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

Health Reform in Prisons, with the cooperation of the Moldovan
Ministry of Prisons and financial assistance from the Open Society
Institute of the Soros Foundation Network, began delivering HIV
prevention programs in prisons in 1999. 204 The organization went on
to provide HIV and harm-reduction programs and services in all 19
prisons in Moldova. These activities include the provision of HIV
prevention education for prisoners and staff, peer education, the creation
and dissemination of educational materials, the purchase of
HIV-prevention and harm-reduction tools, the distribution of condoms
and disinfectants, and the provision of sterile syringes in two prisons.
Up to September 2002, the project had reached approximately 14,000 prisoners (79% of
all prisoners in Moldova) and 1600 prison staff. The organization distributes condoms, disinfectant,
and information in all Moldovan prisons. Since the project was started, over 30,000
items of information have been distributed. 205
In May 1999 a pilot prison
syringe exchange program
was established at
Prison Colony 18, a
medium/maximum-security
prison with 1000 prisoners.
Introduction of needle exchange/distribution programs
The first program
In May 1999 a pilot prison syringe exchange program was established. 206 The site chosen
was Prison Colony 18 in Branesti. There were several reasons why PC18 was chosen for the
pilot. These included its proximity to the city of Chisinau (the capital of Moldova, where the
NGO coordinating the project is based), the fact that it was the prison with the lowest average
age of prisoners (24 to 26 years old), and because at that time it had the highest known
number of prisoners known to be living with HIV/AIDS (18 people).
PC18 is a medium/maximum-security prison with a population of approximately 1000
men. It was originally built in 1950 to house 250 people. The Moldovan prison system is a
military system. Prison staff at PC18 include approximately 200
correctional officers (who are soldiers) and 100 non-military staff.
All prisoners in the institution work at one of several prison industries.
These include underground stone mining, agricultural and
livestock cultivation, grain milling, and baking.
The Prison Administration of the Ministry of Justice was initially
reluctant to authorize the project due to concerns that the provision
of sterile needles would lead to an increase in drug use. However,
these concerns were assuaged by the results of an anonymous survey
of prisoners that demonstrated that as many as eight to 12 prisoners
were sharing one needle, and that some people were using
homemade needles, to inject drugs. On 3 December 1999, Order 115 was enacted, authorizing
the establishment of the needle exchange in PC18.
The pilot program in PC18 evolved through two stages. During stage one needles were distributed
hand-to-hand to prisoners through the prison medical unit. During the four or five
months that this distribution system was in place, between 40 and 50 needles were exchanged.
However, the project team decided that this method of distribution was not satisfactory.
Their most significant concern was that the needle exchange was being accessed by only
25% to 30% of the prisoners known to inject drugs. A number of barriers were identified by
Dr Nicolae Bodrug, head of the prison medical unit, who was responsible for coordinating
the project. These included difficulty in establishing a rapport between the medical staff and
To make the needle exchange
genuinely anonymous, the
prison medical unit recruited
eight prisoners as secondary
exchange volunteers to work
throughout the penal colony.
38 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience