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

• 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;
• reduce risk behaviour and disease (including HIV and HCV) transmission;
• have other positive outcomes for the health of prisoners;
• 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.
Recommendation
This report makes one recommendation, directed at government and prison officials in
Canada: Both federal and provincial/territorial correctional services in Canada should immediately
take steps to implement multi-site pilot needle exchange programs. Although the last
chapter (“Needle Exchange Programs Should Be Implemented in Prisons in Canada”) focuses
on Canada, this recommendation also applies to other countries in which prison systems
face HIV and HCV epidemics driven by injection drug use.
What does this report contain?
The first chapter (Prisoner Health Is a Public Health Issue) provides an introduction to the
issue of prisoner health and needle exchange in prisons in the context of injection drug use,
HIV, and HCV in prison. The second chapter (Methodology) reviews the methods used to
gather evidence for the report. The third chapter (HIV and HCV Epidemics in Prison) summarizes
evidence of HIV and HCV prevalence, injection drug use, and needle sharing in
prisons worldwide. The Canadian evidence is reviewed in greater detail. The fourth chapter
(Human Rights and Legal Standards) sets out the human rights, legal standards, and guidelines
relevant to injection drug use, HIV, and HCV in prisons. The legal obligation of governments
to respect, protect, and fulfill prisoners’ right to health, including the right to preventive
health measures, is examined. The specific legal context in Canada is also examined.
The fifth chapter (Review of International Evidence of Prison Needle Exchange) reviews the
experience and evidence from the six above-mentioned countries with prison needle
exchange programs that were studied for this report – Switzerland, Germany, Spain,
Moldova, Kyrgyzstan, and Belarus. For each country the review includes, where available,
epidemiological information about HIV and HCV, both in the general population and in
prison; a history of the prison system’s response to HIV and HCV; a review of prison needle
exchange programs, including historical information, evaluations, and lessons learned;
the current situation; and future directions.
The sixth chapter (Analysis of the Evidence) draws on the evidence from the literature
review and prison visits to present the findings concerning prison needle exchange programs.
The seventh chapter (Needle Exchange Programs Should Be Implemented in Prisons in
Canada) draws on the findings from the previous chapter to present the case for the implementation
of needle exchange programs in federal and provincial/territorial prisons in
Canada. The eighth and final chapter (Conclusion: A call for leadership on prison needle
exchange programs) calls for leadership on the issue from elected officials, prison authorities,
individual prison staff (both correctional staff and health service staff), and outside
physicians who work in prisons.
Executive Summary xi