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

Distribution of Harm-Reduction Tools in Moldovan Prisons:
2002 System-Wide Figures 212
BLEACH KITS 1,026
IODINE 211
SHAVING RAZORS 3,550
SYRINGES 14,705
CONDOMS 100,056
Evaluation and lessons learned
As reported by Dr Nicolae Bodrug, physician in PC18, normalizing the concept of needle
exchange within prisons was a challenge for both staff and prisoners. However, attitudes
changed over time. Says Dr Bodrug, “We emphasized that harm reduction is a practice that
works well in other places and that can protect staff as well as inmates from HIV infection.” 213
One significant barrier to the eventual acceptance and success of the program in PC18
was that initially prison guards continued to consider syringes as
contraband, and to search for and confiscate them from prisoners.
While drug possession and distribution remain illegal in the prison,
Dr Bodrug explains: “We eventually got the guards to agree that the
project syringes would be ‘legal’ and not confiscated.” 214
The practice of using prisoners as volunteers for needle exchange
has had significant positive results in others areas, including
decreasing stigmatization and increasing the self-esteem of prisoners
living with HIV/AIDS, increasing awareness of HIV transmission
among the prison population, and enhancing the credibility of
the health services by creating a more humane image. 215 While using prisoners increases the
trust in and anonymity of the program, there is the potential for the quality of the information
disseminated to be less than that provided directly by experienced health-care staff. Therefore,
there must be a commitment to ongoing training and support for the peer volunteers.
The Moldovan projects do not adhere to a strict one-for-one exchange policy. Unlike the
programs in Western Europe, there are also no plastic storage cases provided for the syringes,
nor are there regulations about where they may be stored. Initially, the decision against providing
plastic cases was made on economic grounds. Later, it became clear that the programs
were working well and safely without such storage cases and it was therefore decided they
were unnecessary. The Moldovan projects have experienced no instances of syringes being
used as weapons, and no problems with dirty needles.
Of the experience of establishing the first prison needle exchange project in Moldova, Dr
Bodrug says:
The practice of using
prisoners as volunteers for
needle exchange has had
significant positive results in
others areas.
It took two years to break the ice of mistrust. We had to learn a lot, say strange
things, and act oddly in front of a [sceptical] majority. But harm reduction
became normal. And with the head of the prison administration in favor of harm
reduction, as well as the minister of justice now, we can look forward confidently
to expansion. 216
Current situation
A third prison needle exchange was started in the women’s prison in Rusca in August 2003.
In 2003 there were 17 known prisoners living with HIV/AIDS in the women’s institution,
12% of the total population in the institution. 217
40 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience