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

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Kyrgyzstan 218 Summary Kyrgyzstan initiated a pilot prison needle exchange project in October 2002. In early 2003 approval was given to expand needle exchange into all 11 Kyrgyz prisons. Needle exchanges are now operating in all prisons. HIV/AIDS, HCV, and IDU in Kyrgyzstan The sharp increase in intravenous drug use, coupled with a difficult social and economic situation, is creating a serious risk of an escalating HIV epidemic in Kyrgyzstan. As of June 2003 there were 825 known cases of HIV or AIDS in the country, 82% of which were linked to injection drug use. 219 According to a December 2002 report published by UNAIDS and the WHO, a “[m]ore substantial spread of HIV is now also evident” in Kyrgyzstan. 220 In Kyrgystan, needle exchanges are now operating in all prisons. HIV/AIDS, HCV, and IDU in Kyrgyz prisons In the 11 prisons in Kyrgyzstan, the number of identified prisoners living with HIV/AIDS has been steadily rising in recent years. In 2000 there were only three known cases of HIV in Kyrgyz prisons. In September 2001 this number had increased to 24, the majority being people who inject drugs. As of November 2002 there were more than 150 prisoners living with HIV/AIDS in Kyrgyzstan, 56% of all known cases in the country. 221 Injection drug use and needle sharing are highly prevalent in Kyrgyz prisons. A survey conducted by a Kyrgyz non-governmental organization found that 100% of prison staff agreed that drugs are being used in the prisons. The survey also found that 90% of drug users in prisons said they shared needles and did not disinfect them. 222 History of the response to HIV/AIDS, HCV, and IDU in Kyrgyz prisons HIV prevention programs in prisons started in 1998 before the first case of HIV was identified. Initially, the response consisted of education programs for prisoners and prison staff. In February 2001 the Main Directorate for Penalty Implementation (MDPI) and its Department of Correctional Institutions issued a “prikaz” (order) “on prevention of HIV/AIDS in the prison institutions of Kyrgyzstan” urging prisons to take steps to prevent the spread of HIV among prisoners. Based on this order, various HIV prevention and harm-reduction initiatives were implemented. These included the provision of condoms and disinfectants, HIV-prevention education for prisoners and staff, peer education, and voluntary HIV testing. Unofficial needle exchange was also initiated, specifically targeting those living with HIV/AIDS. Introduction of needle exchange/distribution programs The first program In October 2002 a pilot needle exchange project was introduced in Prison IK-47, a maximum-security institution. The project provides services for approximately 50 prisoners who exchange needles on a daily basis (the project averages approximately 50 exchanges per day). It was decided that exchanges should take place in a location where prisoners cannot be seen by guards; they therefore take place in the medical wards. Syringe exchange is provided in the narcological unit of the central prison hospital, and all prisoners have an opportu- Review of International Evidence 41
nity to avail themselves of the program. A prisoner asks to come to the medical unit to receive medical service and while there he exchanges his syringe. The pilot also provides secondary exchange using prisoners as peer volunteers, as in the Moldovan model. The project coordinators found that both options for syringe exchange were needed. At the start of the pilot, everyone was given one syringe. Exchange was made on a onefor-one basis. Only the prisoners involved in the pilot were allowed to access the exchange. Records were maintained of exchanges, and education is provided for staff. Expansion to other prisons In early 2003 an order was issued approving the provision of sterile needles in all Kyrgyz prisons. As of September 2003 needle exchange programs were operating in six of the 11 prisons in Kyrgyzstan (five men’s prisons and one women’s prison). In February 2004 funding was obtained to expand the programs to all 11 prisons and by April 2004 sterile needles were available in all prisons. 223 In all 11 institutions, needle exchange is done using prisoners trained as peer outreach workers who work with the medical unit. This model was adopted following concerns that emerged when the medical unit was the sole point of exchange. Because needles could only be accessed from the medical unit during the day, and most drug trafficking took place in the evening, some non–drug using prisoners were accessing sterile needles during the day that they would later sell at night to prisoners who injected drugs. This problem was rectified by the implementation of the peer outreach worker model. Since the outreach workers live in the prison units, they are available to distribute sterile needles 24 hours a day, and the forprofit market for needles was effectively eliminated. In September 2003 a total of approximately 470 drug users were accessing the six needle exchange programs then in operation on a daily basis. In April 2004, with programs established in all 11 prisons, this figure was approximately 1000. 224 Drug users are provided with one syringe and three extra needle tips. This allows prisoners who inject drugs to inject more – up to three times a day without having to reuse a syringe. This also reduces the cost of the syringe exchange program, since tips cost less than complete needles. There have been no instances of syringes being used as weapons, and prison medical staff have identified a reduction in injection-related health problems such as abscesses. Current situation Syringe exchange programs are currently operating in all 11 Kyrgyz prisons. There are plans to pilot test a methadone maintenance treatment program in 2004. Belarus Summary The Republic of Belarus implemented a pilot syringe exchange program in one prison, Reformatory School 15/1 in Minsk, in April 2003. HIV/AIDS, HCV, and IDU in Belarus There were 5165 people known to be living with HIV/AIDS in Belarus as of 1 September 2003. 225 HIV and injection drug use are issues of significant concern. In April 2003 there were approximately 9400 persons officially registered with drug treatment services. The number of people registered with drug treatment services has experienced an annual growth 42 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience
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Prison Needle Exchange: Lessons fro
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In memory of Andréa Riesch Toepell
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Spain 29 Summary 29 HIV/AIDS, HCV,
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Prison Needle Exchange: 2006 update
Page 12 and 13: Sample Evaluations of Prison Needle
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Page 18 and 19: Executive Summary This report exami
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Page 22 and 23: Prisoner Health Is a Public Health
Page 24 and 25: Methodology The evidence for this r
Page 26 and 27: HIV and HCV Epidemics in Prison Pre
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Page 30 and 31: Many prisoners, whether in pretrial
Page 32 and 33: while in holding cells before incar
Page 34 and 35: While harm-reduction policies do no
Page 36 and 37: • Additional Protocol to the Amer
Page 38 and 39: fit from medical treatment under th
Page 40 and 41: Review of International Evidence of
Page 42 and 43: History of the response to HIV/AIDS
Page 44 and 45: in drug consumption, and there were
Page 46 and 47: lence rate of approximately 0.1% in
Page 48 and 49: ic acid, filters, plaster, and sodi
Page 50 and 51: harm-reduction measures and declare
Page 52 and 53: injection drug use, HCV infection r
Page 54 and 55: the jurisdiction of the government
Page 56 and 57: punished by prison staff for access
Page 58 and 59: changed to a peer model, which has
Page 60 and 61: the prisoners who were injecting, a
Page 64 and 65: of 20% to 40%. However, these treat
Page 66 and 67: working place, it is interesting to
Page 68 and 69: These findings demonstrate that the
Page 70 and 71: grams strongly reduced syringe shar
Page 72 and 73: proven effective in barracks-style
Page 74 and 75: • Prison has opportunity to maint
Page 76 and 77: staff, is also an indication of the
Page 78 and 79: Needle Exchange Programs Should Be
Page 80 and 81: professor of Aboriginal ancestry; a
Page 82 and 83: contained and standards presented i
Page 84 and 85: sophically supportive of the use of
Page 86 and 87: • do not increase drug consumptio
Page 88 and 89: the case in countries, including Ca
Page 90 and 91: 15 Central and Eastern Europe Harm
Page 92 and 93: 67 R Keppler, F Nolte, H Stöver.Tr
Page 94 and 95: 121 Australian National Council on
Page 96 and 97: 180 Delegación del Gobierno para e
Page 98 and 99: 245 Ibid at 14. 246 This analysis i
Page 100 and 101: Bibliography International instrume
Page 102 and 103: Byrne A, K Dolan. Methadone treatme
Page 104 and 105: 2000). Elementos Clave para la Impl
Page 106 and 107: Landry S et al. Étude de prévalen
Page 108 and 109: Shapshak P, RK Fujimura, JB Page, D
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