My name is Peter Ford. I am a physician recently retired from the department of medicine at Queen's.
For the past quarter of a century I have been looking after patients with HIV and associated diseases. Also for about a quarter of a century I have been looking after federal prisoners with HIV, which I do by going into the prisons on a regular basis.
At any one time I have 35 to 50 patients in the eastern Ontario area with HIV. Ninety-five percent of these have hepatitis C, which is, in this particular context, a marker of intravenous drug use.
Because of this high prevalence of hepatitis C in the HIV population, we did some studies back in the nineties--the first one was in 1994--to see what the prevalence of HIV and hepatitis C was in the institutions generally. We looked at a medium security institution in the Kingston area and did an anonymous study, which showed us that 28% of the inmates had hepatitis C and 1% had HIV.
We repeated that study in 1998, by which time 33% of the inmates had hepatitis C and 2% had HIV. With the second study we did a detailed questionnaire, which could be linked to the blood samples anonymously. What we discovered was that almost everybody who had hepatitis C had a history of intravenous drug use. The people who gave a history of sharing injection equipment had the highest incidence of hepatitis C. But the most alarming thing that came out of that study was that there was a group of people who had not injected outside prison but had shared injection equipment in prison, and two-thirds of these people were positive for hepatitis C.
So what we're looking at is a problem with a communicable blood-borne disease, which is being imported into the prisons and is proliferating within the prisons. That has some very serious public health overtones, because these folks are going to get out and they're going to go on doing what got them infected in the first place. In addition, hepatitis C can be spread by sexual transmission--just under 10% is spread by sexual transmission--so the risk is going to move beyond the intravenous drug users to their sexual partners.
The long-term health costs of this are very considerable. It costs about $20,000 to treat somebody with hepatitis C. The treatment is not always successful. The treatment is not always possible because the patients don't identify themselves or because they're not suitable for treatment--and there are some reasons why people do not get treated.
The end product of hepatitis C is liver failure. Liver transplantation due to liver failure from hepatitis C is now the largest cause of liver transplantation in North America, and we're only in the early stages of this epidemic. The epidemic of hepatitis C infection has blossomed with the increase in intravenous drug use, but it takes 20 years to get to end-stage liver failure. So the big bulk of this problem is not going to arrive for quite some time yet.
Corrections is going to find itself looking after people with terminal liver failure, and this is a very expensive prospect. As a physician, I am very concerned about the amount of hepatitis C, and to some extent HIV, that is related to intravenous drug use in our institutions.
I have brought with me something that can be passed around, but if it is going to be passed around I would really asked that you don't open this container. This contains a syringe that was brought into our clinic in Kingston by a very frightened guard who had just stuck himself on it while doing a cell search. This syringe was probably the only syringe on the range from which it came. It's probably been used by at least 10 to 15 different people, several of whom would have been infected with hepatitis C and some of whom would have been infected with HIV.
You will see that this syringe, which is made from a ballpoint pen, tape, and a needle that probably came from an insulin syringe, is dirty. It's not possible to clean it. There is no way you can clean this syringe, even with the best intentions. These syringes are not only responsible for transmission of hepatitis C, HIV, and hepatitis B, but they are also responsible for a large number of rather nasty injection site abscesses that I see in the course of my work in the prison. I think this is a problem that also needs to be addressed.
Thank you, sir.