New Report Shows Benefits of Prison Needle Exchange

As the number of prisoners living with HIV/AIDS and/or hepatitis C in prisons continues to increase, a new report by IHRD grantee Canadian HIV/AIDS Legal Network concludes that prison needle exhange programs are an effective harm-reduction measure.

Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience, the first comprehensive review of prison needle exchange programs worldwide, calls upon prison systems and health ministries in countries that have not yet introduced prison needle exchange programs to at least start pilot studies of such programs, in order to protect prisoners, prison staff, and the public from the further spread of blood-borne infections in prisons.

“Prisoners come from the community and most return to it. What is done - or not done - in prisons with regard to HIV/AIDS, hepatitis, and drug use therefore has an impact on the health of all. Health ministries must work in close collaboration with correctional systems to ensure that the health of all, including prisoners, is protected and promoted,” said Ralf Jьrgens, the Legal Network’s executive director and one of the authors of the report.

“Drug use, including injecting drug use, is a reality in prisons around the world. Over the last ten years, prisons in many countries have increased their efforts to keep drugs out. Nevertheless, drugs get through even the thickest walls,” said Michael Linhart, a former prisoner living with AIDS. “I have seen how prisoners share dirty needles because they don’t have access to clean ones. Many prisoners never shared before they came to prison, and are at great risk of being infected with HIV and hepatitis C in prison,” he added.

“Needle exchange programs have been operating with government funding in many countries since the late 1980s. They are generally regarded as one of the most important factors in preventing HIV epidemics among injection drug users,” added Thomas Kerr, a Research Associate with the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada . “Despite this, and although many international experts have been calling for prison needle exchange programs for over ten years, many prison systems have not yet introduced and evaluated this pragmatic public health measure.”

The Legal Network’s report shows that the number of prisoners infected with HIV and hepatitis C is very high in many countries. “In Canadian federal prisons, 14 cases of HIV/AIDS were known in 1989. In April 1994, 109 cases were known, and in 2002, 251. Today, one out of 50 prisoners is known to be HIV-positive. In provincial prisons in Canada, rates are also very high: studies have shown HIV prevalence rates ranging between 1 and 8.8 percent,” said Jьrgens. Some prison systems in Western Europe (including Portugal , Spain , Italy and Switzerland ) have reported even higher rates. In Eastern Europe, rates are particularly high in Russia, Lithuania, and Ukraine . In South Africa, 41 percent of prisoners are reported to be HIV positive, and high rates have also been found in Latin America and in certain parts of the United States, where rates approach 10 percent among men and 15 percent among women. Hepatitis C prevalence rates are even higher. In many countries, studies have shown rates of 20 to 80 percent among prisoners.

The Network’s report is the first comprehensive review of prison needle exchange programs worldwide. The authors from Canada, Germany, Switzerland, Moldova, and Ireland undertook a literature review, visited prisons in four countries, and corresponded with people responsible for administering prison needle exchange programs. The report concludes that the experience and evidence from the six countries where prison needle exchange programs existed as of April 2004 ( Switzerland, Germany, Spain, Moldova, Kyrgyzstan, and Belarus ) have demonstrated that such programs:

• reduce risk behaviour and disease (including HIV and HCV) transmission;
• have other positive outcomes for the health of prisoners;
• do not endanger staff or prisoner safety, and in fact, make prisons safer places to live and work;
• do not increase drug consumption or injecting;
• have been effective in a wide range of prisons; and
• have successfully employed different methods of needle distribution to meet the needs of staff and prisoners in a range of prisons.

“In light of this evidence, there no longer are any good reasons to deny prisoners who inject drugs access to clean needles. This does not condone their drug use. Rather, it is a pragmatic public health measure that should accompany other efforts to reduce harms related to drug use, such as drug treatment programs, including methadone maintenance,” concluded Ralf Jьrgens.

The Legal Network has a long history of analyzing issues related to HIV/AIDS, hepatitis C, and drug use in prisons. In reports released in 1996 and 2002, the Network called upon governments to implement a comprehensive strategy to fight HIV/AIDS and hepatitis C behind bars. The Network’s recommendations have been supported by many other organizations, including the World Health Organization and UNAIDS. Today, coinciding with the release of the Network’s report, the Ontario Medical Association released a report in Toronto, Canada, that also calls on Canadian governments to introduce prison needle exchange programs.

Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience and the Network’s previous reports on HIV/AIDS in prisons, are available on Canadian HIV/AIDS Legal Network website.