Sandra Ka Hon Chu

Why has the federal government rejected harm reduction in our prisons?

Ottawa Citizen  online

2017-01-24

More than four years ago, a lawsuit was filed by a former prisoner who contracted hepatitis C (HCV) while incarcerated in federal prison and four HIV organizations against the government of Canada. This lawsuit challenged the government’s failure to protect the health of people in prison by refusing to implement needle and syringe programs. Prisoners, when they enter the system, are not stripped of their right to health care comparable to what is available in the community. This right is protected by law. The fact that the overwhelming majority of prisoners are released back into their communities is similarly not considered; prisoner health is public health. And while the idea of equipping people in prison with sterile injection equipment may seem radical, these programs are a proven health measure that is integral to HIV and hepatitis C prevention for people who inject drugs behind bars, where rates of both infections are significantly higher than in the population as a whole. Prison-based needle and syringe programs have also been endorsed by many organizations, including the Canadian Public Health Association, the Canadian Nurses Association, Canadian and Ontario Medical Associations, and the Correctional Investigator of Canada. The World Health Organization and the UN Office on Drugs and Crime concur. Both the Public Health Agency of Canada and the Correctional Service of Canada’s own expert committee also concluded that the evidence points in one direction: implementing such programs to prevent avoidable infections and save lives. Another fact: Canada’s Correctional Service has a “zero tolerance” policy for drugs in prison, a policy that is as unrealistic and unenforceable as one might imagine. Drugs — and the makeshift injection equipment required to use them — exist in prisons, and there is nothing special about Canadian prisons in that regard. But Canada’s Correctional Service refuses to implement needle and syringe programs on the basis that they “compromise institutional security and the safety of staff and inmates.” Their concerns have no basis in reality. These programs have been successfully implemented in 70 prisons in more than a dozen countries around the world for more than two decades. There has never been a single reported incident in which needles from such programs have been used as weapons against guards or other prisoners, nor do studies of such programs indicate any increase in drug use. Rather, these programs create a safer en

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Hold the Human Rights Day celebrations Canada has some serious work to do on women’s human rights, according to a historic and scathing new report from the UN

Toronto Star  online

2016-12-09

Despite our (thankfully) feminist prime minister, Canada has some serious work to do on women’s human rights, according to a historic and scathing new report from the United Nations. As the international community observes Human Rights Day on Dec. 10, which also marks the end of the 16 Days of Activism against Gender-Based Violence, Canada’s position as a global leader on gender equality is now under serious scrutiny. The UN Committee on the Elimination of Discrimination against Women has published its review of Canada’s compliance with the Convention on the Elimination of All Forms of Discrimination against Women. The report-back is both momentous and bleak. The recommendations to Canada are surprising in their scope and level of detail, as well as how forceful and unequivocal the UN is in setting out how we can and must move forward. Women’s right to health was front and centre, especially for some of the most marginalized women in the country, including women living with HIV, women who use drugs, women in prison, and women who sell or trade sex. To the women who feel invisible, threatened and discriminated against on a daily basis, or who face unjust forms of criminalization, this UN report must come as little surprise. But fortunately for our federal government, these recommendations provide an opportunity to reverse some of the harms that have been done and restore the rights of all women in Canada. It’s time for the government to listen up — and Human Rights Day is as good a day as any to move forward on behalf of more than half our population. For the first time, a UN human rights treaty body has directly called attention to the issue of unjust prosecutions of people living with HIV for not disclosing their status in Canada. The Committee said that Canada should limit the use of the criminal law to cases where HIV is intentionally transmitted. The crime we’ve seen applied many times in HIV cases — aggravated sexual assault — is harsh, inappropriate and stigmatizing, and undermines the actual intent of the law, namely to protect survivors of sexual violence. On World AIDS Day (Dec. 1), after the UN issued its report, Canada’s Minister of Justice, Jody Wilson-Raybould, said the government would work to address the overly broad use of the criminal law against people living with HIV. This momentum cannot be lost.

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'That's criminal to me': How Canada is failing to end HIV/AIDS at home

CBC  online

2016-08-22

Two studies released last month show the tools exist to potentially end the more than three-decades-old scourge of HIV/AIDS, but activists and front-line public health workers in Canada say we simply aren't using them effectively. ... High-profile figures in the global fight against HIV/AIDS, including Bill Gates at last month's World AIDS Conference in Durban, South Africa, have suggested talk of "the end of AIDS" is perhaps premature given its continued spread in much of the developing world, particularly Africa. Such talk also seems premature in Canada. Edward says there are two major problems in Canada that deny the promise described in the two studies. First, there remains a powerful stigma around HIV that discourages people from getting tested. The second problem is Truvada, approved as a pre-exposure prophylaxis or PrEP, is very expensive, up to $1,000 a month, and isn't widely available to those who don't have generous private insurance plans. The PARTNER study looked at couples where only one partner had HIV but with a viral load suppressed by medication. Out of nearly 60,000 condomless sex acts, not a single HIV transmission occurred. But HIV infection rates in Canada remain relatively steady, with an estimated 2,500-3,500 new transmissions every year, in part because one in five HIV-positive Canadians don't even know they have the virus, and so they aren't receiving the treatment that will keep them healthy and prevent further spread. Activists argue stigma is a big reason why so many Canadians don't get tested, and it's fuelled by the fact that our laws criminalize the non-disclosure of one's HIV-positive status, even if no transmission occurs and despite the latest evidence that shows viral suppression makes it virtually impossible to transmit the virus. Sandra Ka Hon Chu, director of research and advocacy with the Canadian HIV/AIDS Legal Network (CHALN), says criminal sanctions of HIV-positive people encourage the spread of the virus. "People who might not know their status won't get tested because you would have the knowledge of your HIV status, which is a requirement of a conviction," she says. "That then deters open discussions with health-care providers and creates a lot of stigma that prevents people from getting on ART."

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Why don't harm reduction strategies in prisons include needle exchange programs?

TVO  online

2016-07-05

Steven Simons blames the federal government for his hepatitis C infection. Simons, who was an inmate from 1998 to 2010 at Warkworth Institution, a medium-security prison outside of Peterborough, says he was infected after another prisoner used his personal drug injection equipment. In 2012, two years after his release, he teamed up with the Canadian HIV/AIDS Legal Network and others to sue the federal government for failing to provide the kinds of harm-reduction programs that would prevent such infections. “When I was in prison, I would see people passing one homemade needle around and sharpening it with matchbooks,” says Simons in the press release announcing the lawsuit. “The needle would be dirty and held together with hot glue.” Simons is one of many fighting to prevent the spread of HIV and hepatitis C in prisons. His first court hearing is scheduled with the Ontario Superior Court for the fall of 2017. In the meantime, public health advocates continue to call for all levels of government to implement needle and syringe exchange programs in its prisons. Pushing for prison-based needle and syringe exchange programs has been an ongoing debate in Canada since at least 1999, when the healthcare advisory committee of Correctional Service Canada first reported significant benefits to implementing these needle exchange programs. Seventeen years later, no federal or provincial prison in Canada offers any safe injection initiatives. Now, some 250 organizations across Canada are petitioning both the federal and provincial governments to implement these programs immediately. .... The most recent statistics from Correctional Service Canada are close to a decade old, but broadly point to 10 times higher HIV rates and 30 times higher hepatitis C rates in federal prisons compared to the general population. Current harm reduction strategies in federal prisons include methadone treatment, the distribution of condoms to inmates, and providing bleach for disinfecting needles and syringes. “The funny thing is they provide bleach to help clean needles,” says Sandra Ka Hon Chu, director of research and advocacy at the Canadian HIV/AIDS Legal Network. “So there’s an acknowledgment that injection drug use is happening — they just stop short of needle syringe programs.”

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Legalize the sex trade

National Post  print

2013-06-11

This Thursday, the Supreme Court of Canada is set to hear Bedford vs. Canada, a case on the constitutionality of criminal laws governing sex work. The case, brought forward by three sex workers — Terry-Jean Bedford, Amy Lebovitch, and Valerie Scott — is a direct result of the refusal of consecutive federal governments to respond to enormous volumes of evidence that these laws do more harm than they prevent. The science is unequivocal: criminalization of sex work in Canada, and globally, has been an abject failure in protecting sex workers from violence, predation and murder, and has exacerbated vulnerability to HIV and other health inequities among sex workers. While the buying and selling of sex between consensual adults has never been illegal in Canada, criminal laws prohibit working together indoors, owning or renting an indoor place for sex work, living off the avails of prostitution, or communicating in public spaces for the purposes of sex work by sex workers, clients or third parties. Together, these laws make it virtually impossible for a sex worker to work legally, even though the act itself is not forbidden. Evidence has consistently shown that these criminal laws engender stigma, force sex workers to work in isolated and hidden spaces, and prevent access to basic health and support services, including legal and social protections. Indeed, Justice Susan Himel’s landmark ruling for the Ontario Superior Court, striking down the challenged criminal laws, was based on a large body of expert evidence that laid bare the striking hypocrisy in Canada’s approach to purportedly protecting some of our most marginalized citizens. Justice Himel’s ruling concludes: “By increasing the risk of harm to street prostitutes, the communicating law is simply too high a price to pay for the alleviation of social nuisance.” Enforcement of the communicating law displaces sex workers to isolated areas and forces them to rush transactions with clients for fear of arrest, limiting sex workers’ ability to screen clients or safely negotiate the terms of transactions and condom use. The failure of criminalization was made most evident by the devastating legacy of the missing and murdered women in Vancouver, most of whom were sex workers struggling with poverty and addictions, aboriginal sex workers and other vulnerable populations. Moral and political ideologies are an unconscionable substitute for evidence-based public policy on sex work in Canada.

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Sex work, rights and health: Bill C-36's glaring omission

Rabble  online

2014-07-28

This month's Justice Committee hearings concerning Bill C-36, the Conservative government's proposed sex work legislation, missed a critical mark. While important issues ranging from the bill's constitutionality and impact on sex workers' experiences of violence, to its impact on sex trafficking and police powers were discussed, dissected and debated, there was a very notable oversight: almost no one was talking about the health of sex workers -- and their right to it. This omission is hugely concerning. We already know that sex workers, lawyers and researchers are consistent in their shared view that Bill C-36 would reproduce all the devastating harms of the laws struck down in 2013 by the Supreme Court of Canada, and replace one unconstitutional regime with another. But the human right to health for sex workers in our country must be more carefully explored. Thankfully, a groundbreaking study launched at the International AIDS Conference in Melbourne, Australia could prove a game-changer, if Canada decides to be smart about its sex work laws. This global study concludes that decriminalizing sex work could avert nearly one-third of new HIV infections among sex workers and their clients over the next decade, a finding that is counter to the oft-cited argument that criminalizing sex work in any form protects sex workers. Among the study's findings were that laws criminalizing sex work, and the accompanying police harassment, force sex workers to rush transactions with their clients, forgo condoms or engage in risky sexual practices. These laws displace sex workers to secluded areas, where they have less ability to control the clients they see or the sexual acts in which they engage. They are also less able to insist on condom use.

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How intimate partner violence affects women living with HIV

CATIE  online

2016-08-02

A global study released last year revealed alarming figures concerning women living with HIV and violence. Among 945 women living with HIV from 94 countries who participated in the study, 89 per cent reported having experienced or feared violence before, since and/or because of their HIV diagnosis. Violence they experienced was reported to be higher after HIV diagnosis from their intimate partner and others in their social network. [1]The troubling nexus between HIV and gender-based violence spurred the Canadian HIV/AIDS Legal Network, HIV & AIDS Legal Clinic Ontario and METRAC to produce a legal information guide for women living with HIV who are facing — or at risk of — “intimate partner violence” — that is, physical, sexual or psychological harm from a current or former partner or spouse. In addition to being an exceedingly common experience among women living with HIV, intimate partner violence and HIV are both stigmatized, isolating people who are affected. Intimate partner violence also increases women’s vulnerability to HIV. Women who have violent partners are more likely to have forced sex, are less likely to negotiate condom use, and are more likely to be abused when they insist on condom use— which poses greater risks of HIV transmission. Fear of violence can also influence whether some women get tested for HIV, and can act as a barrier to HIV prevention services, including treatment to prevent vertical HIV transmission (i.e., when HIV is passed from an HIV-positive woman to her baby during pregnancy, labour and delivery or breastfeeding). Because women access more health services than men and are often tested for HIV during pregnancy, it is not uncommon for women to know their HIV status before their partners and in some cases, to be accused of ‘bringing HIV into the home’ — which can intensify existing violence, or trigger new abuse. Not surprisingly, some women are afraid to tell their partners that they are HIV-positive because they fear that their partner will be violent. HIV itself can also be used against a woman as a tool for abuse. A woman living with HIV may stay in an abusive relationship because she fears that her partner will disclose her status to others, or her partner will make false allegations that she did not disclose her HIV-positive status – which has very serious criminal repercussions in Canada.

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AIDS conference told legalizing prostitution a simple way to curb HIV

CBC  online

2014-07-22

As HIV scientists, advocates and patients gather at the International AIDS Conference in Melbourne this week, there is an increasing focus on the role that the criminalization of sex work is playing in the worldwide epidemic. Experts say laws that prohibit prostitution are hampering efforts to control the global HIV epidemic. During the opening session of the conference, the executive director of the joint United Nations program on HIV/AIDS, Michel Sidibé, chided governments for criminalizing sex work. "We cannot run away from the harm caused by criminalizing populations," Sidibé said. "We must implement the recommendations of the Global Commission on HIV and the Law." That UN-convened commission found that making any part of prostitution illegal, whether it be the buying or selling of sex, makes workers less able to protect themselves from infections or seek treatment if they become infected. It's a conclusion supported by a large body of research evidence, including now a series of seven papers on HIV and sex workers published this week by the medical journal Lancet. One of the articles analyzed published studies on HIV rates among sex workers, condom use and other data from three cities — in India, Kenya and Vancouver. Author Steffanie Strathdee of the University of California, San Diego said it's clear sexual violence against female prostitutes and the criminalization of their work make them less likely to use condoms. Eliminating sexual violence would avert an estimated 17 per cent of infections in Kenya and 20 per cent in Canada by creating safer working conditions in which sex workers could demand clients use condoms, she said. But her team showed that decriminalizing sex work would have a far bigger impact in reducing transmission. "We've shown that up to 46 per cent of incident HIV infections could be averted in any of the three cities we examined by just fully decriminalizing prostitution," she said. Sandra Ka Hon Chu is co-director of research and advocacy with the Canadian HIV/AIDS Legal Network in Toronto, which opposes Canada's proposed new prostitution legislation. The bill before Parliament would make it illegal to buy sex, and is expected to receive third reading in the Commons this fall. Chu is among more than 220 legal specialists and advocates who've written an open letter to the prime minister to reconsider the bill. She said its effect will be to create the conditions that lead to riskier sex and more HIV infections.

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New Zealand’s model of sex work respects rights

Toronto Star  online

2013-06-11

The Supreme Court of Canada’s looming consideration of the constitutionality of laws governing prostitution has led to vigorous debate about the merits of the “Swedish model” of sex work as a means to address the harms sex workers currently face. This model — underpinned by a philosophy of eradicating the demand for sex work and the view that all prostitution is inherently a form of violence against women — criminalizes the purchase of sex and those who “promote” sex work, including sex workers themselves. Evidence from Sweden, however, reveals that the law perpetuates rather than addresses stigma, discrimination and violence against sex workers. Since its passage, street sex workers in Sweden have reported increased experiences of violence. Regular clients have avoided them for fear of police harassment and arrest, instead turning to the Internet and to indoor venues. In turn, greater competition for clients has driven prices down and forced sex workers to accept clients they would have otherwise refused, including those who insist on unsafe sex practices. When safer sex practices are being negotiated, both clients and sex workers must do so rapidly and often with unclear communication and in more secluded locales, to avoid lingering for fear of arrest. Sex workers who work indoors continue to be criminalized and are unable to work or live with others, including their partners, since it is illegal to share in any income derived from sex work. More broadly, sex workers are unable to access social security benefits that are available to all other workers in legal labour activities. As in Canada, the Swedish model wrests control from sex workers over their working conditions and institutionalizes an adversarial relationship between sex workers and the police.

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Condoms for sex work: protection or evidence?

CMAJ  print

2014-05-28

The goals of public health departments don’t always coincide with those of police departments, a situation health advocates for sex workers have been concerned about for some time. “On the one hand, you have public health, which is handing out condoms to sex workers, and on the other hand, you have police confiscating them,” says Sandra Ka Hon Chu, co-director of research and advocacy at the Canadian HIV/AIDS Legal Network. “It’s just cancelling out the benefits of condom distribution, which is absolutely essential for sex workers health.” Confiscating multiple condoms from an individual as evidence of prostitution appears to be a fairly common and widespread practice.

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Canada should implement prison-based needle and syringe programs: Researchers

Metro  online

2016-02-12

OTTAWA — The Liberal government should implement prison-based needle and syringe programs to address rates of HIV and hepatitis C estimated to be 10 to 30 times higher than in the general population, proponents say. Emily van der Meulen of Ryerson University, the lead author of a recent study, said she wants to see the government review evidence on the effectiveness of programs that have operated in countries like Switzerland for more than 20 years. "I'm hopeful that the government will look to this evidence, as well as to our recent research report," she said. The issue is about health and human rights, she noted, adding that prisons where such programs have been implemented have seen substantial benefits, including reduced rates of needle-sharing and overdoses. It would also be cost-effective, she said. "The costs associated with HIV and hepatitis C virus are very high in prison — roughly $30,000 per year for HIV treatment and about $60,000 for hepatitis C," she said. "Research has shown that needle and syringe programs are among the most cost-effective health measures for people who use drugs, whether in the community or in prison." Canada lags behind on implementing such programs, said Sandra Ka Hon Chu of the Canadian HIV/AIDS Legal Network. "We have the resources in Canada to implement these programs," she said. "We have the evidence in Canada to implement these programs. There are many groups across the country who support these programs." As the implementation push continues, the issue is playing out in court.

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On Point: making prison needle and syringe programs work in Canada

On Point: making prison needle and syringe programs work in Canada  Toronto

2014-01-23

Evaluating Advocacy

Nonprofit Driven 2016  Toronto

2016-10-20

Sex Work Law Reform in Canada: Considering problems with the Nordic model

2013-10-01

The Nordic model is a piece of legislation, passed in Sweden in 1999, which criminalizes the purchase of sex. In Canada, exchanging sex for money is not illegal, but virtually every activity associated with prostitution is. Following the Ontario Court of Appeal’s decision in Bedford v. Canada, the question of what type of legislation is most appropriate with respect to prostitution has become even more important. This article begins by evaluating the degree of success (or lack thereof) of the Nordic model. The article then goes on to determine whether legislation similar to the Nordic model would be constitutional if adopted in Canada.

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TRAGEDY AND TRIUMPH: RWANDAN WOMEN’S RESILIENCE IN THE FACE OF SEXUAL VIOLENCE

2011-09-01

When we first met Jeanette Uwimana in Rwanda almost three years ago she was living day to day, having been widowed by the Rwandan genocide in 1994. Although she received care and support from Solace Ministries, a Rwandan grassroots organisation run by genocide survivors, she continued to experience physical and psychological trauma resulting from her brutal experiences of sexual violence during the genocide. At the same time, Jeanette, whose formal education was disrupted during the genocide, struggled to support her children. Her prospects were bleak but she told us that she dreamed of one day running her own business. Sadly, Jeanette’s story is not unusual. More than seventeen years ago, an estimated 250,000 to 500,000 women in Rwanda were raped during a genocide that also saw the murder of about one million people. An estimated seventy percent of women who survived rape were infected with HIV—sometimes deliberately. Many of those women were abandoned by their husbands and isolated by their communities. In spite of the many pressing and ongoing needs of survivors of sexual violence, inadequate attention has been paid to them. The prosecution of rape, both internationally and nationally, has rarely been a priority, while a government-administered fund in Rwanda to compensate genocide survivors is overburdened and does not specifically provide for survivors of sexual violence.

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