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

lems. Oberschöngrün also follows a flexible approach to its syringe exchange program, and does
not adhere to a strict one-for-one policy. Again, this has not resulted in any security or safety
problems.
Hindelbank no longer requires program participants to store their syringes in a visible
place. However, the prison maintains a strict policy that all syringes and extra “points” must
be stored in the plastic safety boxes provided by the health unit. Any syringe found outside
its box is considered illegal, and sanctions are imposed on the prisoner in question. In recent
years, Hindelbank has seen the number of exchanges drop, from a high of over 5000 during
the first year of the program to approximately 350 annually in 2003. Staff attribute this drop
to a combination of factors, including the new practice of providing extra “points” and a general
drop in intravenous drug use among younger prisoners, many of whom choose to smoke
or snort rather than inject.
The canton of Berne recently mandated that all prisons under its administrative control
must provide sterile syringes to prisoners. Despite this legislative directive, it was noted by
several people interviewed for this report that this is not happening in an effective manner in
many cantonal prisons. In these cases, prisons that object to syringe exchange have implemented
programs in a manner that makes them virtually inaccessible to the vast majority of
people who inject drugs (primarily by using non-confidential methods of distribution). In
doing so, these prisons are able to fulfill the legal requirement of “providing” syringe
exchange programs, yet have created a situation where prisoners will not use the program.
This results in needle exchange programs that exist in name only. This resistance demonstrates
the challenge posed by the imposition of needle exchange programs where prison
staff were not involved in the planning and implementation. Such resistance has also been
evident in the experience of Saxerriet prison in the Salez canton, where needle exchange programs
were required by order of the cantonal legislature.
Germany
Summary
There are 220 prisons in Germany. Institutions are managed and administered by the state
(Land) in which the institution is located.
In 1996, pilot needle exchange programs were established in three German prisons. In the
women’s prison in Vechta, exchanges were done using one-for-one
syringe dispensing machines. In the men’s prison in Lingen 1 Dept
Groß-Hesepe, exchanges were made by staff from the medical unit
and the drug counselling service. In the open prison Vierlande in
Hamburg, syringes were distributed by an external organization,
which also provided counselling as well as vocational training for
prison personnel. Following a successful two-year pilot phase and
evaluation, the programs were continued in these three institutions
and were expanded to four others. Over the last two years these programs have come under
increasing attack from political leaders and, despite their effectiveness, six programs have
been cancelled.
In 1996, pilot needle
exchange programs were
established in three
German prisons.
HIV/AIDS, HCV, and IDU in Germany
According to figures released by UNAIDS and the WHO in 2002, there are approximately
41,000 adults in Germany living with HIV or AIDS. This represents an HIV/AIDS preva-
24 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience