Taking action to reduce injecting drug‐related harms in prisons: The evidence of effectiveness of prison needle exchange in six countries

Abstract

This article examines the issue of prison needle-exchange programmes (PNEP) based upon the international experience and evidence in six countries. A review of existing literature was undertaken together with original research comprising site visits to prison needle-exchange programmes in four countries operating such initiatives in October 2002. During the course of the research, prison needleexchange programmes were initiated in two other countries, Kyrgyzstan and Belarus. Site visits were not possible in respect of these two countries, and data was gathered via conversations with staff and funding organisations involved and by the examination of documentary evidence. The paper presents an overview of the PNEP initiated and a commentry on the outcomes. Based upon the evidence emerging from the investigation, the paper concludes that while prison syringe-exchange programmes have been implemented in diverse environments and under differing circumstances, the results of the programmes have been remarkably consistent. Improved prisoner health and reduction of needle sharing have been achieved. Fears of violence, increased drug consumption, and other negative consequences have not materialised. Based on the evidence and experience, it can be concluded unequivocally that prison needle-exchange programmes effectively address the health-related harms associated with needle sharing in prisons and do not undermine institutional safety or security.

The harm inside: Injection during incarceration among male injection drug users in Tijuana, Mexico

“…Although the WHO, UNAIDS and UNODC recommend that prisoners be afforded at least the same access to sterile syringes as they would have in the community (United Nations office on Drugs and Crime, 2006), we are not aware of any prison-based syringe exchange programs currently operating in Mexico. These programs have been proven effective elsewhere in reducing syringe sharing behind bars without unintended negative consequences (Dolan et al, 2003; Lines et al, 2005; Stöver, 2003), and their implementation in correctional facilities should be a priority for HIV prevention efforts in Mexico. Since HIV prevalence is currently only 3% among male IDUs in Tijuana (Strathdee et al, 2008a), there is ample opportunity to intervene by re-initiating SEPs and establishing drug treatment programs within the correctional system.…”

“…Despite recommendations by the WHO, the Joint United Nations Program on HIV/AIDS (UNAIDS), and the United Nations Office on Drugs and Crime (UNODC) that prisoners be afforded at least the same access to sterile syringes as they would have in the community (United Nations office on Drugs and Crime, 2006), prison-based syringe exchange programs (SEPs) remain relatively rare. The majority of prison-based SEPs are located in Western Europe (e.g., Switzerland, Germany, Spain), although some have been initiated in former Soviet Republics such as Moldova, Kyrgystan, and Belarus (Davies, 2004; Dolan et al, 2003; Lines et al, 2005). In areas where prison-based SEPs have been established, these programs are considered to be of insufficient size or number to meet demand.…”

Governing Health Risk by Buying Behaviour

“…Controversial projects such as the US government's President's Emergency Plan for AIDS Relief (PEPFAR) initiative and funding from religious denominations such as the Catholic Church has seen an abundance of abstinence‐based policies and little awareness or promotion of condom use as a key tool in prevention strategies (Harman, 2010). Needle exchanges are not widespread globally and only minimally used within prisons as pilot projects, prison‐specific projects or a national policy in under ten countries (Harm Reduction Coalition, 2007; Lines et al ., 2006). While extreme, these policies represent a general unwillingness to recognise or discuss sexual intercourse, reproduction and pleasure within the global HIV/AIDS response.…”

The Prison Economy of Needles and Syringes: What Opportunities Exist for Blood Borne Virus Risk Reduction When Prices Are so High?

“…The risk of acquiring blood borne viruses (BBVs) such as hepatitis C (HCV) and HIV via injecting drug use in prison is well established [ 1 , 2 ], given the lack of access to sterile equipment for drug injecting in most prisons in the world [ 3 , 4 ]. Indeed, prison needle exchange remains a highly controversial program even after a 20 year history [ 5 ].…”