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

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Table of Contents 2006 update to first edition i Executive Summary ix Prisoner Health Is a Public Health Issue 1 Methodology 3 HIV and HCV Epidemics in Prison 5 Prevalence of HIV and HCV in prisons 5 Western Europe, Australia, and the United States 6 Central and Eastern Europe and the former Soviet Union 6 Canada 6 Other countries 8 HCV infection 8 Drug use in prison 8 Injection drug use, shared needles and risk of HIV and HCV transmission 9 International evidence 10 Canadian evidence 12 Harm reduction 12 Human Rights and Legal Standards 14 International human rights law 14 International rules, guidelines, principles, and standards 15 Prisoners’ right to health and access to sterile needles 16 Obligations in Canadian law 18 Review of International Evidence of Prison Needle Exchange 19 Switzerland 20 Summary 20 HIV/AIDS, HCV, and IDU in Switzerland 20 HIV/AIDS, HCV, and IDU in Swiss prisons 20 History of the response to HIV/AIDS, HCV, and IDU in Swiss prisons 21 Introduction of needle exchange/distribution programs 21 The first program 21 Expansion to other prisons 22 Evaluation and lessons learned 22 Current situation 23 Germany 24 Summary 24 HIV/AIDS, HCV, and IDU in Germany 24 HIV/AIDS, HCV, and IDU in German prisons 25 History of the response to HIV/AIDS, HBV/HCV, and IDU in German prisons 25 Introduction of needle exchange/distribution programs 26 The first programs 26 Expansion to other prisons 27 Evaluation and lessons learned 28 Current situation 28
Spain 29 Summary 29 HIV/AIDS, HCV, and IDU in Spain 30 HIV/AIDS, HCV, and IDU in Spanish prisons 30 History of the response to HIV/AIDS, HCV, and IDU in Spanish prisons 31 Introduction of needle exchange/distribution programs 31 The first program 31 Expansion to other prisons 32 Evaluation and lessons learned 34 Current situation 36 Moldova 36 Summary 36 HIV/AIDS, HCV, and IDU in Moldova 37 HIV/AIDS, HCV, and IDU in Moldovan prisons 37 History of the response to HIV/AIDS, HCV, and IDU in Moldovan prisons 37 Introduction of needle exchange/distribution programs 38 The first program 38 Expansion to other prisons 39 Evaluation and lessons learned 40 Current situation 40 Kyrgyzstan 41 Summary 41 HIV/AIDS, HCV, and IDU in Kyrgyzstan 41 HIV/AIDS, HCV, and IDU in Kyrgyz prisons 41 History of the response to HIV/AIDS, HCV, and IDU in Kyrgyz prisons 41 Introduction of needle exchange/distribution programs 41 The first program 41 Expansion to other prisons 42 Current situation 42 Belarus 42 Summary 42 HIV/AIDS, HCV, and IDU in Belarus 42 HIV/AIDS, HCV, and IDU in Belarus prisons 43 History of the response to HIV/AIDS, HCV, and IDU in Belarus prisons 43 Introduction of needle exchange/distribution programs 43 Evaluation and lessons learned 43 Current situation 43 Analysis of the Evidence 44 Refuting objections 44 Increased institutional safety 44 No increase in drug consumption or injecting 46 Part of a continuum of drug-related programming 47 Positive prisoner and public health outcomes 48 Prison needle exchange programs reduce risk behaviour and prevent disease transmission 48 Other positive outcomes on prison health 49 Effective in a wide range of institutions 50 Different methods of needle distribution have been effective 51 Hand-to-hand distribution by prison nurse and/or physician 52 Hand-to-hand distribution by peer outreach workers 52 Hand-to-hand distribution by external non-governmental organizations or health professionals 52 Automated dispensing machines 53
Page 2 and 3: Prison Needle Exchange: Lessons fro
Page 4: In memory of Andréa Riesch Toepell
Page 10 and 11: Prison Needle Exchange: 2006 update
Page 12 and 13: Sample Evaluations of Prison Needle
Page 14 and 15: initiatives occurring in local comm
Page 16 and 17: ings on the feasibility and efficac
Page 18 and 19: Executive Summary This report exami
Page 20 and 21: • do not endanger staff or prison
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
Page 28 and 29: injection drug practices and unprot
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 62 and 63:
Kyrgyzstan 218 Summary Kyrgyzstan i
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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