NSP IN THE AMC IN THE ACT? - WTF!

CAHMA, ATODA, PHAA, ACT HEALTH, & THE EVIDENCE

VS THE CPSU

CAHMA & THE ACT

• Canberra Alliance for Harm Minimisation & Advocacy

• User org for ACT

• small org for a small jurisdiction

• approx 500k

THE AMC

• Alexander Maconochie Centre: “human rights prison”

• Opened 2008/2009

• 2010: 203 prisoners

• 2013: 353 prisoners

A CLOSED SYSTEM?

• 2009 (NSW):

• 85% m / 78% f - ever used illicit

• 40% m / 52% f - ever injected

• 42% m / 54% f - used illicit daily in 12mth prior

• 15% heroin / 10% meth - used inside

• A significant no. reported initiating heroin use inside

All 2009 NSW Inmate Health Survey. (ACT not this detailed)

INCUBATOR!

• 2009 (NSW):

• 28% m /45% f - HCV positive

• prevalence rate in Australia ~1%

• 24% sentences < 2 years

• 17% (m&f) used syringe after at least 6 people

• Recidivism = multiple 3mth - 24 mth sentences = no chance to do drug treatment but plenty chances to HCV +

EVIDENCE

“The need to improve Australia’s response to the epidemic of high risk drug use in our prisons is absolutely clear, based upon the uncontested epidemiological evidence of the sharing of contaminated injecting equipment in prisons and the prevalence and incidence of hepatitis C among the prison population. The relatively short median lengths of stay in Australian prisons (just 2.8 months for remandees and 24 months for sentenced prisoners) means that the great achievements in minimising disease transmission through providing NSPs in the community are being undermined by failing to do so in the highest-risk environments, our prisons.”

David McDonald’s research “The Proposed Needle Syringe Program at the Alexander Maconochie Centre, Canberra’s New Prison” (2005)

HUMAN RIGHTS?

9. Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.

UN General Assembly RES/45/111

68th plenary meeting

14 December 1990

HOWEVER…

CURRENTLY

• syringes are worth more than many drugs

• there are norms around syringe sharing that reinforce other prison power structures. e.g. youngest uses syringe last; owner goes first regardless of BBV status; syringe owner gets free shots; ethnicities tend to share etc.

• most ex-prisoners that use secrete a syringe if possible before going away. it is the single most valuable item in prison

=$$$

BACKGROUND TO DEBATE

• Key organisations: ATODA; PHAA , CAHMA & AIVL

• 2001: ACT government commissioned paper: “Prison-Based Syringe Exchange Programs: A Review of International Research and Program Development”

“the rationale for establishing syringe exchange programs in prisons is even stronger than in communities”

• 2005: Moore Report, “Balancing Access and Safety: Meeting the Challenge of Blood Borne Viruses in Prison” found that no compelling reasons against implementing

• 2005: Human Rights Act

• 2005: McDonald research - “The Proposed Needle Syringe Program at the Alexander Maconochie Centre, Canberra’s New Prison”

BACKGROUND TO DEBATE

Corrections Management Act 2007 states;

S.53

(1)     The director-general must ensure that—

        (a)     detainees have a standard of health care equivalent to that available to other people in the ACT; and

        (b)     arrangements are made to ensure the provision of appropriate health services for detainees; and

        (c)     conditions in detention promote the health and wellbeing of detainees; and

        (d)     as far as practicable, detainees are not exposed to risks of infection.

• Clearly terrain being cleared for opening of prison with an NSP

HISTORY

• CAHMA advocated strongly following AMC announcement

• to ensure NSP built in from beginning

• CAHMA allied with Greens

• Greens discussion paper “Implementing a Needle and Syringe Program in the Alexander Maconochie Centre” (2010) contributed to greatly by CAHMA

• Greens ran for election including NSP as promise

• Katy Gallagher (Lab) also made it an election commitment

• 2012 election, Shane Rattenbury, Green, was required by Labor to form government

• looking good prisoner human rights in the ACT at this point

ADVOCACY

• NSP opposed by prison guards union, the CPSU

• Debate in media including distortions and exploitation of the death of one guard in the 90s

• Claim opposing NSP is harm reduction

• Currently - stalemate heading to arbitration?

• Prison Officer EA clause!

COMPLEXITIES OF ADVOCACY

• CAHMA - representing PWID

• Two challenges represent difficulties of this issue:

• one within allies

• one with “no” camp

INMATES SAY “NO”

• CPSU and ACT liberals claim a survey of inmates - conducted by authorities - returned a 100% opposition to needle exchange…

• CAHMA and Justice Action speak to prisoners daily and we have found overwhelming support from prisoners

• who is right?

CAHMA SAYS “MAYBE?”

• PHAA commissioned report recommended 1-for-1 exchange model for prison based around health care centre

• CAHMA very worried by this model

• how can we register this without appearing to be infighting?

• pragmatic or disastrous?

• prisoners adamant they will not use a NSP run by the prison or maybe even by health staff

• very complex area

• Other models elsewhere

VOICE OF PRISONERS

• government; union; officers; health orgs; researchers all have voice & resources

• prisoners generally silenced or exploited in this debate

• CAHMA interviewed five recent prisoners to get a picture of what is occurring inside right now while others argue incessantly and selfishly outside

IMPORTANCE OF NSP

You would not believe the dramas that happen over a fit. You know if you’ve borrowed someone’s fit and you break it, or something happens to it, then your life is not worth living. You might as well just say righto lock me in strict one out. I’ve borrowed someone’s fit and I’ve been caught with it or I’ve broken it. Where the fuck am I going to get another fit from to replace it? It is real serious trouble. That’s something that someone could be paying for the rest of their time in jail. [Have to] put a hundred bucks in this blokes account every week or pay up for a hundred dollar buy-up every week cos you lost a blokes fit. A fit in jail is fuckin’ money to people. You get a needle exchange in there and that stops one of the black markets straight off the bat.

- Jaryd

CONCERNS

If you have a one-for-one system the screws are going to know who has got the fits and who hasn’t got the fits. It’s gotta be on a basis where the screws don’t know who has got the fits. If the screws know who has got the fits they’re gonna be urining everyone all the time and shit like that. It’s got to be done at the health centre and only the medical staff are the ones to know who has got the syringes.

- Baz

REALISTIC MODELS

You’ve got a syringe box, an average cell has one, you use there and an outside organisation comes in and changes every box every second day. That would be the only way I believe… [because then]… no one would know [you had been] going up to the medical centre and asking for a syringe…

- Janeya

REALISTIC MODELS

“It would have to be every cell has one … Every cell would need to have a box with a syringe in it or without so then no one knows if it has been used or not and then no one can be targeted… It needs to be held very confidential otherwise there’d be hell. I heard about the idea of a box in every cell came from a Swedish jail. An outside organisation comes and changes it every second day, whether it’s been used or not, every single box within the jail.

- Richard

WHERE TO?

• ACT government: prepared to go to arbitration to remove clause allowing guards to veto

• CPSU going to media to fight this

• Officers have said they would sabotage program

• CAHMA decided against releasing paper written around our interviews - for now

• IF it goes ahead the biggest battle will be ensuring it does not fail

• Clear that input from prisoners on the model is crucial

THANK YOUSIONEC@CAHMA.ORG.AU