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

and in prisons; 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.
Switzerland
Summary
Switzerland has approximately 150 prisons spread across the 26 cantons that comprise the
Swiss federation. Although the penal code is federal, the administration of the prisons is the
responsibility of the government of the canton in whose territory the
institution is located. There are approximately 6000 prisoners in
Switzerland. The largest prison has a population of 350, although
the majority of prisoners are incarcerated in small institutions with
fewer than 100 prisoners.
In 1992 Switzerland became the first country to introduce a prison
needle exchange program. The initial program was started on an
informal basis by a physician at the Oberschöngrün men’s prison
who, ignoring prison regulations, began distributing sterile syringes
to patients who were known to inject drugs. In 1994 a formal needle exchange pilot project
was established in the Hindelbank women’s prison. After a successful trial and evaluation at
Hindelbank, needle exchange programs have been expanded to a total of seven Swiss prisons.
In 1992 Switzerland became
the first country to
introduce a prison needle
exchange program.
HIV/AIDS, HCV, and IDU in Switzerland
According to figures released by UNAIDS and the WHO in 2002, there are approximately
19,000 adults (aged 15 to 49) in Switzerland living with HIV or AIDS. This represents an
HIV prevalence rate in the general population of approximately 0.5%. The number of newly
diagnosed HIV infections declined in Switzerland between 1992 and 2000. People who
inject drugs comprised approximately 15% of positive HIV tests in 2000-2001. 122
Swiss drug policy began moving toward harm reduction during the late 1980s. During this
time, open injection drug scenes were a significant feature in cities such as Zurich and Berne.
In Needle Park, as it was known, in the Letten district of Zurich, thousands of people who
inject drugs congregated daily to openly purchase and inject heroin. Needle Park received
international media attention and led the Swiss government to adopt significant harm-reduction
programs, such as expanded needle exchange access, methadone and heroin maintenance,
safe injection facilities, and community health services for drug users. These interventions
successfully ended the open drug scenes and resulted in increased health benefits
for users. 123
HIV/AIDS, HCV, and IDU in Swiss prisons
Switzerland has not undertaken extensive HIV/AIDS or HCV prevalence research in prisons.
However, HIV infection rates have been estimated to be between 2% and 10%. 124 As
early as 1985, blood testing among Swiss prisoners detected the presence of HTLV-III antibodies
in some prisoners. 125 More recently, a 1999 report based on interviews with 234 prisoners
at Realta prison found an HIV infection rate of 5.1%, a result acknowledged as being
comparable to rates in other institutions. The same study found that approximately 9% of the
prisoners injected drugs at the time of the study. 126
20 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience