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

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