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

Canadian developments
Further evidence of injection-related
risk behaviours during incarceration
In the past three years, researchers with the Vancouver Injection Drug Users Study (VIDUS)
have published a number of peer-reviewed articles that further illustrate the relationship
among injection drug use, imprisonment and HIV status. 12 Since its inception in 1996, the
VIDUS study has enrolled over 1500 people who inject drugs, over 1000 of whom report
that they have been incarcerated at least once since they first began injecting drugs. Of those
who had spent time in prison, 351 people reported that they had injected drugs while incarcerated.
13 A 2003 article reported that VIDUS study participants who had recently been
incarcerated were 2.7 times more likely to become HIV-positive than those who had not been
to jail or prison. 14 An external evaluation of the attributable risks reported in that study concluded
that 21 percent of the HIV infections among injection drug users in Vancouver were
likely acquired in prison. 15 The VIDUS researchers subsequently analyzed syringe sharing
in prison. 16 They found that incarceration in the six months prior to being interviewed was
associated with syringe lending by HIV-positive VIDUS study participants during that period.
Similarly, among HIV-negative participants, incarceration in the six months prior to
being interviewed was associated with syringe borrowing during that period.
VIDUS researchers have also published qualitative evidence regarding injection drug use
by VIDUS study participants during periods of incarceration. 17 The small-scale study of
recently released prisoners confirmed the previous reports that injecting within the prison
environment is characterized by a pattern of syringe sharing among large networks composed
of numerous individuals. The study also found that due to the scarcity of syringes,
and out of fear of not being able to obtain syringes from other prisoners, HIV-positive prisoners
conceal their status from injection partners. Study participants also indicated that
bleach distribution is an incomplete solution. Given the illegality of drug use and the possibility
of being caught by prison officials, drug injection is often hurried and prisoners generally
do not decontaminate needles with bleach because this would take too long to complete.
The authors conclude:
Considering the increasing prevalence of blood-borne viruses, the high levels of
syringe sharing documented and the fact that prison-based syringe exchange programs
have demonstrated positive impact in other contexts, the potential of a program
to provide sterile syringe access for Canadian inmates merits exploration. 18
Another peer-reviewed article, published in 2005, reports on a study of female prisoners in
a British Columbia institution in which both provincial and federal prisoners were incarcerated.
19 Of the 104 prisoners who participated in the study, 74 percent reported that their current
prison sentence was related to drug use, 94 percent reported illegal drug use prior to
incarceration, and 65 percent reported injection drug use prior to incarceration. Twenty-one
percent (22/104) of prisoners reported injection drug use inside prison; of this number, 91
percent (20/22) reported being HCV seropositive. Two prisoners reported being both HCV
and HIV seropositive. Nineteen of twenty-two prisoners who reported injecting while in
prison reported sharing a syringe with other prisoners, and three reported not cleaning used
syringes with bleach. Self-reported HIV and HCV infection rates among the prisoners were
8 percent and 25 percent, respectively. The authors conclude:
In British Columbia, as in the rest of Canada, imprisoned injection drug users are
not able to access sterile injection equipment, which undermines harm reduction
iv Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience