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

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• 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
Next steps This report will be sent to a broad range of individuals and organizations working in areas of prisons, injection drug use, and harm reduction and/or HIV/AIDS and hepatitis C, both in Canada and internationally. It will also be sent to appropriate government policymakers in Canada, such as ministers responsible for corrections and justice, and unions and organizations of health-care workers involved in prison issues. The Canadian HIV/AIDS Legal Network is a member of two Canadian prison, HIV, and hepatitis C groups: the Prisons HIV/AIDS and Hepatitis C Networking Group and the Prison HIV/AIDS & Hepatitis C Research & Advocacy Consortium. We will work with the other members of these groups to advocate for the implementation of prison needle exchange programs in federal and provincial/territorial prisons in Canada. For further information… Contact Glenn Betteridge at the Canadian HIV/AIDS Legal Network through the Network’s office in Toronto at tel +1 416 595-1666, fax +1 416 595-0094, email: info@aidslaw.ca. Or contact him directly by email at gbetteridge@aidslaw.ca. Further copies of this report can be retrieved from the website of the Canadian HIV/AIDS Legal Network via www.aidslaw.ca/Maincontent/issues/prisons.htm, or ordered through the Canadian HIV/AIDS Information Centre at tel + 1 613 725-3434 (toll free: + 1 877 999- 7740), fax +1 613 725-1205, email: aidssida@cpha.ca. xii 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 10 and 11: Prison Needle Exchange: 2006 update
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 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
Page 60 and 61: the prisoners who were injecting, a
Page 62 and 63: Kyrgyzstan 218 Summary Kyrgyzstan i
Page 64 and 65: of 20% to 40%. However, these treat
Page 66 and 67: working place, it is interesting to
Page 68 and 69: 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
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Shapshak P, RK Fujimura, JB Page, D
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