endangers the users, obviously, through overdoses or the spread of infectious diseases. It also endangers other inmates through incidents such as assault. It endangers staff - it's much more difficult to handle someone who is under drugs or under certain kinds of drugs than would otherwise be the case - and it undermines a lot of our rehabilitation efforts. People with mind-altering drugs are not exactly focusing on rehabilitation to the extent we would like.
Last year we launched a national drug strategy that focused our efforts on more effective detection, deterrence and treatment of drug abuse. The measures we have taken are, we believe, having widespread impacts. Staff are clearly supportive of this initiative. They now have the kinds of tools they need to bring down what they recognize as being too high a level of drug abuse.
We have strengthened our screening and search procedures of visitors. We have taken cooperative action with the local police and the RCMP. Sanctions, such as the removal or restriction of visiting privileges, are beginning to have an impact. New types of technology to screen and test for drug use are being pilot-tested in various institutions.
During the past year, we've also had two favourable decisions from British Columbia appeal courts supporting the use of random urinalysis testing of inmates. This is of fundamental importance. It is not enough for us to count by observation those we find to be under the influence. We need to know the actual incidence through the inmate population, and the way to do that is by scientific random sampling.
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In visits to institutions, it's important to note that a significant number of inmates themselves have told us they have seen a marked impact and have expressed relief that the threats and strong-arm methods of the prison drug culture are starting to disappear.
I certainly do not want to leave the impression the drug problem has disappeared entirely. It most certainly has not. It is perhaps unlikely it will ever completely disappear. But we're making it more difficult, and judging from experience in other jurisdictions that have followed a similar approach to what we are doing now, we can expect to see a substantial decline in drug use over the coming months.
Let me turn now to health care in federal institutions.
[Translation]
Health services for offenders in federal institutions are comparable to what one would find in the community. We not only provide essential health services, but also health promotion and disease prevention.
For example, we have implemented a no smoking policy in the public and common areas of our institutions. At the request of inmates themselves, some institutions have declared entire cell blocks non-smoking. This policy becomes even more important in light of scientific evidence now emerging that the chemicals in cigarette smoke are capable of boosting the genetic activity of HIV, accelerating its progression to AIDS.
Nursing staff however are available in the health care centres of most institutions. Specialists such as physicians, optometrists, psychiatrists and dentists are retained under contract.
A limited number of in-patient beds are available for short term care. When more complex diagnostic or treatment procedures are required, committee medical services are used. Emergency health services are also available from local hospitals to respond to sudden injury or illness. Many staff members are trained as well in first aid and resuscitation.
CSC has treatment centres in Kingston and Dorchester as well as regional psychiatric or health care centres in Abbottsford B.C. and Saskatoon Saskatchewan. In Quebec, the service has a contract with the Pinel Institute.
[English]
Let me turn now to HIV and AIDS specifically.
We do not know with certainty the full extent of HIV infection and AIDS in the inmate population. We do know, however, the number of reported cases within our facilities has increased from 14 in 1988 to 128 at the end of February 1995. We do not know how much of this increase is better reporting or a rising number of cases. Of these 128, 14 are known AIDS cases.
We also do not know with certainty just how much HIV transmission is actually occurring in our institutions because of inmates' risk-taking behaviours; that is, needle sharing, tattooing, and unprotected sex. We do not know what proportion of inmates with HIV came into prison already affected.
We do know, as Dr. Gilmore has mentioned, that for reported cases, about 1% of inmates have tested positive for HIV or AIDS, and this rate is 10 times higher than that of the general population. On the other hand, the inmate population is not representative of the general population.
Given, as I said at the outset, that most of our inmates will eventually be returned to the community, the consequences of high-risk behaviours within the institutions which contribute to the spread of HIV and AIDS will eventually have impact on the community at large. CSC therefore has, and recognizes it has, a serious public health responsibility. Steps taken to protect against AIDS will ultimately protect the general public.
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We believe we have been in the forefront on this among prison services in developing and implementing educational programs and other preventive measures. We have educational programs for inmates dealing with HIV and AIDS and high-risk behaviours. These continue to be developed and upgraded. I have a number of examples of videos on finding out what you need to know about immuno-deficiency virus, serological testing, and alcohol, drugs, and personal choices. There is a whole variety of educational tools. It is important to stress that in Dr. Gilmore's report, it is said the most important thing is education: reaching out with hard information to help offenders avoid high-risk behaviours.
As has already been mentioned, condoms have been distributed in our prisons since January 1992 - and again, I agree with Dr. Gilmore - without any serious side-effects. They have been used on occasion for smuggling, but I think it is a minor part of the smuggling business.
About staff training, teaching our own staff to recognize problems and use universal precautions has been another priority with us. HIV testing, including pre-test and post-test counselling, is offered to all inmates at reception and on request at any time during their incarceration. I want to come back to anonymous testing in a moment.
We think we have pretty good links with community groups and outside experts to help us do what we can in the area of promoting good behaviours. On a monthly basis, we monitor our statistics on HIV and AIDS. A report comes across my desk once a month - in fact, it comes across on the screen, on our E-mail - telling me what has happened in the previous month. So we're able to monitor at the regional level and at the overall national level.
As I have mentioned, we're also monitoring actual drug use through urinalysis. What's slightly encouraging but very premature at this stage is that the most recent data suggest a decline in positive tests, particularly at the minimum security level, where there's greater freedom but where there are also more privileges to lose: people who abuse can end up in medium or maximum security.
Most of the drug use is not hard drugs in the sense in which we normally refer to them. Most of it is hashish and marijuana, and there is quite a bit in the way of prescription-type drugs such as Valium. So the amount of syringe use, we suspect, is not as high as some would believe. But again, I want to make some comments on how we can find out more about that.
Dr. Gilmore started to explore with you the issues surrounding the spread of HIV and AIDS in the correctional environment, and they are indeed complex. They cover a variety of issues: medical issues, legal issues, moral issues, and issues of confidentiality, of security, and of treatment.
While many public health professionals are inclined to stress the paramountcy of health over security considerations, many in the general public find it very difficult to accept any steps that would seem to condone illegal or inappropriate behaviour. Others have argued that we need mandatory testing and isolation of those afflicted.
It's in that kind of context that we called upon the expert committee to do its study and offer us more informed advice than we had at that time. To be brief, most of the recommendations that came forward we have supported. Indeed, some of the recommendations endorsed steps we had been following at that time.
There were three areas - and they've been mentioned by Dr. Gilmore, and the committee may want to pursue them with me and with my colleagues - that we have not accepted. One is the issue of consensual sexual activity. I might add that at this moment we believe there is not a lot of sexual assault within prisons. We have a study from Professor Cooley in 1993, a study of victimization of inmates by inmates, that shows the numbers of sexual assaults are probably quite low. There are much higher rates of normal physical assault, theft of belongings, and this kind of thing.
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We are not providing methadone maintenance programs - you may want to pursue with us the arguments against that - and we have not agreed to establish a needle exchange program.
There is a rumour, but I cannot pin it down exactly, that there is one prison in the western world that has a needle exchange, one in Switzerland. I've heard it as a rumour. I do not have any facts on it, but to our knowledge that's the only one about which even such a rumour exists. Most prisons have some very built-in resistance to needle exchanges, and Dr. Gilmore touched on that.
We have been launching a pilot test to explore the implications of distributing bleach for sterilizing syringes used for drugs or tattoos. Many, including our own staff, see this as a contradiction to our zero-tolerance drug strategy, and some of that has been touched on withDr. Gilmore.
On the bleach distribution, we are inclined to go to a general implementation, given that some jurisdictions, particularly British Columbia, seem now to have had about 18 months' experience with a bleach distribution program without seemingly adverse side-effects. So we may not wait for the end of the pilot at Matsqui Institution, but rather move on a more general basis. However, before we do so, we are going to have to assure our own staff that liquid bleach will not be used as a weapon against them.
If you've watched or read the media in the last week since I appeared before the justice committee, there was a lot of negative commentary around my making the same points as I've just made.
We are also implementing an anonymous testing program that will be conducted by an outside agency or a person with the results known only to the inmate. I agree that there are inmates who will never fully trust a CSC employee to maintain the confidentiality, so we are going to move to an anonymous testing program, which will basically be a public health nurse coming in and setting up a clinic for sexually transmitted diseases and someone can go there and tell his fellow inmates that he had warts or something of this kind and avoid having to face potential victimization over AIDS or HIV.
We are also contemplating a major survey of our inmate population. Such a survey would respond to the recommendations of ECAP to find out more about behaviours. We may be able to get better information on sexual assaults. We may be able to get better information about discrimination against individual inmates who are suspected of having HIV. We're also obliged by law to consult our inmates, and this will be one way of doing so. It'll also give us, I hope, a strong database for better policy and program development.
There have been such surveys regularly in the Federal Bureau of Prisons in the United States. They have found them very useful. In the case of the United Kingdom, they've had one, in a storm of controversy initially, but again I think the results have been seen as useful.
We would have to use a private firm here, and it'll be a very interesting survey for them to conduct since they cannot assume that they can just send a questionnaire to our inmates. Bear in mind the profile I gave you. A lot of inmates would have serious difficulty in filling out a large and complex questionnaire. So they're going to have to be helped through the process so that the results will be meaningful.
Mr. Chairman, I hope that I have not talked for too long. That was the presentation I wanted to give you, and I'm certainly open to any kinds of questions for as long as you have the patience to remain.
[Translation]
The Acting Chairman (Mr. Ménard): I would like to thank you. If members of the committee agree, we will proceed as usual, that I'll get to comment first, then we'll go to our colleague from the Reform Party and then to the government side.
Thank you for the quality of your presentation. You really gave us a lot of information and a lot of details. I understand that you are essentially in agreement with the recommendations of the Gilmore Report, but that you hesitate somewhat to follow three of them which are not minor, but rather central in the report.
For each of those three recommendations, I would like to understand better why you're so apprehensive. Let's first assume that you are as surprised and concerned as we were when we learned that the HIV positive rate is ten times higher among inmates than among the general population.
You have very carefully explained that people who are admitted in your institutions have a background which could make them susceptible to that.
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If you had in your institutions a system to differentiate between consensual and non-consensual sexual relations, that sort of blackmail that can exist within the prison environment we all know about, would you be more favorable to lifting the prohibition, as suggested in the Gilmore Report?
[English]
Commr Edwards: I'm certain that I'd be supported by 99% of managers and staff within the Correctional Service and by anyone who has experienced life inside a prison when I say we do not believe you can draw a line between consensual and non-consensual. We can do surveys, but we cannot stop the individual manipulation from taking place.
Bear in mind that a lot of offenders will not tell us if they have been sexually assaulted by another inmate. Even if it takes place and we don't get a complaint, we cannot assume that it was consensual. So there is a serious problem that relates to the reality of life inside a prison, and I would invite any of my colleagues to add to my comments if they feel so disposed.
[Translation]
Mr. Irving Kulik (Deputy Commissioner, Ontario region, Correctional Services Canada): I could add something but I'm not sure it would change anything.
I don't really see how you can make the distinction between consensual and non-consensual in a jail situation. As the commissioner just said, some of our prisoners are assaulted. Even under those circumstances, we have difficulty finding witnesses who saw anything during the incident. You can imagine there are even fewer witnesses to any sexual act. In my opinion, it's almost impossible.
The Acting Chairman (Mr. Ménard): I'd like to have some clarification. You are doubtless more knowledgeable than any member of this committee, but the authors of the Gilmore Report, who toured the jails, certainly had some reason for making that recommendation. I'll admit that blackmail and other problems do happen in a prison environment, but in society in general, consensual homosexual relations are allowed as long as they happen in private and involve consenting adults. If the jail population is a sort of reflection of society in general, how is it possible to think that there's no way consensual sexual relations could exist?
What led the authors of the report to make that kind of recommendation? Do you think there's a link between an increase in the number of people infected in a jail environment and unprotected sex?
[English]
Commr Edwards: As I said earlier, we have no problem with most of the recommendations by Dr. Gilmore and his colleagues. There are these three that gave us problems, and on this one I don't believe the committee fully understands the differences between life inside and life outside. I don't think one is a reflection of the other. It has nothing to do with homosexuality or legality; it has to do with people abusing other people.
We had the same problem recently where we put some of our female offenders in a minimum security institution in Saskatchewan. I think we put about five there, and two or three of them became pregnant. We moved all of them out of there so fast. Such women, if you look into their backgrounds, have been abused over time and I think once again they were falling back into behaviours or being exposed to behaviours that were not helpful to them.
It's perfectly legal to have heterosexual sex or homosexual sex in the outside world. Inside prison I think we're dealing with a rather different environment in terms of checks and balances, and as my colleague has indicated, it's very hard to get witnesses. I've been in this job for over two years now and I don't know of a single charge of sexual assault of one inmate by another inmate. So I think that's very important.
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There's another factor that I think has to be put on the table, and I would invite members of the committee, if they're inclined, to visit one of our institutions. We'd be happy to arrange it. There is not much privacy.
I suspect that the amount of condom use in our prisons is probably very low, and it would be low even if we made it not an offence to engage in homosexual activity. Where do you do it? You're under watch most of the time unless you're in a minimum security institution.
It is a very different world from outside. There are no back seats of cars or basements of houses or your own bedrooms. You're in a cell with bars that are open. There is no noise abatement. You know pretty well what's happening in each cell on either side of you. If you go to showers, chances are you're under supervision. It's not very much like life outside. There are no woods to walk off into with your mate. It's a very different world.
[Translation]
The Acting Chairman (Mr. Ménard): Before giving the floor to my colleague, I'd like to say that your invitation is interesting. Maybe the Committee might like taking you up on it and go visit you to understand what the realities of life are in your environment.
I understand that condoms were to be made available to inmates who are allowed out, to be able to have protected sex on the outside. That was the fundamental reason for your decision.
Before going to Mrs. Bridgman, could I hear what your reservations are on the second recommendation to provide methadone support treatment which, if I'm correct, is a substitute product for inmates who have an opium dependency?
[English]
Commr Edwards: Can I ask Dr. Roy to respond to the methadone situation?
[Translation]
Dr. Jacques Roy (National Counsel, Health Services, Canada Correctional Service): I'm a drug addict specialist and I was trained at the Addiction Research Foundation in Toronto. During my training in Toronto, as a doctor, I prescribed methadone to the clients we had over there.
The primary goal of a methadone support program, as can be seen in the documents put out by Health Canada, is to bring about an improvement in the patient's psychosocial adaptation and a decrease in criminal activity.
As you probably know, methadone is not a cure, but helps the individual to have a socially acceptable behaviour and set aside his criminal activity involving assaults and robbery in the community.
In a penitentiary situation, we have a lot of programs to help inmates improve their psychosocial adaptation. As far as criminal activity goes, we have good control over them and we make sure that they're safe every night. So there are no criminal activities underway at that point.
The primary goal of a methadone program can't be met inside our establishments especially when it's a long sentence. However, it was recently suggested to us to set up a methadone program as a step prior to inmates being set free in the community. We're asking the Correctional Service to allow us to set up a pilot project in the Pacific region, more specifically at the William Head establishment, where a community doctor working for us on contract has permission to prescribe methadone. He chose an inmate as a possible candidate for follow-up in the community. It is possible we might set up a program to be implemented before that individual is paroled.
In summary, I don't think there are any medical indications in favour of such programs during the sentence period inside the institution, but there might be indications for the pre-parole stage.
The Acting Chairman (Mr. Ménard): I will now give the floor to our colleague from the Reform Party, Mrs. Bridgman.
[English]
Ms Bridgman: Thank you for coming, gentlemen.
I have three questions I would like some expansion on. One would be on the actual health care coverage. Persons in prisons are not covered by provincial health care, are they? They are not under the health care acts, so I am assuming then in the prison budgets there are certain amounts that must be allocated to health care.
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I would like to know approximately what percent is used on health care and is that adequate or inadequate? We are not only talking programs for illness, but also prevention here as well.
Secondly, there is some discussion about the possibility of moving the health services from within the prison to what's available in the community. I would like to know how you see that as being either an advantage or a disadvantage, not so much economically but from the system and the rehabilitation, etc., and maybe standard of care.
The third thing I'd like to know is what kinds of testing, say, on admission or transfer or on a routine basis...are routine annual physicals done, for example? On admission, is there a history taking done? I am not correlating this, but when someone comes into a hospital, for example, we do a physical medical examination, history taking, these kinds of things. So I am wondering physically, medically, are there examinations done that way? Is a history being taken? Are there psychological assessments done, and how often? I am specifically interested in knowing if there's mandatory testing done. I think I would like to include TB as well as hepatitis B, hepatitis C and AIDS. The TB issue is because of the recent Kingston situation.
Commr Edwards: Yes, we take each one of these, and I will lean quite heavily on Dr. Roy to elaborate.
On our health care coverage, this is entirely a federal expense whilst they're with us, and our basic rule of thumb is that we should be providing comparable levels of care as to what would be found within the community. We quite regularly test our service ranges against what is in the community in order to see that we are maintaining a level that is appropriate. That is very much implied in our legislation.
Moving from institutions to the community, Dr. Gilmore and his colleagues, I believe, recommended that we should look at the notion of contracting out health care presumably because it might be seen as somewhat more anonymous than our providing it directly.
In effect, we provide very little health care in our regular institutions, other than through nursing services, and call in experts from the community as a general rule. The exceptions are psychiatric institutions and what have you, which do have a body of doctors on staff.
On the assessment when inmates come in, yes, there is a thorough assessment. They are encouraged at that time to be exposed to the the double mantou test for TB, I think it's called.
Dr. Roy: The two-step mantou test.
Commr Edwards: They are given a full physical and they are given psychological testing. How intensive that is depends on the offences and what have you.
Again, I'll give you a little bit of information about Corrections. Normally, the initial assessment lasts about six to eight weeks, so we intensively watch them to try to find out - and testing and discussion and self-assessment by the inmates - what kind of person we're dealing with, what kind of support they need, what kind of programming they need, what level of protection other inmates need from them or they need from other inmates and so forth.
Certainly we do not force medical tests on people. In some cases where we believe it's absolutely essential, if they refuse to take a medical test we will take action as though in fact they have failed it. For instance, in the TB testing, in the Ontario region that you were mentioning, in the end we encouraged inmates to the point where I think only two refused, and they were put in isolation for a period of time for observation to find out whether in fact they started to show the more visible symptoms of TB.
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We won't tie them down on the ground and extract blood from inmates against their will, and we certainly will not do mandatory AIDS testing. Indeed, the courts have told us in the Beaulieu case that we do not have the legal authority to do that.
If there are some key pieces I've left out, please add to them, Dr. Roy or Mr. Kulik.
Ms Bridgman: Am I getting the correct message? The psychological examinations are an absolute.
Dr. Roy: Yes, they are. At reception we do a very complete psychological assessment; we are looking for the mental health difficulties of the inmate as they come in. Should there be some acute problem, they would be referred directly to our institution contract physician or to some of our psychologists or to psychiatrists, if required.
Ms Bridgman: So there's no choice on that. They have to go through that process, but they do have a choice -
Commr Edwards: If I might interject, they go through it, which doesn't necessarily mean they cooperate with us. If they don't cooperate, we don't get much out. Most inmates eventually want to talk about themselves, so eventually they generally cooperate; but if an inmate arrives in one of our institutions and categorically refuses to say a word, there's not much we can do about it. That is a very rare situation.
It's mandatory in the same sense that the mantou tests are mandatory or any other tests that we want are mandatory. We will not go to the final stage of forcing it if it's categorically refused.
Dr. Roy: Otherwise, it would be assault and definitely we wouldn't want to go as far as that, to force a test on somebody who does not want to volunteer.
Ms Bridgman: So it's highly encouraged. So what happens to them if they just totally refuse to participate in any of this? Do they get their own way?
Dr. Roy: I can ask Mr. Kulik to answer that on the operational side.
Mr. Kulik: Can I just clarify something in regard to psychological testing? What we do essentially is an assessment, and we do not necessarily do the entire psychological write-up for every single offender. It depends on the kind of case it is. If it's a lifer, if it's a sex offender, obviously it will be a more intensive work-up than there would be with, let us say, somebody who's in for the first time with a two-year sentence for breaking and entering. Obviously, the attention required is the attention that's given for offenders.
I was going to make a comment in regard to TB or any other kind of testing. We were successful in testing close to 3,800 inmates on the mantou TB test. There were two exceptions, as the commissioner mentioned. What works - at least in my short experience in this particular file - is talking to people and educating them and convincing them of the importance of their cooperating in that test, be it any kind of test.
Ms Bridgman: I've asked this to possibly try to illustrate some sort of way of trying to get some base data to compile some statistics on these kinds of things. If you're not going to get this information as they come in, how do we know or do we want to know how many people have AIDS or how many people are carriers? This, to my mind, just seems the most logical kind of thing. You have a box with a bunch of people in it and we don't even know, and we are supposed to provide some kind of ``safety''.
What other parameters are there that can give us some ideas so we can maybe in the future get some statistical data?
Commr Edwards: I think the kinds of things that Dr. Gilmore has been talking about, the anonymous testing for HIV may encourage many more inmates out of curiosity to, out of deep concern but fear of being found out.... It could encourage a much higher level. Eventually we'll learn about people if they move from HIV to AIDS. I think we know pretty well who has AIDS, at least who has AIDS at a reasonably advanced stage.
Inmates are normal human beings, and if they start to worry about their health, they are going to try to get information. If they fear they're getting TB, they'll probably be the first to line up for testing, as was indicated in the Ontario -
Ms Bridgman: Some peer pressure.
Commr Edwards: Peer pressure, but also personal self-interest. Do I have it?
Dr. Roy: Concerning the level of HIV inside the institutions, can I clarify something thatMr. Ménard said earlier concerning the statement from Dr. Hankins in regard to her studies in Montreal. The studies of Dr. Hankins were mostly done in the provincial correctional system.
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Of course, as you know, in a provincial correctional system it's the ``revolving door'' syndrome: people do little crimes; they go in and they come out. There are a lot of prostitutes and so on. This is why the level Dr. Hankins has found in Montreal, especially at Maison Tanguay, 15%, does not relate to our population at the Prison for Women in Kingston. We have already done one anonymous testing survey in one of our institutions in Joyceville and we found 1%. Dr. Gilmore stated that it would be between 1% and 2%, and we fully concur with that. It shouldn't be any higher.
By the way, in the States the state of infection is 1.8% in the Federal Bureau, which is the equivalent to our federal system. Of course in a provincial system, especially in New York, it would be much higher. But with the ``feds'', with the ones who are taking the longer sentences, the population is different and is not as much involved in IV drug use as people who are petty thieves.
Commr Edwards: New York is 12%. In Brazil 20% of the inmate population have HIV.
Ms Fry: I have a suggestion. If the inmates don't want to submit to testing, you can always tell them they can't come into the facility.
Commr Edwards: As overcrowding grows, I'm very tempted just to shut the doors and say ``no more''.
Ms Fry: Yes. You can't come in if you won't submit to testing.
I wanted to ask you two questions that are a repetition of two questions you've had, but with a different slant. One of them I'm going to ask Dr. Roy to respond to, the needle exchange versus methadone issue.
I agree with you that obviously the reasons for using methadone in the outside population aren't the same as in a prison population. However, the fact that it's going to be used here not necessarily for addiction reasons but for public health reasons in terms of safety... Because using needles is not allowed, people using them are going to be using them in a very surreptitious manner. It's obvious, as Dr. Gilmore said, you're therefore going to be having a lot of passing around and using the same needle.
Therefore in the interest of public health I would say methadone would take away that problem as much as it possibly could. It would decrease the problem, because people would not have to take their drug in a syringe any more, because they would get it orally through the methadone. I would see that being used for a different reason, for a public health reason, in an inmate population, as opposed to the addiction reasons that one would be using methadone for originally. I don't understand why it wouldn't be done.
That's my first question. My second question has to do with access to health care.
I know how health care is financed, etc. I'm not discussing how it's financed. I'm discussing actual practical access.
If, for instance, you have HIV/AIDS, the issue we're discussing, if you have a person who comes into the prison system and is HIV positive or who in fact has AIDS, and during that time they develop illnesses that require hospitalization, they'd obviously have to go outside into the community hospitals. It's my understanding, based on some information we have in British Columbia and from the prison health care committee that was going on there with Dr. Préfontaine, that it was very difficult to get community hospitals to want to accept inmates on emergency bases or for in-patient care.
How do you deal with that? That's a denial of access. It's a very difficult problem, and one that needs to be addressed. I don't know how you address it or what plans you have for addressing it. I think it has to be addressed, given the nature of the illness and given the fact that sometimes an HIV-positive person may develop AIDS or an AIDS sufferer may need actual acute health care.
Dr. Roy: I'll start with the second one, which I think is easier to answer. As you are aware, there has been some difficulty in the Fraser Valley in B.C., and also earlier in the Kingston area here. The way we solved the problem was to multiply the dialogue and have people from the local hospitals come inside and visit our institution. Eventually there was more and more collaboration from these two medical communities.
In B.C., I know you were involved in helping us open the door of our local hospital. Finally the medical board there saw that our institutions represented a population that had to be served, and I think the college eventually got involved and sent a letter to these boards.
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So at this time I'm happy to report that we do not have any difficulties in transferring our cases into local hospitals in all of our 41 national institutions across Canada.
Concerning the first one, you heard my reasoning for why I don't think methadone is indicated for inside the institutions for long sentences. I'm always open to new ideas, innovations. I'm in close contact with the physician who is in charge of the drug program at Health Canada. I will submit that to him to see if there could be an indication from Health Canada that this could be using the harm reduction approach, whether or not there would be indications for physicians to start providing methadone inside institutions for long sentences. I will await a recommendation from Health Canada on that.
As you know, Health Canada is really our medical adviser as to what we do inside institutions. We have started doing the two-step mantou on the recommendation of LCDC and other experts at Health Canada. If the drug directorate tells us that, yes, that could be a legitimate indication, then I will present that to senior management. I am not very hopeful that could be so, but we'll listen to LCDC.
Ms Fry: We're talking about this from a report this committee may eventually come up with that may be based on certain recommendations. You said earlier that you were going to explore, in some areas, the availability for using methadone for people prior to their being discharged.
Dr. Roy: Yes.
Ms Fry: If you could do it for that reason, which is really an addictive reason, appropriate treatment of an addiction, etc., and reintegration into society, etc., then I'm thinking that the public health reason is probably even more valid in a closed population within a prison.
Dr. Roy: Yes, but remember that when our inmates get into the population in the local community, we want them to become law-abiding citizens. This might be a way to help them to be like that. As you know, in the community they can get back into their life of crime.
The other big problem we have is that, as you may be aware, only 237 physicians in Canada are permitted to prescribe methadone. One-third of them are in B.C. If we would continue or initiate a methadone program inside our institutions, when the inmates would end up in the community - At this time there is a waiting list of more than 1,000 cases for those physicians who have permission to treat that. So we would not be able to continue treatment, because I'm aware that at this time there are no such physicians in Newfoundland, P.E.I., or the Northwest Territories. So we could develop a need for methadone that would not be continued by services available in the community. So that's the other problem.
Ms Fry: That's your practical problem.
Dr. Roy: Yes.
Ms Fry: To go back to access to health care, I know you've resolved the problem in terms of acute care, etc. The problem, though, is that if a person is HIV positive and has AIDS and develops a problem, there is this added ``discriminatory'' stigma that may make people say, ``I don't mind bringing you into my hospital to do an acute appendectomy or gall bladder operation on you, but my hospital is a community hospital and I'm not prepared to take in people who are HIV positive''.
Dr. Roy: It is strange that you should say that, because, on the contrary, in Quebec we have a contract with one major institution in Laval and we have some secure beds there. Some institutions that are on the outskirts of Montreal sometimes resent the fact that we are not using them. Cowansville, I think, was an example. We had to reply to a concern about that; they asked why we weren't using their beds but rather were sending people to Laval.
As I say, we've had problems in the valley in B.C. and they are solved now, and in Kingston the solution was to keep communications open and have nurses from both sides to visit the two environments.
Mr. Kulik, you may want to add to that.
Mr. Kulik: You talked about consultation or dialogue. Obviously, most of our physicians work in one or the other of the major hospitals in Kingston, which helps.
The other element is, again, the secure ward issue. We are in the process of finalizing one at the Hotel Dieu Hospital in Kingston, where we will have, I think, two or three beds plus, including one room that will have negative pressure for TB cases.
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Even at this point in time, I have not heard any problems about the hospitals taking somebody who is a chronic care case. We have one right now, as a matter of fact.
Mr. Culbert: One of the points, Mr. Edwards, I wanted to get at was a little bit different from the normal health perspective.
I noticed in your presentation that you touched on the fact that you didn't completely condone that it was always necessary for those whom the courts have suggested should be incarcerated to have to be necessarily in a prison atmosphere. I picked up on that because I have given a great deal of thought to it, and I've spoken to some of your staff, as a matter of fact, on that subject and was amazed to learn, to be honest with you, that actually you were moving in some of the directions I had been thinking about. I guess the old saying is what goes around comes around.
I had been thinking previously of things such as the farming community, where those who were there could be - and it relates to what you've said, their experiences in life, alienation and failure - not too optimistic about their future, not had regular employment, not had the opportunity for a great deal of education, let's say.
Those endeavours in the farming community and woodworking shops where they manufacture products that can be useful to other sectors, and perhaps other variations - I'm a great proponent of that, especially for perhaps less serious crimes, specifically where there is some freedom and flexibility. While those prisoners are doing their time, if you will, they're also contributing to society, which is paying to keep them during that process.
If we bring the health element, or in this particular case the HIV/AIDS element, into that scenario, I wonder if ultimately that's not the better process, rather than taking those people in those particular situations and putting them in a cell, locking the door and exercising them once or twice a day, or letting them out in the yard to play basketball or what have you. Wouldn't we better off if we looked at more of that scenario to teach vocations and at the same time be useful to society with products? Perhaps you might like to touch on that.
Commr Edwards: I very much appreciate the comments and the question. I think our minds are following a very similar track in this regard.
The failure in most western countries in the correctional field is that we don't have strong enough community programs. People believe you can have a good probation program with a caseload per probation officer of 130 or something of this kind. All the research tells us that 25 is about as many as can be handled by a probation officer or a parole officer.
I don't believe there is any limit to the kinds of good, useful programs that are enough punishment in the sense that the person is doing things when they might prefer instead to be in a mall with their mates, and what have you. There are all kinds of things that can be done.
Some of them are happening. We do some even inside in our minimum security institutions. About seven of them are working farms. I am certain that is good for the soul. I myself have spent quite a bit of time on farms in my life, and I'm damned certain that is helpful to people to get into a rhythm of life that's different from what they've had, to watch the crops grow and help them grow, or watch the animals mature.
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In addition to agri-business, we also have a number of manufacturing concerns. A lot of them have been aimed literally at woodworking, in the sense of making furniture. Unfortunately, our primary market is the public service, and the public service at the moment, for good reasons of cut-backs and what have you, is no longer buying at the same rate as it was before.
Now we're trying to move inmates more into construction. We do a lot of construction, particularly with the growing population. We're building more capacity. A hundred years ago it was common to have inmates building structures. We lost that and put everything out to contract and work crews came onto the site. We are now moving back to using inmates in construction, which again teaches them work skills and indeed should help them to get employment when they come out. Many of us believe that one of the top three factors that are necessary for someone to stay out successfully is to have employment, to have pride in it, to have the time to put into something useful.
I would love to see restorative justice programs aimed at the less serious criminals where they are literally paying back to those they have injured, whether it's the community or others. There are all kinds of things we could be doing. Generally, however well designed they are, they're so much cheaper than putting people in jail, stripping them away out of the community and locking them up. Most of them are young people, and that I find very sad.
Mr. Culbert: Exactly. I have just one other quick question. Do you have any statistics on results of those who have been in those types of work environment as to things like health, HIV/AIDS contraction, or other communicable diseases, in comparison to those incarcerated in the traditional cell atmosphere?
Commr Edwards: I don't. I thought you were going to ask whether they went through that program. But I think it would be possible for us to generate some data on infectious diseases in our minimum security versus our more tightly secure facilities.
Dr. Roy: The biggest problem is anonymity. We tabulate information from the regions telling us how many have HIV and AIDS, but we don't have the names and that's the only way it can be done. In order to tabulate what you're asking, we would have to identify the individual who is HIV positive, and definitely health care people in the institutions would have a lot of difficulty with that.
Mr. Culbert: Okay, very good.
Finally, do you have any results or statistics as to the success or the repeats of those who have gone through this type of work program, whether it be farm, woodworking, or a factory-type of scenario, versus those who have been in the traditional cell from the point of view of coming back or repeating?
Commr Edwards: I'm sorry to offer you difficulties. I wish I had an easy answer.
The problem is what statisticians refer to as multi-collinearity. There are so many factors at play that we can't unravel them. The less serious inmate - he may have been serious once, but after many years and through treatment and what have you, he is now in a minimum security institution - is likely to have a very high probability of being on a farm. But you can't compare him with the more dangerous person who's being kept in a regular cell in a medium- or maximum-security institution.
We know that those who go through the minimum and then are out on parole and eventually are off and complete their sentence have better records than those who are kept in tight security until they're released onto the street after warrant expiry. But that's pretty obvious. The more serious ones are more likely to end up doing something than those who are less serious. It's a very difficult business to try to unravel some of that.
Ms Augustine: Thank you very much for your presentation. I found it very informative, and there is some information in here that I hope will become of some use at some other point in time in other discussions. I just want to ask one small question.
In terms of the national drug strategy, which deals with the supply and demand sides, and in looking at the characteristics of the individuals who come into the prison system and some of the discussions we've been having here this afternoon, just spend a few minutes talking about where zero tolerance fits into the way in which the system looks at the demand side of the individual's need for substance abuse or the use of substance.
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Commr Edwards: Let me start off, and then I will invite my colleagues to add further thoughts on the subject.
Prison is a very difficult place for most people to survive in. If they get habituated, the chances are they are going to keep coming back to prison anyhow. We get some who just become so attuned to prison life that they go out and come back very fast.
For most people it is very difficult, and those people are looking for escapes from their predicament. Their escape can be through work activities of one kind or another. It can be through hobby crafts. It can be through discovering faith or rediscovering faith through chaplains or through aboriginal elders. It can be a whole variety of things. Some people become obsessed with weight-lifting and become incredibly fit. That is one way for them to tackle life inside. A large number try to raise their academic level, so they become students as something to focus on.
But in their quiet moments, or for those who cannot find an outlet, I suspect they have strong feelings of pressure and tension and are looking for an escape. If they can get their hands on a brew or on some Valium or on drugs, soft or hard, given that many of them had it in their past, they will try to get it again. So there is a demand inside; and where there is demand, the economists tell us there will be supply, or attempted supply.
So what is happening? A visitor may be coming to see her son, let's say. Her son is not necessarily into drugs at all, but he may be pressured by others, with a threat of physical assault or something else, to put pressure on his mother to bring drugs in for him to pass on to others. Or it may be someone who has a visitor coming in and is accustomed either to traffic or to use and he or she brings pressure on that person. We have some incredibly pathetic cases of babies coming in and we find drugs in the diapers, or people abusing their bodies, putting drugs in the various orifices to try to escape detection.
Life is not pleasant in prison. The only thing I can say is that a lot of those people, unless they find a new set of values whilst they are with us, outside are likely to return to the same kind of behaviours as they were in before.
For many of us the hope is that they find a set of values, they have some family support, they get a job. If they need relapse treatment they can get it after they leave our prisons. But if they leave without a set of values, without strong family support, they become isolated and alienated because they have no job and they just live off welfare or what have you, they will probably go back to their old friends; and we have a recidivist.
Drugs come in. The supply is handled in all kinds of ways. Some of our walled prisons, particularly ones that are in cities, have a pedestrian walking along and when no one is looking he or she tosses something over the wall at a predetermined spot. An inmate will try to find that parcel and hide it, use it, traffic with it, or what have you.
Irving, you've had 25 years of experience in this world. Is there anything you can add to that?
Mr. Kulik: It was such a passionate statement I won't even try.
Ms Augustine: I phrased my question badly, but I was thinking more of someone who came into the prison system with an addiction of some sort. You say there is zero tolerance. That individual either needs medical attention immediately or in some way -
We heard earlier that methadone is not provided within the system. I was just wondering how, with zero tolerance, the system responds to an individual with an addiction.
Commr Edwards: That is a good question.
At the level of generality - and again, I will ask my colleagues if they can provide more definition - we don't get inmates directly from the street. They have been detained. They have been through a trial. There is some period after their conviction when they are still with the province before they come to us.
So if it's an issue of withdrawal from drugs, their problems will have been dealt with before they reach us.
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Ms Augustine: The length of the judicial system.
Commr Edwards: I think that's generally true.
Irving again, or Dr. Roy.
Mr. Kulik: If you're talking about withdrawal, I think that's accurate.
There's another aspect as well. It's important not to portray zero tolerance as a punitive attitude. First, you cannot treat somebody who is actively taking drugs and give them substance abuse treatment. That won't work. So you have to get them off that.
Number two, I don't think substance abuse is a stand-alone problem. It's usually a part of other kinds of problems. So the kinds of programs we try to put in place don't deal with substance abuse by itself.
Dr. Roy: As the commissioner said, definitely people spend many months in the provincial system and the detoxification is done there. So when they get to us, they are not actively suffering from withdrawal.
Concerning treatment of substance abuse, we have a multitude of different programs at different levels: primary, secondary and some tertiary. So I think the needs of inmates in that area are well taken care of.
Methadone was a special program, and I've explained why we are not going ahead with that.
Commr Edwards: Our biggest program, I believe, other than academic upgrading, is substance abuse treatment. It's very extensive.
[Translation]
The Acting Chairman (Mr. Ménard): I think this ends our deliberations. I thank you on behalf of the committee for having accepted to meet with us. As far as we are concerned, I remind you we'll have a meeting next Tuesday, May 9th, at 3:30 in room 701, in the Édifice de la promenade. With your permission, I'll adjourn this meeting.
The meeting is adjourned.