Adopt Harm Reduction Practices in Jails and Prisons

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Key Information

Hepatitis C

Hepatitis C is more than three times more prevalent among people who inject drugs than HIV. In most countries, more than half the people who inject drugs live with Hepatitis C. The level of Hepatitis C infection amongst US prisoners is substantially higher than the general population: between 12 and 35 percent of prison inmates are infected with hepatitis C, compared to between 1 and 2 percent of the general population.[1] Global HIV prevalence is up to 50 times higher among the prison population than in the general public, while one in four detainees worldwide is living with Hepatitis C."[2]

Preventing the Spread of Hepatitis C by Treating Infected Prisoners

WHO, the United Nations Office on Drugs and Crime and UNAIDS recommended in 2007 that "prison authorities in countries experiencing or threatened by an epidemic of HIV infections among people who inject drugs should introduce and scale up Needle and Syringe Programs (NSPs) urgently."[3]

An analysis of studies of European Prison NSPs "Ten Year of Experience with Needle and Syringe Exchange Programs in European Prisons" concluded that prison NSPs are not only feasible but effective, especially when embedded within a comprehensive prison-based harm reduction and health-promotion strategy."[4]

There is increasing evidence that experience of imprisonment is a strong predictor of HIV and Hep C transmission for the individual prisoners. Nor is this an issue confined to prison. A majority of prisoners serve short-term sentences, during which they are unable to access long term drug treatment, and return to the wider community having been at significantly higher risk of Blood Borne Virus transmission and subsequently more likely to pass on Blood Borne Viruses. For this reason prisons have been called HIV and Hep C incubators.[5]

Syringe Economy

Syringes in prisons without Needle Syringe programs are sold on illicit markets and very expensive, given high demand and scarcity. In prisons where NSPs operate however, there has not been any illicit market reported where needles and syringes are accessible.[6]

Relevant Research

These findings come from a Harm Reduction International study on HIV, Hep C, TB and Harm Reduction in Prisons[7] . This 2016 study found that:

  • Prison NSPs are feasible and affordable across a wide range of prison settings
  • Prison NSP are effective in decreasing syringe sharing among people who inject drugs in prison, thereby decreasing the risk of blood borne virus transmission between prisoners and from prisoners to prison staff
  • Prison NSP are not associated with increased attacks on prison staff or other prisoners
  • Prison NSP do not lead to increased initiation of drug consumption or injection
  • Prison NSP contribute to workplace safety
  • Prison NSP can reduce the incidence of acscesses
  • Prison NSP facilitate referral to available drug-dependence treatment programs
  • Prison NSP can be delivered successfully via a range of methods in response to staff and inmate needs
  • Prison NSP are effective in a wide range of prison systems
  • Prison NSP can successfully coexist with other drug prevention and drug dependence treatment programs

Important factors in the success of prison NSPs include:

  • Easy and confidential access to the service
  • Providing the right type of syringes
  • Building trust with the prisoners accessing the program

Impactful Federal, State, and Local Policies

Promising Practices

There are four main models of prison needle exchange programs

  1. Hand-to-hand distribution by prison health staff, social workers, physicians, or nurses. This method is used in several Spanish and Swiss prisons. The used syringes are either exchanged at the cell door or in the medical unit.
  2. Hand-to-hand distribution by trained peers (i.e., prisoners) to ensure confidential contact with prisoners who use drugs as well as access at almost all times. This system is mostly used in Moldovan prisons.
  3. Hand-to-hand distribution by external personnel or NGOs who also provide other harm reduction services.
  4. Automated dispensing machines e.g., Germany and Hindelbank women's prison, Switzerland (one-for-one exchange, starting with a dummy syringe as the first device).

Germany, Switzerland, and Spain had 19 programs in total by 2000.

Evaluations of these pilot programs have shown that the aims of the programs have been achieved. These include:

  • Reduction in syringe sharing
  • Subsequent reduction in Blood borne Virus rates
  • No increase in drug use
  • No syringes used as weapons

Available Tools and Resources

TR - Adopt Harm Reduction Practices in Prisons