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

lence rate of approximately 0.1% in the general population. 139
There are two sources for AIDS and HIV-related data in Germany. According to the
National Case Report Register for AIDS, the total number of AIDS cases diagnosed up to
the end of 2001 was 21,189, approximately 75% of whom have died. Nearly 16% of AIDS
cases have been diagnosed among people who inject drugs. At the end of 2001 there were
2152 males living with AIDS who reported injecting drugs, 11.6% of all AIDS diagnoses
among men. Among the 2620 women living with AIDS, 43.7% inject or used to inject drugs.
Epidemiological data based on HIV testing is also available. Of the 18,000 laboratory tests
for HIV conducted since 1993, 10.4% of the 1900 positive test results were among people
who currently inject drugs or had a history of injection drug use. Women accounted for 28%
of HIV-infected drug users. 140
HIV/AIDS, HCV, and IDU in German prisons
Several studies have estimated the HIV prevalence rate among German prisoners, with
results ranging from 1.1% to 1.9%. These studies found that between 2.1% and 6.3% of prisoners
who injected drugs were HIV-positive. 141
Another study has indicated a link between incarceration, injection
drug use, and the transmission of bloodborne diseases such as
HIV and HCV. A 1993 study of over 612 people in Berlin who injected
drugs concluded that the most significant factor for HIV infection
among the group was sharing of needles during incarceration.
Imprisonment was also found to be the second most common reason
cited by the participants for needle sharing. The study concluded that
a lack of access to sterile needles was counterproductive to HIV prevention
measures implemented in the general community. 142
Rates of HCV infection among German prisoners are higher. A
1998 study in a Hamburg high-security prison for men found an
HCV prevalence of 25% among all prisoners, and a 96% infection rate among people who
inject drugs. A study at a women’s prison in Lower Saxony found an HCV prevalence rate
of 75%, and identified 20 women who had seroconverted while incarcerated. 143 Other studies
have found HCV prevalence rates of 77% among prisoners who inject drugs, and 18%
for prisoners who did not inject drugs. A 2001 study of prisoners who had injected drugs
only in prison found a 100% rate of HCV infection. 144
History of the response to HIV/AIDS, HBV/HCV,
and IDU in German prisons
A 1993 study of over 612
people in Berlin who injected
drugs concluded that the
most significant factor for
HIV infection among the
group was sharing of needles
during incarceration.
The development of the response to HIV/AIDS and hepatitis in German prisons can be
described as a long process toward normalization. In the mid-1980s, when HIV/AIDS was
first identified in the prison setting, there was a debate about separation, isolation of HIVpositive
prisoners, and mandatory HIV testing. At this time there was also a lack of knowledge
among the prison staff about transmission routes. Voluntary HIV testing is provided,
although the term “voluntary” has been differently interpreted and practised from state to state.
In the early years, some prisons treated all those who refused testing as HIV infected. Due to
different test practices in the 16 Länder, the test rate varied from 10% to more than 90%.
More than 90% of HIV- and/or HBV/HCV-positive prisoners inject drugs or have a history
of injection drug use. Injecting is therefore the primary risk factor for HIV and hepatitis
transmission in prisons. Despite this fact, the main response to the risks posed by injec-
Review of International Evidence 25