[Recorded by Electronic Apparatus]
Tuesday, November 26, 1996
.1538 
[English]
The Chairman: Pursuant to Standing Order 108(2), I call this meeting to order.
We have a method of presentation in which we allow all the witnesses to make their presentations. Then we have three 10-minute question periods. We then go to 5-minute periods if any more questions are required. I give latitude to the person answering the question, of course, so you may find that my colleagues ask all of their questions at once in order to get them in. We allow that because we allow you all the time you need to answer them.
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I also understand that some people have requested that certain people start. We allow everyone to make their presentations, and I have no problem with allowing the witnesses to decide who will start first.
First of all, I will introduce Dr. Ralf Jürgens, Canadian HIV/AIDS Legal Network's project coordinator and member of the board of directors. From the Correctional Service of Canada, we have Commissioner Ole Ingstrup; from Aboriginal People in Prisons, Pat hSasakamoose-Tait; and from Prisoners with HIV/AIDS Support Action Network, Rick Lines.
That's all I have on the list. If anyone else needs to be introduced, the witnesses can go ahead and do so.
Mr. Ingstrup, you are going to lead off with your presentation. Please proceed.
Mr. Ole Ingstrup (Commissioner, Correctional Service of Canada): Thank you very much, Mr. Chairman, and good afternoon, ladies and gentlemen.
Mr. Chairman, I would like to thank you for this opportunity for the Correctional Service of Canada to appear before you and to discuss with you and other panellists the very important issue of HIV and AIDS as it relates to inmates in federal institutions.
I have with me two individuals from the Correctional Service of Canada. One is Karen Wiseman, the assistant commissioner of executive services. She will help me with information and also take notes if there is something you would like us to look further into. As well, Dr. Robert Climie, our head of health care services in the Correctional Service of Canada, will answer questions on more health-related issues.
The Correctional Service of Canada is the organization in this country responsible for the administration of offenders serving sentences of two years or more. We are one of the correctional services in the world that handles offenders through the entirety of the correctional process. That means handling them from the very beginning when they enter our institutions, through their incarceration, through conditional release, and all the way to the expiration of the sentence.
It's a fairly large organization. We manage 41 penitentiaries, 11 that are maximum security institutions, 19 that are medium security institutions and 11 that are minimum security institutions. On top of that we have 15 community centres, places where people can stay when they are on conditional release, and we have 64 parole officers spread across Canada. On top of that, we have numerous contracts, about 160, for residential facilities with private agencies like the St. Leonard's Society, the Salvation Army and a number of other organizations.
Our institutional population is about 14,000 on an average day and the population out in the community is approximately 7,000.
I understand, Mr. Chairman, the mandate of this committee is to focus on the impact poverty and other forms of marginalization have on the delivery of AIDS/HIV services. These issues are certainly very familiar to our offender population.
[Translation]
Let us not forget that individuals who end up in a penal institution are, as a general rule, some of the most marginalized people in society.
In our experience, incarceration is often associated with poverty. Numerous types of past abuse, family breakdowns, violence and drug or alcohol addictions play a very significant role in an offender's past.
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More than 80% of all offenders in federal penitentiaries are serving fixed sentences. This means that they will eventually and inevitably be released back into the community, whether it is under a gradual and controlled form of conditional release, or upon termination of the sentence.
Our challenge is therefore to help make that transition back to the community as safe as possible. This, of course, includes health-related issues.
[English]
At present in the law there is no provision for mandatory testing. Therefore, in Correctional Services Canada, testing is done on a voluntary basis. This obviously has impacts on our ability to gather accurate statistics on the full extent of HIV infection and AIDS in the inmate population.
The information we do have, however, shows that as of September 1996, 128 inmates out of 14,000 had tested positive for HIV, and 17 had full-blown AIDS. This represents a quite substantial increase of around 45% or 46% from the 109 inmates with HIV or AIDS that we had in our federal institutions as of April 1994.
When data was first collected in federal penitentiaries in December 1988, there were only14 known cases of HIV in the whole system, and we didn't have anyone registered with AIDS.
On the basis of reported cases, our conclusion is, of course, that approximately 1 in 100 inmates is known to be infected with HIV or has AIDS. This rate is, I understand, approximately 10 times higher than that of the general population, according to information from Health Canada.
In October and November of 1995, as a response to the recommendations of the expert committee on AIDS in prisons, we conducted a national inmate survey to see what kind of information we could get out of that. That's very involved. It was a random sample of almost4,300 male inmates. The survey presented data on high-risk behaviours.
The numbers we have show us that of this sample of almost 4,300, 26% of the inmates who responded reported that they engaged in ``risky practices'', as we label them, such as needle exchange, tattooing or unprotected sex. More specifically, 11% of the survey respondents had injected an illegal drug, 6% reported that they had sex with another male inmate, and 68% of that6% reported that sex had been unprotected. Of the respondents, 45% had a tattoo done, and 17% had their skin pierced for one reason or the other. For both of these practices, a high proportion was unsure, according to their own reports, about the cleanliness of the equipment used.
Naturally, Mr. Chairman, this is cause for concern. We are concerned about these things in the Correctional Service of Canada. I know there are many things that can be done, but let me give you some examples of the things we are doing.
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We have established educational programs for inmates dealing with HIV and AIDS and high-risk behaviours, and we continue to develop those programs and upgrade them to the best of our understanding of what has to be in programs like that. All inmates at the reception level receive information about HIV, and at that stage they are also being offered testing.
The second major area is in staff training, which has been and will continue to be a priority, with emphasis on the issues faced by correctional officers and health care staff.
Third, what is in my view a very interesting pilot project has just been concluded in one of our institutions, Dorchester institution in New Brunswick. The project demonstrates a benefit of inmate peer education. We get the inmates actually involved in counselling their fellow inmates about the importance of not getting involved in high-risk activities. They have a high level of information about what it takes to prevent the spread of HIV and other communicable diseases within prisons as well as a component on support for those who are already infected. This initiative has been quite well received and accepted by inmates and by staff, and by prison administration. We will be receiving a report on that within a week or so, with more details, but the general trend is that this has been very well received by all parties. I'll be looking at ways of expanding that program.
[Translation]
In February of this year, our Quebec region organized a conference involving a number of key organizations, including representatives of L'Office des droits des détenu(e)s, to look at preventive measures as well as ways to deal with those who are affected by the disease. I understand that discussions have taken place towards the organization of a second conference in Quebec.
[English]
Over the years the Correctional Service of Canada has been compelled to make some hard choices on the prevention and spread of HIV/AIDS. For instance, sexual activity among inmates is considered a disciplinary offence. It's not being condoned by the service. However, in January of 1992 we did begin to make condoms available to offenders, in an attempt to prevent the spread of HIV and AIDS - we could already at that time see it was on the increase - and also, of course, other infectious diseases, because we recognized that despite our best efforts we are unlikely to be able to eliminate high-risk behaviour completely.
By the way, I know of no correctional system in this world that would be courageous enough to claim they had complete control, to the extent that all high-risk behaviour would be eliminated.
It is national Correctional Service of Canada policy that condoms, lubricants, dental dams, and bleach kits are available to all inmates in all our institutions.
Again, let me be very clear about this. We do not condone high-risk behaviour. The combined use of searches, the urinalysis program, drug dogs and other detection technologies, such as ion scanners, which detect drug residues on a person's clothing or other objects, video cameras, etc. - all of that has had a dramatic impact on drug interdiction in the institutions over the last number of years.
.1555
Just to illustrate, Mr. Chairman, the results of random urinalysis testing reveal that in 1993 the positive rate, which shows the people who had been taking drugs, was slightly over 31%. As these random testings have become more routinely applied in our system, the positive rate has declined significantly to around 11% at this stage.
We implement a wide range of substance-abuse programs to meet the needs of the offender population. Annually, there are over 5,000 offenders involved in programs, and there are another 3,400 offenders, or thereabouts, receiving counselling. My information tells me that our offender substance abuse pre-release program, an intensive program just before release, is capable of reducing reconviction by over 50% for those who go through the program. The number actually given to me is 54%.
Having said this, there is one area in the HIV/AIDS strategy where I believe the Correctional of Service Canada is still weak, and that is in our capacity to provide HIV/AIDS programming specific to the needs of both aboriginal people and women. I believe this is the same observation you will find behind recommendations 11 and 12 in Dr. Jürgens's report.
It is my intention, Mr. Chairman, to see to it that we develop specialized programs for these offenders as part of a major strategy. To do so, we will be relying on key members of our team - a newly-appointed deputy commissioner for women, a national HIV/AIDS coordinator, a newly-appointed person from Health Canada, and a corporate adviser on aboriginal issues. We'll also involve elders in the process.
[Translation]
In our resolve to deal effectively with HIV/AIDS in federal penitentiaries, there are many legal, ethical and social complexities that surround the issue. Obviously, security issues are also extremely important to us. Needle exchange is one such example. CSC does not have a needle exchange program in its institutions. We are, however, studying carefully what other jurisdictions are doing to prepare our best response to the recommendations of Dr. Jürgens in this area. We are doing so as well with respect to Dr. Jürgens' recommendation concerning the methadone maintenance therapy in correctional institutions.
[English]
In my view and in the view of my colleagues, Dr. Jürgens's report has provided us with valuable insights in this respect. I'll continue to seek his assistance, and work closely with him and with others in this area who can help us by sharing their expertise and by helping to guide our service.
Dr. Jürgens's report focuses on the legal and moral obligation of government to allow prisoners to protect themselves against HIV even if they engage in illegal or forbidden behaviours. I believe giving inmates the knowledge and the means to protect themselves is safer and more effective than mandatory testing and segregation, from the viewpoint of both the individual involved and the communities to which they will eventually return.
I will be through my presentation very soon, Mr. Chairman, but I have to tell you that I'm extremely pleased to say that the federal and provincial heads of corrections met earlier this month, and we all agreed that we should work together to see if we can find joint solutions to this problem that we all regard as very important.
[Translation]
In addition to working closely with its provincial colleagues, the Correctional Service of Canada will strengthen its partnerships with health care experts and other knowledgeable organizations, both in Canada and on the international scene.
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We have an obligation, under the Corrections and Conditional Release Act, to provide every inmate essential health care that conforms to professionally accepted standards.
We also want to ensure that our thinking and our actions in this crucial area reflect our Mission Statement and our core values.
[English]
Mr. Chairman, I thank you for your patience in allowing me to take this time for my opening remarks.
The Chairman: Thank you, Mr. Commissioner. That was a little longer than we usually allow, but we'll forgive you for now. The questioners may have something else to say to that.
We'll go now to the Canadian HIV/AIDS Legal Network.
I believe you are next on the list, Ralf Jürgens.
Dr. Ralf Jürgens (Project Coordinator and Member, Board of Directors, Canadian HIV/AIDS Legal Network): Thank you very much, Mr. Chairman, and dear members of the committee. I'm here today to represent the Canadian HIV/AIDS Legal Network. The network is the only national, community-based charitable organization in Canada working exclusively in the area of policy and legal issues raised by HIV/AIDS.
The network has prepared a comprehensive brief on HIV/AIDS and discrimination for the subcommittee, and recently released this 200-page report on AIDS in prisons. Copies of these documents have been made available to all the members of the subcommittee.
In my very short presentation today, I will very briefly address HIV/AIDS-related discrimination in Canada, and then focus on the issues raised by HIV/AIDS in prisons.
1996 has been a year of hope for persons living with HIV and AIDS. New, promising drugs have received approval, and many of those fortunate enough to have access to these drugs have started feeling better, sometimes stopping their consideration of AIDS as a necessarily fatal disease. However, HIV/AIDS remains different from other diseases.
Whereas most illnesses produce sympathy and support from family, friends and neighbours, persons with HIV or AIDS continue to be feared and shunned. Fifteen years into the epidemic, discrimination against persons with HIV and AIDS remains a primary concern in Canada. Persons living with HIV and AIDS are still losing their jobs, are refused medical care, housing, child care for their children, etc.
As recently as last week, the Legal Network received a call from a teacher in a school in Montreal. One of the students of the school had just revealed to his teachers and fellow students that he was living with HIV. Their reaction was fear and rejection, not compassion. Fifteen years into the epidemic, and although there was absolutely no risk to fellow students and teachers, some teachers seriously considered banning the student from attending classes. This was not an isolated case; every week, the Legal Network and other community-based organizations in Canada receive other similar calls.
Such discrimination against persons living with HIV or AIDS is devastating not only for the individuals themselves but also for the community and for efforts to prevent the spread of HIV. Discrimination causes considerable economic cost to the community. Those who could continue in employment may find themselves forced onto social security. Human rights must be protected not only because it is right to do so but also because preventing discrimination helps to ensure a more effective HIV prevention program.
Let me now address some of the issues raised by AIDS in prisons. In 1995, over sixty individuals and organizations expressed their frustration about the inaction of prison systems and governments, and asked the Canadian HIV/AIDS Legal Network and the Canadian AIDS Society to undertake a project on AIDS in prisons. The project undertook extensive research and wide consultations, visited many prisons in Canada and in Switzerland, and produced this final report.
This is what we found. In Canada, since 1987, the National Advisory Committee on AIDS, the Royal Society of Canada, the parliamentary ad hoc committee on AIDS, PASAN, and the Expert Committee on HIV and AIDS in Prison have each urged prisons to undertake measures aimed at reducing the risk of HIV transmission in Canadian prisons.
.1605
These measures include such things as making condoms, bleach, methadone and sterile injection equipment available. Internationally, similar recommendations have been made, most notably by the World Health Organization, and very recently, in September of this year, by the United Nations. However, nine years after the first recommendations were made, far from enough is being done.
The Correctional Service of Canada is failing to meet its moral and legal responsibility to act without further delay to prevent the spread of infectious diseases and to better care for inmates living with HIV and other infections. Measures that have been successfully undertaken outside prison with government funding and support, such as making sterile injection equipment and methadone maintenance available to injection drug users, are not being undertaken in Canadian federal prisons. This is so although other prison systems have shown that they can be introduced successfully, and that they can receive support from staff, from prisoners, prison administrations, politicians and the public.
In particular, while the Correctional Service accepted many of the recommendations of the Expert Committee on HIV and AIDS in Prison in 1994 and, as Mr. Ingstrup pointed out, is undertaking some positive initiatives such as making bleach and condoms available to inmates, the service has failed to act on many of the promises it made in 1994 in response to the report of the Expert Committee on HIV and AIDS in Prison. It also remains reluctant to face the reality of HIV and drug use in prisons. Some of the most important recommendations made by the expert committee in 1994, such as the recommendation to make methadone maintenance available and to undertake a pilot study of distribution of sterile injection equipment, were rejected.
Immediate action is necessary. Rates of HIV infection are already more than ten times higher in prisons than among the general population, and studies have also shown that at least every third prisoner is infected with the hepatitis C virus. Other prison systems - for example, those in Switzerland, Germany and Australia - have made sterile injection equipment and/or methadone treatment accessible to inmates. Evaluation of such programs has demonstrated clear, positive results. The health status of prisoners improved, a decrease in needle sharing was observed, there was no increase in drug consumption, and needles were not used as weapons. Prison staff in these prisons, who were initially sceptical about the introduction of the programs, are now supportive of them. As stated by the warden of one Swiss prison I visited in March of this year, drugs were a reality in prisons; he couldn't close his eyes and ignore them. Staff support the project, and needle distribution has become part of their daily work, a non-issue.
Making bleach, sterile needles and methadone programs available to inmates does not mean condoning drug use. It does not mean giving prisoners the right to use drugs. But it is a pragmatic and necessary health measure. It recognizes that although reduction of drug use remains an important goal, reduction of the spread of HIV and other infections is even more crucial.
In contrast, opposing the distribution of condoms, bleach and sterile needles to prisoners, and suggesting that instead all inmates should be tested for HIV and be segregated if HIV-positive, is a dangerous approach. I was glad to hear from Mr. Ingstrup that the Correctional Service of Canada also thinks this approach wouldn't work. Indeed, it is widely recognized that mandatory testing and segregation of HIV-positive prisoners are not only inefficient, unnecessary and discriminatory measures, they're also very costly. Prison systems that applied such measures early in the HIV epidemic - for example, some prison systems in Australia - have since abandoned them, given their high cost and few benefits. Mandatory testing and segregation would create a dangerously false impression of security. For their own safety, everyone in a prison must take universal precautions.
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Inmates return to the community. Caring for their healths in prison is protecting society as a whole. No prisoner has received, or deserves, a sentence to contract HIV infection. No prison employee deserves to contract HIV in the workplace. Mandatory testing and segregation would not protect them, but public health measures that have proven successful in the community and in many prisons around the world will protect both prisoners and staff.
Let me conclude by saying that fifteen years into the HIV epidemic, AIDS still provokes fear, misunderstanding and irrational responses. Unless a concerted effort is made both inside and outside of prisons to confront the HIV epidemic and the epidemic of fear, prejudice and discrimination, the gains and investments to date may be lost. Abandoning Canada's approach to AIDS - its AIDS strategy - and cutting AIDS funding now would only, if at all, have short-term budgetary benefits. In the long term, it would result in the preventable infection and death of many Canadians, would continue discrimination against those infected and affected, and would entail enormous human and financial costs.
Thank you very much.
The Chairman: Thank you, Mr. Jürgens. We appreciate that.
We will now go to Pat Sasakamoose-Tait, an educator and counsellor.
Ms Patricia Sasakamoose-Tait (Aboriginal Counsellor and AIDS Educator, Katarokwi Native Friendship Centre): Mr. Chairman, members, ttunse. I'm an aboriginal counsellor and AIDS educator working at Katarokwi Native Friendship Centre under the Ontario aboriginal HIV/AIDS strategy. Our project location in Kingston has seen me regularly in prisons. Indeed, the Kingston sight was chosen specifically, though not exclusively, because of the close proximity to so many federal institutions.
The tragic statistics of overrepresentation of first nations people in prisons is well documented and, sadly, growing. Today we are 14% of the total population in federal prisons, though only 2% to 3% of the population of Canada. Provincial statistics are even more disproportionate.
Within the abundance of reports on prisons, in particular on aboriginal people in prisons, there are clear directions suggested, clear recommendations made, and honest shortcomings in practices pinpointed. The result has been some progress in program delivery that acknowledges the unique and special qualities needed to address first nations programming within correctional settings.
Within the directives of Correctional Service of Canada, in particular C.D. subsection 702(5) - and I will paraphrase - the needs of all aboriginal offenders will be identified, and programs and services will be developed and maintained to meet those needs. With respect to HIV/AIDS and those prisoners infected or affected by this virus, with respect to the education of aboriginal prisoners about HIV/AIDS, and with regard to sensitive, informed counsellors for those faced with HIV and AIDS, this directive is an abysmal failure. In all of Ontario region, there is no HIV/AIDS programming entrenched into even the newest aboriginal prisoner programs. Where peer health teams are in place, they are without aboriginal representation. Peer training tools have been developed without either representation from or inclusion of first nations.
One must question the intent of this obvious omission. Is it with total disregard for the recommendations of the HIV/AIDS in Prisons ECAP report? Or were we just forgotten? Although Mr. Ingstrup's comments and commitments are commendable, they have been very slow in coming, and the result of delays is far-reaching and deadly. The 1996 follow-up report to the 1994 ECAP report indicates that nothing has changed for native offenders. There is no need for this. There are options and there are alternatives to this unconscionable state of affairs. They are outlined in those ECAP recommendations.
.1615
The report calls for healers and medicines to be made available. In fact, in a recent document for federal prisoners that outlines alternative therapy, traditional healers and medicines are notable by their omission, while t'ai chi, yoga and acupuncture are included.
Educational and prevention programs should be developed. These programs should be developed and delivered by aboriginal organizations and economically supported by the Correctional Service of Canada. First nations inmates should be included in culturally appropriate peer health teams. These too should be supported by corrections.
All HIV/AIDS education, counselling and training for prisoners in Ontario are provided by caring community-based service organizations, with little or no funding from Corrections. Like most social agencies today, we are all sadly underfunded. It has been my experience that I had to go knocking on doors to get an opportunity to present any HIV/AIDS education within the prisons; this despite my providing liaison officers with a brief overview of what was available and how much time I could commit to their individual institutions. An offer to present to new staff at the college while they were in training was refused.
About educating prisoners, programs at reception, when an inmate first arrives in the system, would ensure those men and women could make informed decisions in their life choices while serving their sentences and upon release. This must go beyond a written document that gives them information they may indeed never read, or for that matter may not be able to read.
We are talking about a life-threatening illness. Responsible, proactive measures must be taken. Bleach kits and condoms are a credible start, but it is a flawed process if it is not accompanied by education, education that is developed and delivered in a way that is understood. Otherwise it sets prisoners up with a false sense of security, a false sense of safety. It is not the ultimate answer.
Innovative projects must be undertaken: pre-test and post-test counselling resources, staff training and sensitization, anonymous testing, and needle exchanges, all in close consultation with the aboriginal community and prisoners. This will ultimately benefit the society to which most of these inmates will be returning.
I would further suggest that a special adviser to the commissioner of prisons or to the Minister of Health, to address exclusively aboriginal prisoners' HIV and other health issues in prisons, be appointed. This person should certainly be from outside government structures.
In conclusion, I wish you to know that for aboriginal people, community extends behind those walls. It extends behind those fences. Our commitment is great, but work with HIV is hard. Our commitments deserve to be acknowledged and recognized.
Once more we are here allowing you to prove there is honour and integrity in the justice system, Mr. Ingstrup. Once more we speak to you with the power and hope that promises will not be just hollow words and commitments not just autumn leaves, now snow-covered and soon to be little more than compost.
I cannot thank you for inviting me today, because I have not seen the outcome of these hearings. I have not seen the outcome of your recommendations making a difference in the lives of aboriginal prisoners in the justice system across this land. One day I hope I will come to you all to say meegwetch.
The Chairman: Thank you, Ms Sasakamoose-Tait. We appreciate that very much.
I do want to point out that we are a subcommittee of the Standing Committee on Health. We will be making a report. We have you here to give evidence so indeed all of us can learn.
I would advise everyone here that the commissioner is not on trial. The commissioner is here to give us evidence also, and any questions that come to the commissioner will come from the members.
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We do hope that what report we produce will make a difference; otherwise, we have other things to do. So we certainly are hoping that will happen.
Moving on to the next set of witnesses, I hope the witnesses understand that because of our parliamentary timetable we have grouped you together, not for any particular reason other than to economize the time we have to fulfil our mandate.
The fourth set is the Prisoners with HIV/AIDS Support Action Network and Mr. Rick Lines.
Mr. Rick Lines (Prison Outreach Coordinator, Prisoners with HIV/AIDS Support Action Network): Good afternoon. I'm here today representing PASAN, the Prisoners with HIV/AIDS Support Action Network in Toronto. PASAN is the only community-based organization in Canada working specifically to provide HIV education, support and advocacy to prisoners, ex-prisoners and young offenders.
Since 1993 we've worked with over 130 prisoners living with HIV and AIDS from across Canada. We currently provide AIDS services to adult and youth prisoners in over 25 institutions around Ontario.
We're pleased that the parliamentary subcommittee on AIDS has recognized the importance of investigating the barriers faced by prisoners in accessing AIDS services. But the very fact that we're still discussing this issue today is testament to the failure of the Correctional Service to respond to the AIDS crisis in this country.
For almost five years now PASAN has been advocating for the implementation of a comprehensive, community-based HIV and AIDS strategy for the Canadian prison system. It was the release of our document outlining this strategy in June 1992 that prompted the Correctional Service of Canada to empanel the Expert Committee on HIV and AIDS in Prison, or ECAP. Almost two years after PASAN's document was released, ECAP issued a report that supported our recommendations and again urged CSC to implement a comprehensive AIDS strategy. Yet we sit here again today, more than two years after the report of CSC's own expert committee and more than four years after PASAN's initial recommendations, and we're still only talking about how the Correctional Service should respond to AIDS.
For community-based AIDS service organizations across this country there's no question about what needs to be done. The recommendations already exist. The concrete proposals and programs already exist.
The question we are asking is, why isn't the Correctional Service acting to implement these recommendations? Why aren't they acting rapidly to implement the recommendations of their own expert committee? Why aren't they looking to European prison health projects as proof of the viability of those recommendations from the expert committee?
The questions are obvious and the needed policy initiatives are clear. Yet in the meantime, people are dying and needlessly getting infected with HIV in prison. In this context, delay equals death.
The Correctional Service continues to tell the community that it has a commitment to HIV and AIDS, and it continually tells AIDS service organizations from across Canada that the Correctional Service has indeed made great progress on AIDS. Yet today we must again ask the question: how far have they really come?
The time for discussion and debate is long over. It was over years ago. What is urgently needed now is action. We need the federal government to act to implement a comprehensive and coordinated HIV and AIDS strategy for the adult and youth prisons in this country. AIDS organizations have been running successful community-based HIV prevention and support programs across Canada for more than ten years. We need to make those same programs available for people in prison. Nothing less is needed and nothing less will do.
At the same time, we need a commitment from the federal government to renew the national AIDS strategy. It's pointless to discuss the implementation of these programs when our federal government won't commit to the financial and political support and prioritization of HIV and AIDS prevention, support and research past March of 1998. The very fact that we sit here today and that the parliamentary subcommittee and the members here have identified access to AIDS services as a problem clearly illustrates the continuing need for a comprehensive HIV and AIDS strategy in Canada.
Had our federal government adopted PASAN's recommendations in 1992, or even ECAP's in 1994, Canada could have taken centre stage as the world's leader in innovative and effective HIV prevention and health promotion programs in prison. Yet unwillingness to act today, in 1996, now places Canada far behind many European countries where, as we've heard from Mr. Jürgens, innovative HIV and AIDS prevention and harm reduction programs are already in place. These programs, which include prison needle exchange projects in several countries, clearly demonstrate that these programs for prisoners are not only possible, but are in fact -
The Chairman: Could I ask you to speak just a little slower? Our interpreters are having a hard time keeping up with you. Sorry about that.
Mr. Lines: It is my curse. I apologize. I speak quickly.
The Chairman: We're not going to rush you. You can take your time.
Mr. Lines: I'm used to speaking too long and being cut off, so I'm trying to get everything in.
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The Chairman: We can do that, too, but we'll give you some latitude there.
Mr. Lines: These programs, including prison needle-exchange programs in several European countries, clearly demonstrate that such programs for prisoners are not only possible, but in fact are safe, efficient and cost-effective.
The focus of these hearings today is on marginalized populations. While prisoners obviously face unique barriers in accessing AIDS services, the prison itself is not the ultimate source of that marginalization. Most people who end up in prison find themselves there because they are members of marginalized communities in society. Imprisonment is the end result of this social marginalization. Once there, incarcerated people face further barriers in accessing AIDS services.
While it has become a cliché, the observation that there are no rich people in prison is also very true. Anyone who spends any time in prison or working with prisoners quickly realizes that the vast majority of people in custody are poor. Disproportionately, they are people of colour and first nations people, and a majority of them are drug users.
So while the recommendations I stated earlier are crucial in beginning to overcome these barriers for prisoners, it's also just as important to begin to address the reasons why people end up in prison and what social structures and changes we can make in law and in society to provide people and communities with alternatives to prison.
Key to this process is a comprehensive re-examination of drug policies in this country, which have done nothing at all to decrease the prevalence or use of drugs. The only accomplishment of our national drug policy has been the incarceration of thousands of non-violent offenders. These are people whose only crime is a dependence upon a proscribed substance.
The sooner Canadian policy-makers begin to address substance use within a health care model rather than a law and order model, the sooner our society can begin to move toward the social goals that the war on drugs has promised yet has failed so dismally to deliver.
The elected officials and policy-makers must take a fresh look at zero tolerance drug policies in Canada and have the courage to take new, creative and effective approaches to drug use in our country. We must create social and medical supports for drug users other than incarceration. We need to expand the availability and access to methadone maintenance programs and other pharmacological replacement programs. We need to initiate scripting programs for drug users. We need to seriously examine the decriminalization of certain classes of proscribed drugs.
Similar programs that were pioneered in Merseyside, England, have been adopted by various European cities with great success.
Canadian politicians and policy-makers need to rise above the rhetoric and the prejudice about HIV/AIDS and people in prison that is unfortunately all too common in these debates.
The time for discussion and study has long passed. We know what the issues are. We know that the conservative estimates place the rate of HIV infection in Canadian prisons at more than ten times that of the general community.
Ultimately, we're not just talking about HIV. Dramatic increases in hepatitis B and C and threats of tuberculosis infection among prison populations clearly demonstrate the need for comprehensive evaluations and changes in the prison system itself. The situation cries out to our government to act now in the interests of both the individual and community health of people in Canada.
Thank you.
The Chairman: Thank you very much, Mr. Lines.
I believe the next witnesses are Sébastien Brousseau and Jean-Pierre Fontaine Védrine from - this is in English - the office of prisoners' rights. Is that close?
Mr. Sébastien Brousseau (Coordinator, Office des droits des détenu(e)s du Québec): It's the prisoners' rights committee.
[Translation]
The Chairman: Thank you.
Mr. Brousseau: Mr. Chairman, members of the committee, my name is Sébastien Brousseau and I represent the Office des droits des détenu(e)s. L'Office des droits des détenu(e)s is a non profit organization founded in 1972 whose objective is to promote and protect the right of imprisoned individuals, former inmates as well as their families.
As early as 1988, our organization held a joint press conference with Comité SIDA-AIDE Montréal to alert public opinion and the authorities of detention centres to the fact that certain inmates who were HIV positive or had symptoms of AIDS were victims of discrimination.
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We thought that the situation would change quickly. Today, in 1996, here we are before the subcommittee and we've realized that the expression used by Mr. Jürgens, "too little and too slowly", correctly reflects the reality within the Correctional Service of Canada. I wouldn't be surprised at all to see us before a subcommittee again in five or ten years asking the same questions on the same issues.
The issues to which I refer can be categorized into three groups. The first is prevention of AIDS in prison. The second is access to adequate health care for inmates. The third is compassionate or humanitarian release for inmates at the terminal stage.
With regard to preventing AIDS in penal institutions, we believe that the Correctional Service of Canada has a moral and legal obligation to prevent the transmission of AIDS. This obligation results, among other things, from the constitutional guarantees of the Canadian Charter of Rights and Freedoms and international agreements concerning the rights and freedoms of individuals. The spread of AIDS is a scourge and we must act quickly. In the United States, for example, AIDS is already the leading cause of mortality in prisons.
In order to prevent the spread of AIDS, we endorse the various recommendations made by Mr. Ralf Jürgens in his report, namely making condoms, lubricants, bleach, syringes and needles available to inmates. These objects should be easily accessible in a discreet and confidential manner.
However, as opposed to Mr. Jürgens, we do not think it should be necessary to obtain the consent of institutional staff to implement a needle and syringe distribution system. The right to health, life, liberty and the security of the person are rights inherent to human beings, whether or not they are in prison, and only the greater public good could justify any infringement of those rights, which is not the case here.
AIDS must also be prevented in penal institutions through education. It is not sufficient for correctional services to organize two days of awareness training at the Kingston penitentiary to discharge an obligation that could save lives. Education must be aimed at inmates in order to encourage them not to engage in behaviour that places them at risk, but also at guards and staff members to help them manage the cases they will encounter appropriately.
With regard to access to adequate health care for inmates, a detained person is a person who, by definition, continues to enjoy all of his or her rights, except that of moving freely in society. Subsection 4(e) of the Corrections and Conditional Release Act states:
(e) that offenders retain the rights and privileges of all members of society, except those rights and privileges that are necessarily removed or restricted as a consequence of the sentence;
It would therefore seem that access, quantity or quality of care that is less than that of the general population is not permitted under the law because this does not constitute a necessary consequence of imprisonment. The Canadian courts have in fact confirmed that the right to security includes the right of an inmate to appropriate medical care, because a criminal sentence does not bring about the elimination of the right to bodily integrity. Moreover, many international agreements confirm the rights of inmates to obtain health care that is equivalent to that of the general population.
Despite the widely recognized principle that inmates have the right to obtain health care that is equivalent to that provided to the general population, it would seem that the reality is quite different. The Office des droits des détenu(e)s feels that the very wording of section 86 of the Corrections and Conditional Release Act is discriminatory. As Mr. Ingstrup rightly pointed out, this section states that correctional services strive to provide inmates with essential health care and as far as possible, care that may facilitate rehabilitation and reintegration into society.
In penitentiaries, the administrative authorities have broad discretionary powers to decide what is essential or not. Too often, essential care is defined as minimum care. The absence of exclusive and detailed legislative provisions on health care in penal institutions, accompanied by broad administrative authority, leaves the door open to abuse.
Considering that Correctional Services of Canada discharges its obligation by providing only essential health care, we believe that discrimination does exist since the general population can obtain much more than essential care in any hospital or neighbourhood clinic. While in prison, people with AIDS have difficulty gaining access to specialized care and experimental treatment. They have trouble seeing a doctor on a frequent and regular basis.
Moreover, the problems encountered during transfers between penitentiaries and the almost total lack of confidentiality are additional constraints that confront the inmate.
.1635
It is a clear violation of section 15 of the Canadian Charter of Rights and Freedoms to impose a double standard in the quality, quantity or accessibility of health care provided to the general population and that afforded to inmates. And yet, that is the reality.
Mr. Védrine, who is accompanying me, will be telling you about four specific cases that demonstrate that there is really a difference in the quality and quantity of health care provided to persons with AIDS within penitentiary walls and that provided to persons with AIDS outside the walls.
Our third point is with regard to compassionate or humanitarian relief. Section 121 of the Corrections and Conditional Release Act provides for the possibility of conditional release to an offender:
(a) who is terminally ill;
(b) whose physical or mental health is likely to suffer serious damage if the offender continues to be held in confinement;
(c) for whom continued confinement would constitute an excessive hardship that was not reasonably foreseeable at the time the offender was sentenced;
Persons with AIDS could therefore benefit from this protection to avoid dying in prison, just as one could benefit from the protection afforded by section 12 of the Charter concerning cruel and unusual punishment. Unfortunately, and often for security reasons, the National Parole Board is reluctant to approve such releases for people living with AIDS. I would refer you to the case of P.G., as it appears in a text by the ODD of which you have a copy and which Mr. Védrine will discuss later.
We believe that the creation of transition houses that are adapted to the needs of people living with AIDS is necessary. These establishments could be sufficiently secure to meet the standards of the National Parole Board, while being a better environment for people who are suffering. Moreover, by being outside the walls, inmates living with AIDS in transition houses could gain easier access to the specialized care that their state of health requires.
In conclusion, the Office des droits des détenu(e)s requests that the Correctional Service of Canada apply the recommendations listed in Mr. Jürgens' report and open transition houses that are adapted to the needs of people living with AIDS.
The Chairman: Thank you.
[English]
Mr. Fontaine Védrine.
Before you start, I don't want to cut anybody off or cut it short, but we have to vacate this room at 5 p.m. Our questions are going to be very short following your presentation.
[Translation]
Mr. Ménard (Hochelaga - Maisonneuve): Mr. Chairman, isn't the vote scheduled for 5:30 p.m.?
[English]
The Chairman: This room is booked at 5 p.m. by another group. We'll try to squeeze it a little longer.
At any rate, proceed.
[Translation]
Mr. Jean-Pierre Fontaine Védrine (Psychologist, Office des droits des détenu(e)s du Québec): My name is Jean-Pierre Fontaine Védrine and I am a clinical psychologist. I had planned to present four cases to you, but I will present only one or two.
In my capacity as a psychologist under contract at the Port-Cartier Institution in the Quebec City region, a federal institution of Correctional Services Canada, as early as 1989, I met HIV positive individuals who contracted AIDS.
But first, allow me a brief preamble. I have chosen to cite specific cases. I especially want to shatter the corporate smugness of Correctional Services. If I attempted to engage in a philosophical debate with an institution of that size in a speech, I would have no chance to win.
Correctional Services is indeed a master in the art of hiding behind documents and procedures. These are needed in an institution of this size, but it is also true that in a clinic, in day-to-day practice, we are forced to take into account procedures that are very difficult to apply with real clients or patients. Correctional Services has texts such as the one that was called ``Correctional Service of Canada Mission'' in 1988-89. If you look at the literary quality and the format of this text which, in my opinion, is aimed at the general public, I'm sure you would agree that this is a remarkable document.
However, there is the document and the spirit of the document. What do Correctional Service employees do to try to translate this philosophical approach into reality? It's more difficult than it seems. One can understand that an officer whose mandate it is to supervise people may not always comply with the spirit of this document. But this slippage between the text itself and its spirit can also occur among professionals.
.1640
Within the major Correctional Service establishments, it is not rare to encounter - I'm thinking of the mental health units, psychiatric centres, psychologists, psychiatrists and physicians who feel bound by their contract or by the employee relationship they have with Correctional Service Canada.
In other words, the corporate mentality of Correctional Service supersedes the obligations of members of provincial professional bodies.
In short, I have noted and deplored the potentialities of certain stakeholders whose creativity is impeded, to say the least, given the unfortunate weightiness of the institutional model.
I would like to tell you about one case that was widely talked about. The Office des droits des détenu(e)s had discussed it at length. At his lawyer's request, I met with Pierre Gravel. His family agreed to reveal his name, which is why I'm using it. This gentleman was incarcerated in the federal training centre in Montreal.
As a person living with AIDS whose disease was well documented, his extreme fatigue forced him to use a wheelchair. I met with him as an external psychologist, at the request of the lawyer who was defending his rights, because inmates do have a certain number of rights even though they have committed a crime. He was to appear soon before the National Parole Board and hoped to be released for humanitarian or compassionate reasons, as Dr. Jürgens said.
Despite his past offences and the very particular nature of these offences, we recommended parole into a resource for people with AIDS in the terminal phase. The Maison Amaryllis, an organization which receives no government assistance, does reserve one bed for former inmates in Montreal. I presented Mr. Gravel's file to this organization. I noted that Pierre had difficulty obtaining the most recent treatments in specialized clinics such as the Clinique L'Actuel in Montreal. There is a timing problem. I'm not saying this is deliberate, but the latest therapy is not used.
On the day of the hearing, a board member stated that what people living with AIDS need is love. Having said that, since she was familiar with la Maison Amaryllis, she felt that the risk of paroling Mr. Pierre Gravel was too high. There is the security aspect, of course. In another case presented in my report, you will see that there are people who think that because they have AIDS, they may be released sooner.
I do occasionally understand the hesitations Correctional Service may have because of security reasons. The point is not to release everyone who is gravely ill. That is not what l'Office des droits des détenu(e)s is saying. The board member added that the security aspects of the facility selected - these were completely personal enquiries - were virtually non-existent and had no reason to be in place given the therapeutic orientation of this facility.
The decision of the board, which was based on security reasons, is very well documented. Unfortunately, from a therapeutic standpoint, I think there was an error committed. On January 30, 1995, Mr. Pierre Gravel was found dead in a bathtub in the penitentiary.
Among the other three cases, there is one that I assessed recently. It is going before the National Parole Board next month. Unfortunately, I think this inmate will not be released because there are no secure resources, either within Correctional Service, or under contract with CSC, to protect society from the potential offences that might be committed by an extremely ill gentleman who may supposedly escape by the back door and commit a new offence. That is the major premise of the Board and it is also very important to the Correctional Service.
I don't want to generalize on the basis of four specific cases. These are clinical cases. What I'm seeing are inmates arriving at a penitentiary where they may or may not undergo a screening test. They can ask for one and get one. Secondly, they get the results. Thirdly, if they are HIV positive, there is microbiological follow up and standard medication is dispensed.
.1645
For the Quebec-Montreal region, I believe there is a service contract with the Cité de la santé in Laval.
Fourthly, there is a deterioration in the physical and psychological health of the individuals, of course, because one of the most significant variables for a person living with AIDS is stress. It has been virtually demonstrated that the immune system tends to weaken for biological and microbiological reasons but also for stress-related reasons. I must tell you that the second most important stress factor on the general stress scale, after the death of a spouse, is imprisonment.
We have to try to put ourselves in the place of someone who is gravely ill and who is in a very stressful environment. He may put in a request for compassionate release - I reiterate this because I find that adjective very pretty - but because of the absence of external resources vetted by Correctional Service Canada in the community, his compassionate release is refused. The stress becomes very strong, and in the best-case scenario, the patient-inmate - that's what I like to call them - is released in extremis before his death.
Here are the recommendations that I would like to make. Why provide for a treatment plan outside the institution, in a community resource mandated by CSC, in the context of these service contracts that Mr. Ingstrup evoked in his presentation, since the prime variable is stress? Secondly, since this disease continues to be fatal to this day, what allows patients to survive is hope, the wish to be in a calm and reassuring environment where they can get adequate nourishment and resume contact with a significant group of people who meet their emotional needs. Thirdly, they should have an opportunity to obtain in the community the latest treatments which are giving increasingly encouraging results, and to benefit from the positive influence of the many support groups in existence, since there are many HIV positive individuals or people living with AIDS who help each other out.
In the course of my work in preparing another report for the Office des droits des détenu(e)s, I have noted, and I am somewhat surprised by this, that in the regional mental health unit that is attached to the Archambault Institution, there were spaces provided for people living with AIDS, and I wonder why. Apart from extreme cases where there are neurological symptoms, and I would hope that people are released before that phase, I wonder how one can decide to place people with AIDS in a resource set aside for people with mental health problems.
I thank you and I particularly wish to thank Mr. Ménard for having invited us.
[English]
The Chairman: I thank all the witnesses. We're trying to make arrangements to keep this room a little longer. Another meeting is supposed to start at 5 p.m. We're trying to shove them into the smaller room. We'll work on that.
We now go to 10-minute rounds of questions, starting with the official opposition.
[Translation]
Mr. Ménard: You know how much I was looking forward to this meeting. I had tabled a motion a little after the holidays because it seemed important to me, before the report was tabled - because this exercise may seem academic, but it goes much further than listening to witnesses - to ensure that we engage in a somewhat broader discussion than we can have in Parliament.
I will start from the principle that good faith can be assumed and that bad faith has to be proven. At this point, that is how we must approach this without being complacent. I will put my four questions to you and ask you to provide me with a general answer afterward.
My first question would be for Commissioner Ingstrup of Correctional Service of Canada. Commissioner, can you tell us in very concrete terms, that to your knowledge, you and your predecessors have always used all the means at your disposal to avoid having people die in prison? I personally made several representations on behalf of families who wanted to make the Correctional Service aware of the need to obtain specialized care for these people. Obviously, we don't expect a Gervais Fréchette or any other AIDS specialist in a prison, but I do hope that you can assure this committee that you and your subordinates have always used all the means at your disposal, in all circumstances, to ensure that there are specialized services and specialists available.
.1650
I also hope that you will be eloquent about the need for the committee's report to recommend providing the Correctional Service with the necessary resources. I think that everyone here recognizes that whatever one may have done during one's lifetime, one does deserve to be treated with dignity at the moment of death.
My second question is also for the Commissioner. Out of curiosity, I'd like to know what type of relationship you have with the Office des droits des détenu(e) and Ralf Jürgens, whose name has come up on a number of occasions. I'd also like you to tell us what your position is with respect to the report and whether we have understood you correctly to say that your door is always open and members of the committee can have your word that in the future the Office des droits des détenu(e)s and Ralf Jürgens will be able to have access to your premises whenever necessary.
I'll put my third question to Ralf Jürgens, whom I first of all would like to thank for taking a great amount of time for an in-depth examination of this matter. You pointed out that there were a certain number of positive initiatives being taken in prisons, including the distribution of condoms and education programs for staff, but you also showed quite clearly that, unlike other countries, Canada has not gone far enough with respect to methadone treatment and the distribution of sterile material.
It seems somewhat of a paradox because all the members here know that needle distribution programs in certain areas and needle exchange programs in different Canadian communities were first of all funded as a part of the national strategy relating to AIDS.
Mr. Jürgens, I'd like to ask you why, in your view, there is a refusal to take the two next steps. What advice would you like to give to the committee so that we can bring appropriate pressure to bear on the Canadian Correctional Service to go along with the two other recommendations contained in your report?
I'd like to put my fourth and last question to Mr. Fontaine Védrine. How can we be of assistance to you? I know that you are particularly sensitive to inmates' rights and that it is not a moral stand that you are taking since the assistance that you would like to see provided to people has nothing to do with the sentence they've been given.
They are prisoners and your attitude is based on the principle that they have rights that are to be respected. So how can we be useful to your organization in furthering your aims? I'd like you to give us some concrete suggestions on how we can further the actions started by your organization several years ago.
Those are my questions. I'd like to come back on a second round. Thank you.
[English]
Mr. Volpe (Eglinton - Lawrence): I wonder, Mr. Chairman, whether you need a consensus motion here to allow the interveners to respond at least in kind. That would take us to about 5:30 p.m., if I extrapolate proportionately.
The Chairman: We have managed to keep the room. The next reason we would have to stop would be if the bells went for the vote, which would be at 5:30 p.m. If the committee wishes to carry on past 5 p.m. -
Mr. Volpe: I was wondering about the 10-minute allocation for questions.
The Chairman: I cut Mr. Ménard off one time and now he asks all his questions at once. I will not cut off the people who answer. I will also tell the witnesses that any witness who is not asked a question may, in fact, answer the question in kind after the original question is asked. I believe he asked four.
I'll start with Mr. Ingstrup.
Mr. Ingstrup: On a practical note, I don't know if I've been careless, but I have a reservation for a flight to Edmonton at 7:30 p.m. I guess you plan to finish this session on time - or should I make arrangements to change it?
The Chairman: If in fact you have to leave, you can. If we could have the courtesy of your answers first, we would be more than happy.
Mr. Ingstrup: Many thanks. I'll do my best to answer the question.
.1655
[Translation]
The first question was are we doing our utmost to avoid the death of inmates? I don't think that a responsible manager can give a yes or no answer to this question. I can say that whenever I see the possibility of improving the health or safety of inmates, I act in as responsible a manner as possible in the situation.
If we compare what is being done in the Canadian Correctional Service and almost all the other correctional services in the world that I'm familiar with, Mr. Chairman, we realize that Canada has done a great deal.
There may be an impression that the Correctional Service has done very little but there are only four or five penitentiaries in the world that have needle exchange programs.
Of course this is not as easy a matter for us to assess as in society at large because we must take into account the general security of other inmates, staff etc. It is in this context that we are studying the question, Mr. Ménard.
Mr. Ménard: Including specialized care? When it is drawn to your attention that an inmate requires specialized care, do you refer him to a specialist?
Mr. Ingstrup: Once again, it's difficult to determine how much can be done for it to be enough. However, if we compare ourselves with other services, we do have a fairly high rating. There are probably specialized services that can be improved. I have no doubt about this and we intend to do so.
I can say that we will be studying all your recommendations. The recommendations, comments and evidence to be found in the Jürgens report are also very important to us. We take them seriously and once we are finished with our studies, we'll attempt to develop an overall strategy for AIDS and other diseases of this type within the Correctional Service of Canada.
[English]
I hope very much we will be able to do that in the spring, but it is a complex issue that involves more than just doing the same as one does outside. It is a prison environment. There are different considerations that have to be taken into consideration. In the countries that have, for instance, syringes and methadone maintenance programs, it's true there are experiences, and we'll study them from a very positive point of view. But it is also true that in those countries those policies have not been generally adopted.
Two institutions in Switzerland have adopted this policy - it has been around for two or three years - but the other institutions have not. I'd like to know why. What are the reasons? We will study these things seriously.
[Translation]
As for your second question, sir, it is possible to work with the Office des droits des détenu(e)s, if one wishes to do so.
Mr. Ménard: Are you in regular contact?
Mr. Ingstrup: There is of course a contact between our Quebec region and the Office. If the Office wishes to designate a contact person in Ottawa, I'd be quite willing to work with this person on one condition, namely that they recognize that we are managing a penitentiary system and not a social program. This may mean that certain proposals have to be adjusted from time to time. Thank you.
[English]
The Chairman: Mr. Jürgens, I believe you were asked the next question.
[Translation]
Mr. Jürgens: Yes. The question was: why is there refusal to take the two next steps, namely to make methadone and sterile needles available?
First of all, a distinction must be made between methadone and sterile needles. I don't think there is any really good reason why methadone should not be made immediately available.
.1700
As a matter of fact, here in Canada the provincial Correctional Service of British Columbia has adopted such a policy. Penitentiary systems offering methadone treatment are far more numerous than those making sterile needles available to prisoners. It's very clearly a health matter and it could be done immediately.
As for the distribution of needles, I recognize it is a more difficult problem but there is no good reason not to implement a pilot project, not only in one Canadian prison but in several.
It's often claimed that making needles available to prisoners would amount to turning a blind eye to the use of drugs. It's also said that this would be a threat to security in the institutions. In the final analysis, I think it is mainly a fear of public reaction. Let me take a few minutes to elaborate on these three points.
First of all, distributing sterile needles does not mean turning a blind eye to the use of drugs in institutions; it's a public health measure. This has been done in Canada outside prisons for a long time now. It is understood that something must be done to protect the health of people who take drugs for whatever reasons.
Secondly, there is the security problem. In prisons in countries where needles are distributed, the correctional services have come up with ways of dealing with the fears of personnel. I think it's very important to involve personnel in the operation. I'm not giving a veto to personnel, a point already raised by Sébastien Brousseau. We must immediately begin a dialogue in Canada with personnel, prisoners, etc., to discuss the security problems and avoid creating any.
Lastly, there is the fear of public reaction. Distributing needles in Canadian prisons is a decision that also has a political dimension. I think it's important for us to deal with the reaction caused by the publication of this report. With one or two exceptions, media reaction was very favourable. We received support from the media as well as from the majority of the population.
I have taken part in lots of radio programs and there are many people supporting our position. I think it's important to state clearly that the population of Canada does support certain measures and that people are starting to understand that this question does not only concern prisoners. People are starting to realize that prisoners are part of the community and that everything we do or do not do in prison may have a major impact on the health of all Canadians. It is in order to safeguard the health of all Canadians that such measures must be taken.
In conclusion, let me take 30 seconds to answer a question asked by Mr. Ingstrup.
[English]
Why have not all prisons in Switzerland adopted needle exchanges? It's a good question. It's true that some prisons in Switzerland started making needles available in 1993 and not all are doing it. I visited prisons in Switzerland earlier this year and asked exactly that question. The answer was that it was not necessary to make needles available in all prisons.
Other prisons are undertaking other measures. They are making methadone maintenance available to prisoners, instituting drug-free wings, and addressing the issue in a variety of ways. They give prisoners the choice to say if they really want to get rid of their drug habit and go into a methadone maintenance program. They have that choice. A prisoner who wants to get rid of drugs, doesn't want to go on methadone and wants to be given a realistic chance to not be able to get any drugs can be put in a drug-free wing. They have the choice.
.1705
While it is important to make needle exchange programs available, it probably not necessary to make them available in all prisons. We need to give prisoners a choice, and that is what is being done in Switzerland.
The Chairman: Thank you.
Mr. Fontaine Védrine, you had the fourth question, I believe.
[Translation]
Mr. Fontaine Védrine: I'll be quite brief. As a psychologist, I work as a volunteer with the Office des droits des détenu(e)s. I tend to agree with Mr. Ingstrup. Last week I joked that we could also call the office the Office of Inmates' Rights and Obligations.
What I mean by that is that I'm not here to defend any point of view. As a professional working within the framework of the Correctional Service of Canada, I think that it might perhaps be necessary for all professionals to be members in good standing of their professional order in order to improve things and even, taking things to an extreme, that inmates be given permission to file a complaint. The term may be rather frightening but inmates should be able to ask the order of psychologists or the College of Physicians, for example, if a particular service they received was provided in accordance with recognized practice or not.
I'd now like to ask Sébastien Brousseau to answer your questions dealing more specifically with the Office des droits des détenu(e)s.
Mr. Brousseau: Mr. Ménard asked how the subcommittee could be of assistance to the Office des droits des détenu(e)s. We are a small community organization that has always operated with very reduced means and we are quite proud of this. If you wish to help the Office, you must first of all help inmates.
How would you do this? By taking into account the recommendations made by Mr. Jürgens and ensuring that they are applied as of now and not 10 or 15 years from now.
The suicide rate in Canadian prisons is very high. The repeat offense rate is also very high. Imprisonment is not an effective solution in certain cases or it is not the best solution. There's a good deal of research done by criminologists, even within the correctional service, but very few initiatives have been taken. There is very little in the way of innovation or change.
So my answer is that concrete action must be taken, innovative measures for the benefit of the entire system. This will be of benefit both to inmates and society because recidivism is an enormous burden for society.
[English]
The Chairman: Mr. Ringma, it's your turn.
[Translation]
Mr. Ringma (Nanaimo - Cowichan): I'll ask my question in English but if anyone would like to answer in French, that would be fine. Thank you.
[English]
I'll try really hard to be quick. I have about three questions. The first may be very quickly answered.
I come at this from a public point of view. I heard the phrase from Mr. Jürgens several times, on parle de l'opinion publique. I think it's a reality of life. What is public opinion out there? Public opinion is coloured by a lot of ignorance, I think, and that includes me; I don't know enough about this.
Question one is, what prevents us from saying, no, you have to have a compulsory testing program? Does the Charter of Rights prevent us from saying they must be tested as they enter prison, or whatever?
Does anyone know the answer to that? I assume it's the Charter of Rights.
Mr. Ingstrup: Among other things, we asked the Department of Justice some time ago for an opinion about that. The opinion we have so far is that in both general legislation and several sections of the Charter there are some potential difficulties. We're talking with the department about our special circumstances.
Mr. Ringma: It's not clear-cut but it's probable.
Mr. Ingstrup: Not yet, but that's the advice we're getting.
.1710
Mr. Lines: I can add to that as well. It's just that mandatory testing as a strategy to combat the spread of HIV is not an effective strategy. It's not a strategy that's been proven effective, both because it sends out false messages about how to protect ourselves from HIV transmission rather than protecting ourselves from people and because of the way the HIV test works.
There's what's called a ``window period'', and it can be up to as many as 14 weeks or more, between when a person contracts the HIV virus and when the person will test HIV-positive. So if you happen to be tested within that window period, it's quite possible you can get false-negative results.
Again, it's the antithesis of what the public health message has been from Health Canada and Ministries of Health around educating people to protect themselves from HIV transmission, in addition to the legal things, which other people can talk about more authoritatively.
Mr. Ringma: Thank you very much.
Ms Sasakamoose-Tait, I'm a little distressed to hear you say the input of the native population has virtually been ignored. You referred to a report, ECAP or something like that. I don't know what that is. That's not, by chance, the royal commission? Okay, it's something else.
Have you had a chance to read this recent five-year culminated study of the royal commission on native affairs generally across Canada? Did it make some mention - it must have, it was in the thousands of pages - of this prison situation with regard to natives?
Ms Sasakamoose-Tait: I have not had the opportunity to read the document.
Mr. Ringma: You haven't.
The Chairman: It's thousands of pages long.
Ms Sasakamoose-Tait: That's correct.
The Chairman: I just started it.
Ms Sasakamoose-Tait: Having said that, however, I don't want to be misunderstood. I'm not suggesting nothing is happening in aboriginal programs in the institutions, because that is not the case. Certainly they're not up to where I would like to see them. The input of elders and the opportunity for aboriginal offenders to seek elders and healers is certainly not there.
When I was speaking, I was speaking most directly about the issues of HIV/AIDS programming, counselling and resources within the justice system. New and innovative programs are being tested across this country, and I certainly don't want to suggest that is not the case. In other areas, what I am speaking to is the lack of inclusion of HIV programming entrenched in any of those projects.
Mr. Ringma: Thank you.
Do you have a response, Mr. Ingstrup, on the royal commission, maybe a very brief one?
The Chairman: You're at the four-minute mark. You're doing fine.
Mr. Ringma: Yes, but it deprives others.
Mr. Ingstrup: We have looked at the report. I believe it's 4,000 pages long.
The Chairman: I'm on page 6.
Some hon. members: Oh, oh!
Mr. Ingstrup: Mr. Chairman, I'm afraid we can beat that. We have found on pages 141 to 143 some mention about AIDS in aboriginal communities, but I don't believe there is any mention of AIDS in prison. It is mostly in the community.
Mind you, there may be other parts of the report that would contain these things, but so far, we've looked and we have not found anything particular.
I would like to say, though, that I agree with Ms Tait. There are very good aboriginal programs, with elders and everything else in place, in our prison system, but it does need some integration here.
We think, as you do, we have to improve.
Mr. Ringma: I have a third and final question for anyone who'd like to have at it.
The public view here, again, is, for goodness sake, when people are put in prison, they shouldn't be allowed drugs and sex and all of this, so why are you ineffective? Everyone has covered this, in a sense. Everyone's saying the pragmatic approach here is it's going to happen, so to be pragmatic, you provide the bleach, the condoms, the lube and all of these things.
But the public still comes back and says, yes, but if they're supposed to be under lock and key and they're not supposed to have drugs and all of this, why is it happening? People don't get a good answer or a good feeling of what is happening in the prisons.
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Therefore I ask you this question. It relates a little bit to the answer Mr. Jürgens added regarding Swiss prisons, I think. Has an attempt been made in the Correctional Service to say, ``In this prison we're going to have absolutely no drugs, no sex, and no anything else. We'll keep it absolutely clean'', such as perhaps the wing of one of these Swiss prisons? Has that been done, and if it has, what are the results?
Mr. Ingstrup: There are two parts to your question. The first is about the public opinion. I believe, sir, to some extent you're right that it could be seen as if we are sending out a double message. But we have done a lot to explain we're not doing that. We're just saying the fact of life in all prisons in the world is you cannot avoid this 100%, and the risk is enormous. In that sense we agree with Dr. Jürgens and everybody else.
Our reading, as a matter of fact, is that the media, to the extent that they represent the public, have received both bleach and condom programs quite positively. There's a high level of understanding that this is a fact of life and we did the best we could. No system is perfect, but this is probably the best thing we could do at the time.
The second question you asked is actually something we will have to study under this drug strategy. A couple of European nations, including my own old country, Denmark, have established special wings in prisons that must be absolutely drug-free, and people are thrown out if they don't live by those rules. We have not done that in Canada, but we will look at what they have done and what they got out of it.
Some members have said it is as if we - and that means my minister - are afraid of making a policy decision. With respect, sir, I don't think so, because it's a policy decision no matter which way you go. There is no question that the minister is prepared to make the right policy decision. What we'd like to do is give him the best possible decision-making basis.
Mr. Ringma: Thanks very much for your comments.
The Chairman: Thank you very much.
If you're wondering what those bells and whistles are, that means we're being called for a vote. We may have 15 minutes or half an hour.
We'll go to Mr. Szabo for his round.
Mr. Szabo (Mississauga South): I'll ask one question.
A couple of meetings ago a renowned expert and doctor presented to the committee that there are risk factors that would tend to indicate why people would not protect themselves when they are engaging in sexual activity. The two top reasons or linkages surprised me. One group was high school drop-outs, and the other was people who had been abused as children. They were most likely to engage in unprotected sex, because they didn't care. It was a correlation.
That was very new to me, and I think it's relevant to find out from any of you whether or not there are other factors prevalent within a prison population, compared with the general population, that also would add to the prevalence of having unprotected sex and therefore account for the higher incidence of HIV/AIDS within the prison population.
Mr. Lines: I'd respond to that in a couple of ways. A main part of my job is to go into institutions and do AIDS prevention education with prisoners, and certainly it's been my consistent experience that prisoners want to protect themselves from HIV. They may have, as in the general society, stereotypes about who's at risk for HIV. That's something that exists outside of prison as well. In my experience, prisoners are more likely than other members of society to have known people who have died of AIDS, particularly given the high number of drug users in prison.
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With regard to sexual activity in the prisons, the biggest barrier we come up against when talking to prisoners is inaccessibility in the way condoms are distributed, and, as Mr. Ingstrup mentioned, the fact that consensual sexual activity is an institutional offence. We've argued time and time again that by making consensual sexual activity an institutional offence, if you're at risk of having disciplinary charges brought against you for being caught in a relationship with your lover, it doesn't encourage you to take the time to practice safer sex. It doesn't encourage you to perhaps identify yourself by being seen to access condoms.
As well, I think it's important to not overemphasize sexual transmission. I think probably for all of us here, our concerns are in part sexual transmission but very much as well transmission through sharing of injection drug equipment.
The Chairman: Before moving on, we have to dismiss a couple of the members. There is a vote in less than 10 minutes. Any member who has to vote is free to go. I'll stay and finish up with the witnesses.
Sorry about that. We're bound by orders from our boss. If the government falls, we're in deep trouble here. The ground's too frozen to do election signs.
Madam Sasakamoose-Tait, go ahead.
Ms Sasakamoose-Tait: In response to Mr. Szabo's comment that many of the people in the two categories he addressed did not care whether they used precautions in their lives, I would suggest to you that in particular, with individuals who are aboriginal people - and I think it follows that women and prisoners also fall into the same categories. These people often are very marginalized. Aboriginal people are marginalized, prisoners are marginalized and women are marginalized.
Those categories of people often are in a position where they do not feel they are worthy of taking care of themselves. They often do not have the self-worth or self-esteem that would allow them to take the precautions necessary to keep them and their partners safe.
There is a sense of hopelessness that I believe is indicative of life in prison. It's certainly indicative of that residential experience and the inter-generational experience of aboriginal people as well. I think that is a factor in why persons who, again, have not completed high school - We're talking about issues of worth and worthiness.
I think it's important we clarify that these are not people who do not care; they believe they're not worthy.
The Chairman: Mr. Jürgens.
Dr. Jürgens: While it's true that it is not enough to make condoms, bleach and sterile needles available, that education and support is also necessary, the peer education model that has proven successful will be very valuable in that respect. It is also true that scientific studies have shown that many injection drug users stop sharing when injection equipment is available to them. These people who have learned to stop sharing and to care for themselves outside prisons, when they then get into prison, start sharing again. The only reason is that the injection equipment is not available and they need to share. So it's scientifically proven that there is a correlation.
The Chairman: Thank you.
Does anyone want to add to that?
[Translation]
Mr. Brousseau: I am in full agreement with Mr. Jürgens. I would add that there seems to be a certain hypocrisy within the Correctional Service of Canada. On one hand, homosexuality is considered to be an offence, a type of sexual relationship which is not legitimate and on the other hand, condoms are being distributed. Everyone knows that people take drugs in prison and that there are very few needles, so that needles are obviously being shared. It is also known that there is a high rate of AIDS in the jail population but needles are not distributed.
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I wonder whether it is more important to protect the life of people who are in prison, to avoid the spread of the virus or perhaps even -
I say "perhaps" because studies show that the distribution of needles does not result in an increased use of drugs. In 1990, the correctional system was against the distribution of condoms in prison. Today, in 1996, it is in favour of this. One of the objections at the time was the fear of increasing drug dealing. Mr. Ingstrup's figures, obtained through certain tests, show that the use of drugs has decreased.
There may be moral barriers, but from a scientific point of view, according to experts, all indications are that handing out syringes and needles in prisons helps stop the spread of aids and does not lead to increased drug use.
The Chairman: Thank you.
[English]
We're pairing off here, so we don't have to go for another five minutes. If Mr. Ménard and I are paired for the vote, we won't get beaten up by our whip or cast aside.
I think it's very important that we get all of your comments on the record for the purposes of our report.
Mr. Ingstrup, you wanted to add onto that.
Mr. Ingstrup: We do a lot more than just telling inmates they can't use drugs and trying to chase down drugs in our institutions, and among our visitors. We have educational programs that I believe are unparalleled in most systems. We have a voluntary testing program that is preceded and followed by intensive counselling of inmates. There is no hypocrisy in having condoms at the same time as we prohibit sexual activities. We are facing the fact of life that we cannot control everything.
It should be noted that we do distribute 80,000 condoms on an annual basis in our institutions. At the same time, the inmates are saying that only 6% of them are actually engaged in sexual activities, and of those 6%, 68% have unprotected sex.
When that is compared to the situation in the area of AIDS and needle exchanges, our response has been to introduce bleach kits. We realize that the sharing of needles can be dangerous - we certainly tell our inmates that - but the bleach kits are there to make sure that inmates, if they engage in these high-risk activities, can use the bleach kits to clean their needles. But there is more to it than doing just that, because it's part of certain drug cultures that one shares a needle that goes around. So we have to attack this from a number of different angles, and I believe we do.
It is true that in the Senate committee I did argue against the distribution of condoms at one point in time. I believe I said basically the same as I'm saying here, that we're studying it and we want to understand what we're doing before we do it.
On January 1, 1992, we had a better understanding of what it meant and we introduced condoms into prisons. It's not that we take a position and are completely unwilling to change if we have strong evidence to the contrary. When you deal with methadone programs I think it's important to make a distinction between those who are already on a maintenance program when they come to the prisons, and the other issue of whether one should be started in prison. The B.C. project Dr. Jürgens mentioned is a project where you continue for people who are already started on methadone.
The Chairman: Mr. Jürgens.
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Dr. Jürgens: It is true that in the British Columbia provincial system now they are only allowing people already on such a program on the outside to continue it, but they've also stated that they are looking at allowing people to start methadone who were not on such a program on the outside. Many other prison systems worldwide do allow prisoners to start. But again, there is perspective.
The Chairman: Thank you very much.
I want to thank witnesses for coming. I assure you that all of your comments will be recorded and we will certainly include them in our report. It's been very informative and worthwhile. Thank you very much, each and all. As I said at the start, we hope we are doing something positive, and hopefully that will be taken note of.
This meeting is adjourned.