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

Prison Colony 18 in Moldova, and in other jurisdictions, prison staff trained in an ethos of a
zero-tolerance approach to drugs and drug use and an abstinence-based approach to drug
treatment have had to come to terms with confiscating drugs but not injection equipment.
However, as the experience in Germany and Moldova demonstrates,
staff attitudes have changed as staff have learned first-hand about
the needle exchange programs and the harm-reduction ethos, and as
they have participated in the implementation and review of needle
exchange programs. This is the same process that has been observed
in the community, where police attitudes have evolved to accommodate
needle exchange programs. Police forces in countries with
community needle exchange programs have integrated the broader
harm-reduction philosophy into their work without undermining
their mandate to protect and safeguard the populations they serve.
In fact, a harm-reduction approach is consistent with the ultimate aim of protecting and preserving
life. As the head of the Merseyside Police Drug Squad has stated:
Refusing to make sterile
needles available in prison
systems where injection drug
use and needle sharing take
place is to condone the
spread of HIV and HCV.
As police officers, part of our oath is to protect life. In the drugs field that policy
must include saving life as well as enforcing the law. Clearly, we must reach
injectors and get them the help they require, but in the meantime we must try and
keep them healthy, for we are their police as well.... People can be cured of drug
addiction, but at the moment they cannot be cured of AIDS. 239
This sentiment was echoed by Martin Lachat, the Interim Director of Hindelbank institution
in Switzerland in 1994:
The transmission of HIV or any other serious disease cannot be tolerated. Given
that all we can do is restrict, not suppress, the entry of drugs, we feel it is our
responsibility to at least provide sterile syringes to inmates. The ambiguity of our
mandate leads to a contradiction that we have to live with. 240
In prisons in all six countries studied for this report, prison needle exchange programs are
part of larger harm-reduction initiatives. Other harm-reduction measures provided to prisoners
include HIV/HCV education, substitution therapy for drug treatment, condom distribution,
distribution of bleach or other disinfectants, antiseptic wipes, razors for shaving, and
anonymous HIV and HCV testing.
In reality, the refusal on the part of elected and prisons officials to make sterile needles
available in prison systems where injection drug use and needle sharing take place is to condone
the spread of HIV and HCV in the prison population and in the community at large.
Moreover, the provision of sterile needles to prisoners is not incompatible with the goal of
reducing drug use in prisons.
Positive prisoner and public health outcomes
Prison needle exchange programs reduce risk
behaviour and prevent disease transmission
The most important lesson emerging from the international evidence on prison needle
exchange is that these programs are very effective in reducing needle sharing and therefore in
preventing the transmission of HIV and HCV. In a recent review of evaluated prison needle
exchange programs in Switzerland, Germany, and Spain, Stöver and Nelles found that the pro-
48 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience