HIV and Hepatitis in UK Prisons - Prison Reform Trust

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HIV and hepatitis in prisons: addressing prisoners’ healthcare needs 11 Other research has been more critical of the coercive approach in prisons, with its neglect of rehabilitative methods of encouraging people to turn away from drug misuse. Research conducted in 1997 concluded that: 28 [t]he MDT process is counterproductive. It deflects attention from the real issue of the purposes and funding of the prison system. Drug testing also deflects attention from other crucial areas like the spread of HIV and AIDS in prison. MDT increases tension in prisons, appears to be encouraging a shift from ‘soft’ to ‘hard’ drugs, is adding to the workload of an already overburdened staff, is costing a lot of money that could be better spent and is failing to provide adequate treatment and follow-up procedures. It is, thus, primarily an indiscriminate punitive regime … 29 Scotland and Northern Ireland Scottish prisons test 10 per cent of their prisoners each month. SPS reported that 80 per cent of prisoners who admit injecting heroin say they share needles. 30 The Scottish Prison Service is currently undertaking a review of its drug testing procedures.This review includes the reasons drug tests occur as well as the methodology used.At this time, no firm decisions have been made as to the future of mandatory random drug testing in Scotland.There are plans to introduce mandatory drug testing in prison establishments in Northern Ireland. Harm minimisation and injecting drug use Harm minimisation is an essential response to injecting drug use in prisons if there is to be a reduction in transmission of HIV and hepatitis. Recent government documents on hepatitis C outline key elements of the harm minimisation approach (see for example 'Hepatitis C Strategy for England' August 2002 Department of Health; 'Hepatitis C Action Plan for England' July 2004 Department of Health; 'Hepatitis C Proposed Action Plan for Scotland' June 2005 Scottish Executive; 'Strategic Framework and Action Plan for the Prevention and Control of Hepatitis C in Northern Ireland 2004-07'). Methadone treatment programmes The HM Prison Service drug strategy sets out key points of a harm minimisation strategy, which include the management of symptoms of withdrawal in line with the Department of Health guidelines, rehabilitation programmes and therapeutic communities. However, as the PRT/NAT survey shows, not all prisons offer these services. 31 Substitution treatment programmes, including methadone maintenance, have been shown to benefit drug-dependent prisoners, in particular by reducing their frequency of injecting. 32 Methadone maintenance therapy (MMT) is an essential component of a comprehensive harm minimisation approach. For those willing to stop injecting heroin, methadone blocks opiate withdrawal symptoms. Forty-three per cent of the prisons in England and Wales responding to the PRT/NAT survey said that they provided maintenance prescribing for opiate dependency. This is welcome as far as it goes but MMT should be made available throughout the prison system. Methadone maintenance therapy cannot, however, be considered an adequate substitute for needle exchange.There are often issues of the capacity of MMT programmes to meet demand. Moreover, prisoners may continue to inject drugs even while on MMT and MMT is not appropriate for occasional or recreational users who inject opiates. 33 28 M. MacDonald,“Mandatory Drug Testing in Prisons”, University of Central England in Birmingham, January 1997. 29 Ibid. 30 Prison drug tests “failing to have impact”,The Scotsman, 22 April 2005 (http://thescotsman.scotsman.com/index.cfmid=428522005) 31 See M. MacDonald and D. Berto, Harm Reduction in Italian and UK Prisons:The Gap Between Policy and Implementation for HIV and Drugs, Paper presented at the 13th International Conference on the Reduction of Drug Related Harm, Ljubljana, Slovenia, 3-7 March 2002. 32 See WHO, UNAIDS and UN Office on Drugs and Crime, Evidence for action on HIV/AIDS and injecting drug use – Policy Brief: Reduction of HIV Transmission in Prisons, 2004. 33 See 'Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience' Canadian HIV/AIDS Legal Network 2004
12 HIV and hepatitis in prisons: addressing prisoners’ healthcare needs Disinfecting tablets in prison Disinfecting tablets were introduced in English prisons in 1995 but quickly withdrawn upon advice from the Department of Health.A pilot project was then conducted in 1998 in 11 Prison Service establishments but never extended to all prisons in England and Wales. Prison Service Instruction 53/2003 provides that tablets for disinfecting shared needles and syringes were to be made available to prisoners from 1 April 2004. Due to unexpected preparatory work, the re-introduction of disinfecting tablets has taken longer than planned and therefore they are not currently available in all establishments. Only eight out of the 61 English and Welsh prisons which responded to this question in the PRT/NAT survey said that disinfecting tablets were available. Prisons in Scotland and Northern Ireland have pursued markedly different approaches. Disinfecting tablets were introduced in Scottish prisons in December 1993. In contrast, in Northern Ireland, they are not available. A key element to the use of disinfecting tablets by prisoners is the provision of adequate information on how to use them, including drawings for prisoners who cannot read. As is the case with MMT, whilst disinfecting tablets are an essential aspect of harm minimisation, medical literature suggests that they are not fully effective in destroying all blood-borne viruses present in used needles.As a result, they should not be used as a substitute for sterile needles. This view is shared by the Department of Health.When the re-introduction of cleansing tablets was announced, a DH spokesperson stated that cleansing tablets were not the best way to protect against the transmission of diseases: “[We would not encourage the introduction of cleansing tablets] as being as effective as the issuing of sterile needles.We don't recommend it.We regard the needle exchange programmes in place throughout the whole of the [health] system as the most effective way of reducing blood-borne diseases.” 34 Needle exchange programmes Evidence demonstrates that the most effective measure for preventing transmission of hepatitis C and HIV among injecting drug users is the use of sterile needles and syringes.A number of studies suggest that disinfection is less effective at preventing the transmission of hepatitis. Needle exchange programmes are widely available throughout the UK as a key harm minimisation intervention for IDUs. Nevertheless, none of the prison services in the UK has plans to introduce needle exchange schemes in prisons. The policy on needle exchange schemes was recently challenged by a prisoner. Judicial review proceedings against the Home Secretary were started in November 2004 for the government’s failure to introduce needle exchanges in prisons, or even to conduct a trial into the practice. So far the case has not been successful.The judge refused permission for the case to continue and a renewed application heard at the Royal Courts of Justice (Administrative Court) in April 2005 was also dismissed 35 . The judge was satisfied that the Home Office clearly showed that it had considered the issues and that it was within its discretion to consider that needle exchanges should not be introduced.The judge put significant weight on security concerns (i.e. assaults by prisoners on other prisoners or prison officers) despite the fact that the Home Office produced no evidence for this and did not really refer to the matter in its arguments. 36 34 Health officials and Prison Service clash over HIV-prevention scheme, the Guardian, 1/03/2004. 35 John Shelley v.The Secretary of State for the Home Department. 36 It is uncertain whether the case will go to the Court of Appeal due to funding issues. If the case goes to the Court of Appeal and is allowed to continue and is successful, it would mean that the Home Office would have to take harm reduction measures in prison a step further, for example by introducing pilot programs.
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HIV and Hepatitis in UK Prisons - Prison Reform Trust

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