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

Prisoner Health Is a Public
Health Issue
In 1992, Dr Franz Probst was faced with a dilemma. A part-time physician at the
Oberschöngrün prison for men in the Swiss canton of Solothurn, Dr Probst knew that more
than 20 percent of the prisoners in the institution injected drugs. He also knew that these men
had no access to sterile syringes and, as a result, were sharing syringes by necessity. As
described by Nelles and Harding,
Unlike most of his fellow prison doctors, all of whom fe[lt] obliged to compromise
their ethical and public health principles daily, Probst began distributing
sterile injection material without informing the prison director. When this courageous
but apparently foolhardy gesture was discovered, the director, instead of
firing Probst on the spot, listened to his arguments about prevention of HIV and
hepatitis, as well as injection-site abscesses, and sought approval from the
Cantonal authorities to sanction the distribution of needles and syringes. Thus,
the world’s first distribution of injection material inside prison began as an act of
medical disobedience. 1
More than 10 years later, this act of medical disobedience remains an innovative and effective
prison health-care initiative, and one that continues to highlight the failure of most prison
systems worldwide to effectively address HIV and hepatitis C virus (HCV) transmission via
injection drug use occurring within their walls. It is also a development that has inspired imitation,
not only in other Swiss prisons but in prisons in Spain, Moldova, Germany,
Kyrgyzstan, and Belarus. Although each of these countries deals with different social, political,
correctional, and health-care circumstances, each arrived at the conclusion that providing
sterile syringes to prisoners, while controversial, was necessary to prevent the transmission
of HIV and HCV.
Prisoner Health Is a Public Health Issue 1