- © 2007 Canadian Medical Association or its licensors
In the wake of the release of a draft evaluation report indicating that a federal prison sterile tattooing pilot project was reducing potential exposure to infectious diseases like HIV and hepatitis C (HCV), questions continue to abound about the government's decision to axe the initiative.
Although the draft evaluation report on the tattooing pilot was censored by Corrections Canada's Access to Information and Privacy officials (including eliminating 1 of its 2 official recommendations), among the 10 findings was one stating that “the initiative has demonstrated potential to reduce harm, reduce exposure to health risk, and enhance the health and safety of staff members, inmates and the general public.”
Despite this endorsement, Public Safety Minister Stockwell Day cancelled the initiative (CMAJ 2007;176:307-8). In a letter to the media, he indicated that Correctional Service Commissioner Keith Coulter had recommended the 6 tattoo sites be closed and that correctional officers opposed the program, fearing they'd be assaulted with tattooing needles. Moreover, the draft evaluation “failed to conclusively determine that the health and safety of staff members, inmates and the general public would be protected by maintaining this program,” Day wrote.
But Canadian HIV/AIDS Legal Network spokesman Leon Mar says Day appears “to be reading a completely different document than what everyone else is reading.”
“We wanted to see this program run for a full year and then see, publicly, a report that evaluated the effectiveness of the program and then, a decision based on the evidence. Instead, what we've seen is a minister who has done not a good enough job explaining his rationale and has not made public, or been forthcoming about, the evidence he's used to make his decision to close down the program.”
“If the minister has clear evidence, then he needs to do a better job of explaining that to Canadian taxpayers,” Mar added.
The censored version of the report, crafted by the Correctional Service's evaluation branch and peer reviewed by the Public Health Agency of Canada, says the initiative was cost effective relative to the public health benefits but could be made even more so by charging inmates $14, rather than $5, for a 2-hour tattooing session, and by achieving operational efficiencies through measures like purchasing local supplies (such as ink) to decrease delivery charges.
From a public health perspective, the report states that reducing the risk of infection through sterile tattooing ultimately reduces the risk of infectious disease transmission to correctional officers and indeed, all Canadians once inmates are released to communities.
It further states that “Taking into consideration the cost of [medical treatment], the STPI [Safer Tattooing Practices Initiative] is cost-effective if one of every 38 tattoo sessions were to result in an ‚avoided' HCV infection, or if one of every 50 tattoo sessions resulted in an avoided HIV infection. Moreover, the Initiative is cost effective if one out of 248 sessions results in an avoided liver transplant.”
Although Coulter and the correctional officers union opposed the initiative, the report states that a survey of prison staff indicated most (64.8%) felt the pilot made the institution safer.