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

Evaluation and lessons learned
An evaluation was conducted of the pilot programs in Vechta and Lingen 1 Dept Groß-Hesepe
after two years. 149 The evaluation yielded results very similar to those found in Switzerland.
The provision of sterile needles did not lead to an increase in drug use, and the amount of
drugs seized within the prison did not change with the availability of needle exchange. In
fact, the number of drug users entering treatment programs actually increased after the
implementation of the pilot, indicating that, as is the case in the outside community, prison needle
exchange programs are effective outreach and referral points for people who inject drugs.
There were no instances of syringes being used as weapons against staff or other prisoners,
despite the fact that over 20,000 syringes were distributed in the two institutions during
the two-year pilot phase. Observance of the program rules by participants was found to be
high, with only occasional minor infractions occurring in the prop-
er storage of syringes by some prisoners, or the possession of
syringes by some prisoners in the methadone program (who were
not allowed to also be part of the needle exchange project).
Staff and prisoners both found the existence of the program nonthreatening.
Staff adapted quickly to the new programs, which came
be seen as a normal part of the institutional routine. There were differences
found in the level of acceptance of the programs by prisoners
in the two different institutions. The evaluator reported that the women in Vechta had
much more confidence and trust in the program than did the men in Lingen. This was the
result of the differing methods of needle distribution in the two prisons (anonymous dispensing
machines in Vechta; hand-to-hand distribution by prison health staff in Lingen). It
was found that many prisoners in Lingen were hesitant to participate in the program, as doing
so would be to identify themselves to staff as injection drug users.
Finally, the evaluator found that there were no new cases of HIV among the participants
who were permanent members of the exchange program. A significant decrease in abscesses was
also identified.
Lichtenberg, which was visited in the preparation of this report, has experienced no incidents
of syringes being used as weapons, although one staff member suffered an accidental
needle-stick injury. In this incident, a staff member found a syringe in the prison and stored
it in an envelope. A second staff member was accidentally pricked when picking up the envelope.
At the start of the program in Lichtenberg, there were a significant number of
exchanges, although the rate has since declined. Staff attribute this to the fact that many
women participated in the program initially, as they believed that a
Since 2001, prison syringe
exchange programs in
Germany have come under
political attack.
Since the termination of the
prison needle exchange
program, many prisoners
have started to share
syringes.
high level of participation would ensure the continuation of the
intervention.
Current situation
Since 2001, prison syringe exchange programs in Germany have
come under political attack. In 2002 needle exchange programs
operating in the Hannöversand women’s prison, Am Hasenberge
men’s prison, and the Vierlande open prison (men and women) in
Hamburg were terminated. The decision to terminate the programs was taken by a centreright
coalition government formed in September 2001, in the absence of any reports or other
evidence of problems with the programs. It is clear that the termination of the programs was
politically and ideologically motivated. Ignoring six years of evidence of the success of
prison syringe exchange programs in Germany, the governing coalition acted to abolish
28 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience