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

Expansion to other prisons
At the same time as these developments were occurring at Oberschöngrün, plans were being
developed for a pilot needle exchange program in the Hindelbank Institutions for Women. 132
The Hindelbank project has its foundations in a 1991 survey
of prisoners conducted by the prison physician. This survey of
injection drug use in the institution found that almost all the
people who injected drugs in Hindelbank had shared syringes
while incarcerated. Armed with these findings, the doctor proposed
developing a pilot needle exchange program within the
prison. This proposal was supported by the Swiss Federal
Office of Public Health.
The Hindelbank needle exchange pilot project was launched in
1994 as one component of a broader health-promotion and harmreduction
initiative that included prevention education, coun-
selling, and condom distribution. In the short term, the program
sought to reduce the harms from drug use and to prevent infection
or reinfection by bloodborne pathogens such as HIV and hepatitis
B and C. In the medium term, the program aimed to reduce the
number of new drug users and of former users who relapse. While
in the Oberschöngrün program syringes were distributed from the medical unit, the Hindelbank
pilot project adopted a new approach. At Hindelbank, syringes could be obtained via automatic
dispensing units that were placed in six discreet locations around the institution. These units
operated on a one-for-one basis; inserting a used syringe into the machine would cause a new
one to be released. New prisoners entering Hindelbank were given a “dummy” syringe that
would operate the machine but were not themselves functional. During the first year of the pilot,
5335 syringes were distributed.
In 1996 and 1997, needle exchange programs were established in Champ Dollon prison
(Geneva) and Realta prison (Graubünden) respectively. The Champ Dollon project follows
the Oberschöngrün model of distribution of syringes through the medical unit, while Realta
uses a single dispensing machine. In 1998, prison needle exchange programs were started at
the Witzwil and Thorberg prisons in Berne. Both programs distribute syringes through prison
medical staff. In 2000, the Saxerriet prison in Salez became the seventh Swiss prison to provide
sterile needles. 133
Insertion of used syringe in dispensing
unit causes a new one to be released.
Saxerriet Prison, Switzerland
Evaluation and lessons learned
The Hindelbank pilot project was the subject of an extensive scientific evaluation during its
first year. 134 A series of structured interviews were conducted with the prisoners prior to the
launch of the pilot, then again at three-, six-, and 12-month intervals.
Eighty-five percent of the prisoners participated in at least one stage
of the evaluation process. The interviews were supplemented with
voluntary blood testing and information from other correctional
sources.
The evaluation found that syringe sharing virtually disappeared with
the introduction of the pilot project. At the start of the pilot, eight of
19 women who injected drugs admitted sharing syringes within the
past month in the institution, two of these sharing with more than
one person. At the end of the 12-month pilot, only one woman (who had been imprisoned
just before the interview) admitted sharing a syringe. There was no evidence of an increase
The evaluation found that
syringe sharing virtually
disappeared with the
introduction of the pilot
project.
22 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience