professionals, to develop and implement
comprehensive educational programs for staff
and inmates. Procedures were outlined to deal
with inmates who had an infectious disease. It
introduced the concept of universal
precautions—the handling of body fluids of all
inmates as if potentially infectious. Basic
training for correctional officers included a
component on communicable diseases,
including AIDS. Written and video materials
were available to staff and inmates at each
institution,

HIV and other infectious diseases were
increasing in both the community and
correctional centre populations. Despite
attempts to address the importation and use of
drugs in correctional centres, drug use by
inmates continued to be a problem. Western
countries recognized the disease transmission
problem, and were implementing harm
reduction measures.”

The Branch funded a three-month study to test
the prevalence of HIV infection among
provincial inmates in late 1992.”* In addition to
determining rates of infection, the study
assessed how rates of infection varied according
to inmate demographics and risk behaviours,
such as injection drug use. Results from this
study revealed that HIV had “established a clear
foothold in inmate populations” with a 1.1%
infection rate among male inmates, and an
alarmingly high rate of 3.3% among women
inmates.

In step with the advice suggested in this report,

the Branch started to adopt harm reduction

strategies to address the significant risk of

disease transmission in correctional centres.

Over time, the following measures were

initiated:

« Bleach was provided for cleaning injection,
tattooing and piercing equipment;

» Condoms and lubricant were made available
to prevent sexual transmission of diseases;

« Methadone treatment was introduced to help
eliminate the craving for heroin and its
associated high-risk injection practices; and

» Individuals leaving custody were encouraged
to use community needle exchange programs.

In addition to harm reduction, HIV testing and
pre and post-test counselling were deemed
essential to stem the spread of infection among
inmates. They also complemented the
promotion of infection awareness that was
conveyed through individual and group HIV
educational sessions. Other strategies to combat
the spread of diseases included:

» Vaccination for hepatitis A and B,
pneumococcal pneumonia and influenza; and

» Testing, counselling and treatment for
tuberculosis, and hepatitis A, B and C.

Impact of the Cain Report

In 1993, as a result of a growing number of
B.C. deaths due to illicit narcotic overdoses, the
Government of British Columbia requested the
Chief Coroner, Vince Cain, to conduct an

23 Harm reduction is an approach that seeks to reduce the harmful consequences of drug use, such as HIV and
hepatitis C, without necessarily reducing drug consumption. It emphasizes risk behaviour prevention (e.g. using
clean needles, reducing injecting frequency, not sharing needles, treatment with methadone) rather than the

elimination of drug use.

24 Dr. Diane A. Rothon, et al, Canadian Medical Association Journal, 151 (6), Canadian Medical Association, 1994, pp.

781-787.

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Corrections in British Columbia