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

More documents

Recommendations

Info

the case in countries, including Canada, that have acted to implement other harm-reduction measures to address injection drug use, HIV, and HCV in prisons. Yet, as has been explored in this report, a harm-reduction strategy that does not include sterile needle exchange is not only a suboptimal public health measure; it is in contravention of international norms related to prison health, and fails to meet best practice. Given the report’s goal, among the lessons learned from the research conducted for this report, two stand out in encouraging prison systems with HIV and HCV epidemics driven by injection drug use to implement needle exchange programs. The first lesson is that prison needle exchange is a pragmatic and necessary health response to the problems of HIV, HCV, and injection drug use that has been proven to be effective and safe. Needle exchange has been available in some prisons for as long as 10 years, and it is an approach that has been rigorously evaluated everywhere it has been enacted. Prison systems and governments can no longer avoid their responsibilities to provide for the health of prisoners by dismissing prison needle exchange programs as something new or untested. They are neither. The second lesson that emerges is that no matter how effective in practice, prison harmreduction initiatives remain controversial. Decisions about prison conditions, or the failure to make decisions, are often unrelated to the evidence, to the detriment of the health of prisoners, prison staff, and the general public. For some people, prisons become a focal point for expressions of political ideology, with little regard for the evidence about measures that in fact promote the health and safety of prisoners, prison staff, and the general public. This was demonstrated in the case of Germany, where long-term successful needle exchange programs were terminated by newly elected governments. These two lessons point to the need for leadership from elected officials and prison authorities on the issue of prison needle exchange programs. Leadership is also required from individual prison staff (both correctional staff and health service staff) and from outside physicians who work in prisons. In the context of needle exchange programs in prisons, leadership implies a number of attributes. First, leadership implies an understanding of the legal obligations of prison systems to respect, protect, and fulfill prisoners’ right to health. Second, leadership implies knowledge of the experience of and evidence from existing prison needle exchange programs. This report is a comprehensive resource for such knowledge. Third, leadership implies a willingness and commitment to make prison needle exchange programs responsive to the needs of prisoners and prison staff (both health care and correctional). This means involving prisoners and prison staff in the design and implementation of programs. Conclusion: A Call for Leadership 67
Notes 1 J Nelles,T Harding. Preventing HIV transmission in prison: a tale of medical disobedience and Swiss pragmatism. Lancet 1995; 346: 1507. 2 TM Hammett. AIDS in Correctional Facilities: Issues and Options. 3rd ed.Washington, DC: US Department of Justice, 1988, at 26. 3 US National Commission on AIDS. Report: HIV Disease in Correctional Facilities.Washington, DC:The Commission, 1991, at 10. 4 Spanish Focal Point. National Report 2001 for the European Monitoring Centre for Drugs and Drug Addiction. Madrid: Government Delegation for the National Plan on Drugs, October 2001, at 84, with reference. 5 T Harding, G Schaller. HIV/AIDS Policy for Prisons or for Prisoners? In: J Mann, D Tarantola,T Netter (eds). AIDS in the World. Cambridge, MA: Harvard University Press, 1992, 761-769, at 762; with reference to T Harding.AIDS in prison. Lancet 1987; 2:1260- 1263. 6 H Heilpern, S Egger.AIDS in Australian Prisons - Issues and Policy Options. Canberra: Department of Community Services and Health, 1989 at 21. 7 T Harding, G Schaller. HIV/AIDS and Prisons: Updating and Policy Review.A survey covering 55 prison systems in 31 countries. Geneva:WHO Global Programme on AIDS, 1992, at 20. 8 Heilpern & Egger, supra, note 6. 9 TM Hammett, MP Harmon,W Rhodes.The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997. American Journal of Public Health 2002; 92: 1789-1794. 10 Bureau of Justice Statistics Bulletin. HIV in Prisons, 2001.Washington: US Department of Justice, Office of Justice Programs, January 2004 (NCJ 202293). 11 A Bobrik. Health and health-related factors at the penal system of Russia. January 2004 (unpublished). 12 Central and Eastern Europe Harm Reduction Network. Injecting Drug Users, HIV/AIDS Treatment and Primary Care in Central and Eastern Europe and the Former Soviet Union.Vilnius:The Network, July 2002, at 5. 13 International Harm Reduction Development. Drugs, AIDS, and Harm Reduction: How to Slow the HIV Epidemic in Eastern Europe and the Former Soviet Union. New York: Open Society Institute, 2001, at 14 with reference. 14 M Schonteich. Latvia: exploring alternatives to pre-trial detention. Open Society Justice initiative, 2003.Available at www.justiceinitiative.org/publications/justiceinitiatives/2003/schoenteich0603. 68 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience
Page 2 and 3:
Prison Needle Exchange: Lessons fro
Page 4:
In memory of Andréa Riesch Toepell
Page 7 and 8:
Spain 29 Summary 29 HIV/AIDS, HCV,
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 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
show all

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

Create successful ePaper yourself

Delete template?

Save as template?