Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience

Spain Summary HIV/AIDS, HCV, and IDU in Spain HIV/AIDS, HCV, and IDU in Spanish prisons History of the response to HIV/AIDS, HCV, and IDU in Spanish prisons Introduction of needle exchange/distribution programs The first program Expansion to other prisons Evaluation and lessons learned Current situation Moldova Summary HIV/AIDS, HCV, and IDU in Moldova HIV/AIDS, HCV, and IDU in Moldovan prisons History of the response to HIV/AIDS, HCV, and IDU in Moldovan prisons Introduction of needle exchange/distribution programs The first program Expansion to other prisons Evaluation and lessons learned Current situation Kyrgyzstan Summary HIV/AIDS, HCV, and IDU in Kyrgyzstan HIV/AIDS, HCV, and IDU in Kyrgyz prisons History of the response to HIV/AIDS, HCV, and IDU in Kyrgyz prisons Introduction of needle exchange/distribution programs The first program Expansion to other prisons Current situation Belarus Summary HIV/AIDS, HCV, and IDU in Belarus HIV/AIDS, HCV, and IDU in Belarus prisons History of the response to HIV/AIDS, HCV, and IDU in Belarus prisons Introduction of needle exchange/distribution programs Evaluation and lessons learned Current situation Analysis of the Evidence Prison Needle Exchange: 2006 update to first edition This section updates developments since April 2004, when the first edition of Prison needle exchange: lessons from a comprehensive review of international experience and evidence was completed.There have been a number of significant developments, both in Canada and internationally, which support the evidence, analysis and findings presented in the first edition of the report.Internationally, we present and review evidence from existing prison needle exchange programs (PNEPs) and report on additional countries that have implemented or are planning to implement such programs.Regarding Canada, we review research concerning the association between injection drug use, incarceration and the transmission of blood-borne pathogens.We report on recent recommendations from the medical community and a prison ombudsperson calling for pilot PNEPs, and on initiatives within the Canadian government to study the feasibility of piloting PNEPs. International developmentsThe six countries featured in the previous edition of the reportThe first edition of the report examined PNEPs in Switzerland, Germany, Spain, Moldova, the Kyrgyz Republic and Belarus.There is new information or documentation relating to the experiences in five of those countries. In Switzerland, as of 2006, distribution of sterile needles was being undertaken in seven prisons in different parts of the country. 1 An article published in December 2005 reports findings from one of the most systematic studies undertaken to date on the effectiveness of needle exchange programs. 2v v i Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and ExperienceThe Correctional Investigator commented on the health advantages of needle exchange programs and found that, "the prohibition of drug injection, and the resulting clandestine use of scare injection tools, have resulted in great harm" to federal prisoners. 25 Accordingly, he made the following recommendations: CSC introduce, before March 31, 2005, a safe needle exchange program based on thorough consultation with medical and security experts, offenders, CSC staff and concerned community organizations.Failing a positive response from CSC, the Minister direct the introduction of such a program. 26Recognition that prisoner health is public health Since the release of the original report, CSC has embraced the view that prisoner health is public health, and has taken the position that the Public Health Agency of Canada (PHAC) is primarily responsible for addressing the public health needs of all Canadians, including prisoners. 27In April 2005, PHAC and CSC entered into a memorandum of understanding regarding the potential introduction of needle exchange programs in federal correctional institutions. 28Under the memorandum, PHAC undertook to: provide scientific, medical and technical advice on the effectiveness of needle exchange programs in prisons, from a public health perspective; analyze published and unpublished evaluations concerning the effectiveness of prison needle exchange programs; and analyze the potential risks and benefits of introducing needle exchange programs in Canadian prisons.PHAC was expected to have delivered its report, including advice and recommendations, to CSC by August 2005.As of 1 April 2006, it had not done so.Health Reform in Prisons, with the cooperation of the Moldovan Ministry of Prisons and financial assistance from the Open Society Institute of the Soros Foundation Network, began delivering HIV prevention programs in prisons in 1999. 204 The organization went on to provide HIV and harm-reduction programs and services in all 19 prisons in Moldova.These activities include the provision of HIV prevention education for prisoners and staff, peer education, the creation and dissemination of educational materials, the purchase of HIV-prevention and harm-reduction tools, the distribution of condoms and disinfectants, and the provision of sterile syringes in two prisons.Up to September 2002, the project had reached approximately 14,000 prisoners (79% of all prisoners in Moldova) and 1600 prison staff.The organization distributes condoms, disinfectant, and information in all Moldovan prisons.Since the project was started, over 30,000 items of information have been distributed. 205 History of the response to HIV/AIDS, HCV, and IDU in Kyrgyz prisonsHIV prevention programs in prisons started in 1998 before the first case of HIV was identified.Initially, the response consisted of education programs for prisoners and prison staff.In February 2001 the Main Directorate for Penalty Implementation (MDPI) and its Department of Correctional Institutions issued a "prikaz" (order) "on prevention of HIV/AIDS in the prison institutions of Kyrgyzstan" urging prisons to take steps to prevent the spread of HIV among prisoners.Based on this order, various HIV prevention and harm-reduction initiatives were implemented.These included the provision of condoms and disinfectants, HIV-prevention education for prisoners and staff, peer education, and voluntary HIV testing.Unofficial needle exchange was also initiated, specifically targeting those living with HIV/AIDS. History of the response to HIV/AIDS, HCV, and IDU in Belarus prisonsPrisoners in Belarus must undergo mandatory HIV testing when entering detention centres. 228 The syringe exchange program is one component of a project that provides education for staff and prisoners, peer education, provision of information, voluntary HIV testing, and condom and bleach distribution.The project works with the support of the Committee on Execution of Penalties of the Ministry of Internal Affairs and with the prison administration.

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