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

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While harm-reduction policies do not condone illegal drug use, they do recognize that reducing the transmission of bloodborne diseases and overdose deaths in society is a more urgent and achievable goal than is ending illegal drug use. As drug users are often isolated from health services, harm-reduction initiatives such as needle exchange and methadone maintenance programs also create important links between health professionals and these marginalized communities, thus enabling drug users to maintain and improve their overall health status. Already in 2001, there were over 200 needle exchange sites operating in communities across Canada. 75 While many governments have recognized the value of needle exchange programs and supported their implementation in the community, few have made efforts to extend the availability of these programs to prisoners. Some jurisdictions, including most Canadian jurisdictions, have recognized the risks associated with injection drug use and have implemented limited harm-reduction measures in prisons, such as bleach distribution and/or methadone maintenance treatment. 76 Unfortunately, most countries continue to fail to act in a pragmatic and decisive manner to protect the health of prisoners who engage in behaviours that put them at risk of HIV and HCV infection. According to UNAIDS: “Whether the authorities admit it or not – and however much they try to repress it – drugs are introduced and consumed by inmates in many countries…. Denying or ignoring these facts will not help solve the problem of the continuing spread of HIV.” 77 The experience of health services in many countries, as well as in many prison systems internationally, demonstrates that harm reduction provides the framework for effective action to prevent the transmission of HIV and HCV in prisons. Harm-reduction policies do not condone illegal drug use. They recognize that reducing the transmission of bloodborne diseases and overdose deaths is a more urgent and achievable goal than is ending illegal drug use. HIV and HCV Epidemics in Prison 13
Human Rights and Legal Standards Numerous international instruments address the rights of prisoners and prisoners’ access to health services. These international instruments are relevant in the context of injection drug use and HIV/AIDS and HCV transmission in prisons. Taken together, these laws, rules, guidelines, and standards are an expression of the norms that should guide decision-makers, both legislators and prison authorities. It is important to distinguish between two general categories of instruments that protect rights, as each has different implications for governments. International human rights law is binding on governments; international rules, standards, and guidelines are not law, and are therefore not binding on governments. International human rights law Human rights are legally guaranteed under existing human rights laws adopted by international bodies. They protect all humans, both groups and individuals, against actions that interfere with their fundamental freedoms and human dignity. Human rights are primarily concerned with the relationship between a person or groups of people and the state, and impose obligations on states to respect, protect, and fulfil certain fundamental rights. The community of nations has recognized that all human rights are universal, interdependent, and interrelated. 78 States have a duty, regardless of their political, economic, and cultural systems, to protect and promote human rights. Numerous international laws, while general in nature, are relevant to the rights of prisoners in the context of HIV/AIDS epidemic: • International Covenant on Civil and Political Rights 79 • International Covenant on Economic, Social and Cultural Rights 80 • African Charter on Human and Peoples’ Rights 81 • American Convention on Human Rights 82 14 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 20 and 21: • do not endanger staff or prison
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 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
Page 70 and 71: grams strongly reduced syringe shar
Page 72 and 73: proven effective in barracks-style
Page 74 and 75: • Prison has opportunity to maint
Page 76 and 77: staff, is also an indication of the
Page 78 and 79: Needle Exchange Programs Should Be
Page 80 and 81: professor of Aboriginal ancestry; a
Page 82 and 83: contained and standards presented i
Page 84 and 85:
sophically supportive of the use of
Page 86 and 87:
• do not increase drug consumptio
Page 88 and 89:
the case in countries, including Ca
Page 90 and 91:
15 Central and Eastern Europe Harm
Page 92 and 93:
67 R Keppler, F Nolte, H Stöver.Tr
Page 94 and 95:
121 Australian National Council on
Page 96 and 97:
180 Delegación del Gobierno para e
Page 98 and 99:
245 Ibid at 14. 246 This analysis i
Page 100 and 101:
Bibliography International instrume
Page 102 and 103:
Byrne A, K Dolan. Methadone treatme
Page 104 and 105:
2000). Elementos Clave para la Impl
Page 106 and 107:
Landry S et al. Étude de prévalen
Page 108 and 109:
Shapshak P, RK Fujimura, JB Page, D
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