Prison Needle Exchange: Lessons from a Comprehensive Review ...

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Prison Needle Exchange: 2006 update to first edition This section updates developments since April 2004, when the first edition of Prison needle exchange: lessons from a comprehensive review of international experience and evidence was completed. There have been a number of significant developments, both in Canada and internationally, which support the evidence, analysis and findings presented in the first edition of the report. Internationally, we present and review evidence from existing prison needle exchange programs (PNEPs) and report on additional countries that have implemented or are planning to implement such programs. Regarding Canada, we review research concerning the association between injection drug use, incarceration and the transmission of blood-borne pathogens. We report on recent recommendations from the medical community and a prison ombudsperson calling for pilot PNEPs, and on initiatives within the Canadian government to study the feasibility of piloting PNEPs. International developments The six countries featured in the previous edition of the report The first edition of the report examined PNEPs in Switzerland, Germany, Spain, Moldova, the Kyrgyz Republic and Belarus. There is new information or documentation relating to the experiences in five of those countries. • In Switzerland, as of 2006, distribution of sterile needles was being undertaken in seven prisons in different parts of the country. 1 • An article published in December 2005 reports findings from one of the most systematic studies undertaken to date on the effectiveness of needle exchange programs. 2 2006 update to first edition i
The study was carried out in two prisons in Germany from October 1998 to June 2001 — a men’s prison and a women’s prison in Berlin. Any prisoner who had ever used illegal drugs was eligible to participate in the study. Study participants were tested for HIV, the Hepatitis B virus (HBV) and the hepatitis C virus (HCV) when they enrolled and at four-month intervals thereafter, making this one of the only studies to rigorously examine the relationship between prison needle exchange and seroconversion. Needles were distributed by automatic dispensing machines in the women’s prison and by a non-governmental organization using hand-to-hand exchange in the men’s prison. • Of the 213 people who were incarcerated in the two prisons during the study period, 174 participated in the study. Of the participants, 91 percent reported injecting in the six months prior to their enrolment. Seventy-one percent of prisoners who had previously injected in prison reported syringe sharing in prison prior to their enrolment in the study. Significantly, injection drug use during a term of imprisonment prior to the study period was found to be an independent predictor of HIV and HCV infection. • During the course of the study, 67 percent of women and 90 percent of men continued to inject, with reported injection of both heroin and cocaine. However, the authors report “an impressive reduction of syringe sharing”: syringe sharing decreased to 11 percent at month four of the study, two percent at month eight, and zero percent in subsequent follow-ups. During the course of the study, no HIV or HBV seroconversions were observed. However, four out of 22 people who were HCV negative at the outset of the study seroconverted. Three of these prisoners reported sharing paraphernalia in the preparation of drugs. • There were no adverse events (e.g. overall increase in injection drug use, violence involving needles against staff or other prisoners) observed during the study period. The limitation of the study was the relatively short time during which follow-up was conducted (a median of 12 months), which did not allow the authors to assess longterm preventative effects of the needle exchange program. • In Spain, as of late 2005, needle exchange programs were operating in 38 prisons. 3 • In the Republic of Moldova, it has recently been reported that the total number of syringes exchanged has grown from 3650 in 2000–2001 to 37 813 in 2003–2004 and 61 433 in 2004–2005. 4 Moreover, prisons with needle exchange programs report few incidents of needle sharing. 5 • Further documentation of the Kyrgyz Republic’s experience with prison needle exchange was published in 2005 6 A number of evaluations of prison needle exchange programs in different countries have now been reported. The results are summarized in the table below. ii Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience
Page 2 and 3: Prison Needle Exchange: Lessons fro
Page 4: In memory of Andréa Riesch Toepell
Page 7 and 8: Spain 29 Summary 29 HIV/AIDS, HCV,
Page 12 and 13: Sample Evaluations of Prison Needle
Page 14 and 15: initiatives occurring in local comm
Page 16 and 17: ings on the feasibility and efficac
Page 18 and 19: Executive Summary This report exami
Page 20 and 21: • do not endanger staff or prison
Page 22 and 23: Prisoner Health Is a Public Health
Page 24 and 25: Methodology The evidence for this r
Page 26 and 27: HIV and HCV Epidemics in Prison Pre
Page 28 and 29: injection drug practices and unprot
Page 30 and 31: Many prisoners, whether in pretrial
Page 32 and 33: while in holding cells before incar
Page 34 and 35: While harm-reduction policies do no
Page 36 and 37: • Additional Protocol to the Amer
Page 38 and 39: fit from medical treatment under th
Page 40 and 41: Review of International Evidence of
Page 42 and 43: History of the response to HIV/AIDS
Page 44 and 45: in drug consumption, and there were
Page 46 and 47: lence rate of approximately 0.1% in
Page 48 and 49: ic acid, filters, plaster, and sodi
Page 50 and 51: harm-reduction measures and declare
Page 52 and 53: injection drug use, HCV infection r
Page 54 and 55: the jurisdiction of the government
Page 56 and 57: punished by prison staff for access
Page 58 and 59: changed to a peer model, which has
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the prisoners who were injecting, a
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Kyrgyzstan 218 Summary Kyrgyzstan i
Page 64 and 65:
of 20% to 40%. However, these treat
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working place, it is interesting to
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These findings demonstrate that the
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grams strongly reduced syringe shar
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proven effective in barracks-style
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• Prison has opportunity to maint
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staff, is also an indication of the
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Needle Exchange Programs Should Be
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professor of Aboriginal ancestry; a
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contained and standards presented i
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sophically supportive of the use of
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• do not increase drug consumptio
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the case in countries, including Ca
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15 Central and Eastern Europe Harm
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67 R Keppler, F Nolte, H Stöver.Tr
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121 Australian National Council on
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180 Delegación del Gobierno para e
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245 Ibid at 14. 246 This analysis i
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Bibliography International instrume
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Byrne A, K Dolan. Methadone treatme
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2000). Elementos Clave para la Impl
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Landry S et al. Étude de prévalen
Page 108 and 109:
Shapshak P, RK Fujimura, JB Page, D
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