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270 In a syringe sterilized with bleach, traces of bleach are likely to remain present even after flushing with water. Bleach contains<br />

free chlorine, a known oxidant, and in vitro laboratory studies have shown that low concentrations of oxidants can lead to both tissue<br />

inflammation and HIV-1 replication.Therefore, although not statistically proven,“Hypothetically, oxidant effects of the residual<br />

bleach in the bleach-sterilized syringes could enhance the possibility of infection by remaining HIV-1 contained in a contaminated<br />

syringe.” C Contoreggi, S Jones, P Simpson,WR Lange,WA Meyer. Effects of varying concentrations of bleach on in vitro HIV-1<br />

replication and the relevance to injection drug use. Intervirology 2000; 43(1): 1-5.<br />

271 F Kapadia, D Vlahov, DC Des Jarlais, SA Strathdee, L Ouellet, P Kerndt, EV Morse, I Williams, RS Garfein, S Richard, for the<br />

Second Collaborative Injection Drug User Study (CIDUS-II) Group. Does bleach disinfection of syringes protect against hepatitis C<br />

infection among young adult injection drug users? Epidemiology 2002; 13(6): 738-741. See also N Flynn, S Jain, EM Keddie, JR Carlson,<br />

MB Jennings, HW Haverkos, N Nassar, R Anderson, S Cohen, D Goldberg. In vitro activity of readily available household materials<br />

against HIV-1: is bleach enough? Journal of Acquired Immune Deficiency Syndromes 1994; 7(7): 747-753.<br />

272 UNAIDS, <strong>Prison</strong>s and AIDS: UNAIDS Technical Update, supra, note 77, at 6.<br />

273 E Senay,A Uchtenhagen. Methadone in the treatment of opioid dependence:A review of world literature. In: J Westermeyer (ed).<br />

Methadone Maintenance in the Management of Opioid Dependence. New York: Prager, 1990.<br />

274 G Bertschy. Methadone maintenance treatment: an update. European Archives of Psychiatry and Clinical Neuroscience 1995; 245(2):<br />

114-124; M Rosenbaum,A Washburn, K Knight, M Kelley, J Irwin.Treatment as harm reduction, defunding as harm maximization: the<br />

case of methadone maintenance. Journal of Psychoactive Drugs 1996; 28(3): 241-249.<br />

275 DR Gibson, NM Flynn, JJ McCarthy. Effectiveness of methadone treatment in reducing HIV risk behavior and HIV seroconversion<br />

among injecting drug users. AIDS 1999; 13(14): 1807-1818; DM Hartel, EE Schoenbaum. Methadone treatment protects against HIV<br />

infection: two decades of experience in the Bronx, New York City. Public Health Reports 1998; 113(Suppl 1): 107-115; KA Dolan, J<br />

Shearer, M MacDonald, RP Mattick,W Hall,AD Wodak.A randomised controlled trial of methadone maintenance treatment versus<br />

wait list control in an Australian prison system. Drug and Alcohol Dependence 2003; 72(1): 59-65.<br />

276 A Byrne, K Dolan. Methadone treatment is widely accepted in prisons in New South Wales. British Medical Journal 1998;<br />

316(7146): 1744-1745; D Goldberg,A Taylor, J McGregor, B Davis, J Wrench, L Gruer:A lasting public health response to an outbreak<br />

of HIV infection in a Scottish prison? International Journal of STD & AIDS 1998; 9(1): 25-30.<br />

277 K Dolan, Hall W,Wodak A: Methadone maintenance reduces injecting in prison. British Medical Journal 1996; 312(7039): 1162;<br />

Dolan et al, supra, note 275.<br />

278 Ibid.<br />

279 Commissioner’s Directive 800-1. Methadone Treatment Guidelines (2 May 2002); Policy Bulletin 127, 2 May 2002. See generally R<br />

Jürgens. HIV/AIDS in prisons: more new developments. Canadian HIV/AIDS Policy & Law <strong>Review</strong> 2002: 7(1); 15-17.<br />

280 B Sibbald. Methadone maintenance expands inside federal prisons. Canadian Medical Association Journal 2002; 167(10): 1154.<br />

281 See Lines, supra, note 18; N Whitling. New policy on methadone maintenance treatment in prisons established in Alberta.<br />

Canadian HIV/AIDS Policy & Law <strong>Review</strong> 2003; 8(3): 45-47.<br />

282 See the analysis of needle exchange in Spanish prisons, above.<br />

283 Final Report of the Study Group, supra, note 252.<br />

284 CSC, HIV/AIDS in <strong>Prison</strong>s: Background Materials, supra, note 18 at 94.<br />

285 Dolan et al, supra, note 34.<br />

286 Australian National Council on Drugs, supra, note 121.<br />

287 Holtgrave et al, supra, note 120.<br />

288 FN Laufer. Cost-effectiveness of syringe exchange as an HIV prevention strategy. Journal of Acquired Immune Deficiency Syndromes<br />

2001; 28(3): 273-278.<br />

289 HB Krentz, MC Auld, MJ Gill.The changing direct costs of medical care for patients with HIV/AIDS, 1995-2001. Canadian Medical<br />

Association Journal 2003; 169(2): 106-110.<br />

290 Personal correspondence with Heino Stöver.<br />

78 <strong>Prison</strong> <strong>Needle</strong> <strong>Exchange</strong>: <strong>Lessons</strong> <strong>from</strong> a <strong>Comprehensive</strong> <strong>Review</strong> of International Evidence and Experience

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