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

Injection drug use and high rates of HIV and HCV infection among prisoners are not
unique to these six countries. Many countries, including Canada, are faced with HIV and
HCV prevalence rates within prisons that are many times higher than those in the general
population. In many countries the high rates of these bloodborne
infections in prisons are attributable to a large extent to injection
drug use both in the community and inside the prison itself.
Throughout most of the world, the primary response to problems
associated with illicit drug use has been to intensify law enforcement
efforts. The result has been an unprecedented growth in prison
populations and the incarceration of increasing numbers of people
who use illicit drugs. Despite the fact that drug use and possession
is illegal in prisons, and despite prison systems’ efforts to prevent drugs from entering the
prisons, drugs remain widely available. Many people enter prison with drug habits, while
others begin consuming drugs while in prison as a means of coping with the prison environment.
This report focuses on prison needle exchange programs, which represent a reasoned
public health response to harms associated with injection drug use and the sharing of
syringes (and even home-made injecting equipment) within prisons.
Due to the closed nature of prisons, the health of prisoners is an issue that rarely comes
to the attention of the public at large. However, the health of prisoners is an issue of public
health concern. Everyone in the prison environment – prisoners, prison staff, or their family
members – benefits from enhancing the health of prisoners and reducing the incidence of
communicable disease. Measures to decrease the risk of HIV and HCV transmission, including
measures to minimize accidental exposure to these bloodborne
The world’s first distribution
of injection material inside
prison began as an act of
medical disobedience.
infections, make prisons a safer place to live and work. The high
degree of mobility between prison and community means that communicable
diseases and related illnesses transmitted or exacerbated
in prison do not remain there. When people living with HIV and
HCV are released from incarceration, prison health issues necessarily
become community health issues.
Prison presents a prime opportunity to respond to behaviours that pose a high risk of HIV
and HCV transmission, such as needle sharing, using proven public health measures such as
needle exchange programs. Prison authorities and elected officials responsible for prisons
also have a legal responsibility to respect, protect, and fulfill prisoners’ right to the highest
attainable standard of health. In the context of the HIV epidemic and the transmission of
HCV in prisons, prisoners’ right to health includes access to measures to protect themselves
from infection (or re-infection) with HIV and HCV, including needle exchange programs.
Where authorities and officials fail in this duty they put the health not only of prisoners but
of the entire community at risk.
The health of prisoners
is an issue of
public health concern.
A note on the use of terms
The term “needle exchange” is used to refer to the one-for-one exchange of a used needle
for a sterile needle, as well as to the distribution of sterile needles without exchange. Unless
otherwise indicated explicitly or by context, the terms “needle” and “syringe” mean a device
used to inject fluids into the body, and are used interchangeably throughout the report.
2 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience