Did you know the first prison needle exchange program was started in Switzerland in 1992? Would you guess that the five other countries maintaining needle exchange programs in their criminal justice systems are Germany, Spain, Moldova, Kyrgyzstan and Belarus? In the United States, where Los Angeles television stations recently refused to air a public service announcement on the dangers of syphilis for fear of reprisal from the Federal Communications Commission, a national harm reduction policy addressing the spread of HIV and hepatitis C in our prisons and jails sounds like a pipe dream.

This, however, is the recommendation from the Canadian HIV/AIDS Legal Network, who forcefully argue for needle exchange programs in Canada's federal and territorial prisons in their recent report Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience . Relying on international law and standards and the overwhelmingly positive experiences of the prisons and jails that have implemented needle exchange, this report refutes common fears and prejudices which impede these programs and makes a convincing case for their implementation.

Prison needle exchanges programs in these varied countries were brought about by the common understanding that the criminal justice system incarcerates a disproportionately high number of injection drug users, who are at great risk for spreading or becoming infected by HIV or hepatitis-C during incarceration because of the availability of drugs and the lack of clean needles. Each country conducted a needs assessment and determined that, as in the United States, the rate of HIV and hepatitis C was substantially higher on the inside than in the general population and that a significant number of cases in the community were persons who had been formerly incarcerated. (In the United States, an estimated 25% of persons infected with HIV pass through jail or prison each year.)

The report emphasizes that each institution should tailor its needle exchange program to its unique population and culture. Methods for needle distribution discussed include automatic dispensing machines, hand-to-hand distribution by prison medical staff or outside community health workers, and programs using prisoners trained as peer outreach workers. In some cases needle exchange was strictly one for one; other programs allowed for multiple needles to be given through various mechanisms. In quite a few facilities, the first needle was given in a translucent, hard plastic "hygiene kit" that also contained items such as a condom, disinfectant, and distilled water. In each country, evaluations demonstrated conclusively that the needle exchange programs resulted in a reduction in needle sharing and concomitant reduction in the spread of HIV and hepatitis C.

Other benefits were noted as well. For example, needle exchange programs do not endanger staff or prisoner safety, and in fact, make prisons safer places to live and work; they do not increase drug use, and in fact serve to link and attract people who inject drugs to other harm reduction strategies and intervention; and the number of overdose deaths in prison dramatically decreased. Furthermore, staff in these institutions came to support these programs and feel needle exchange is in their own interest.

It is important to note that drug use and drug possession remained illegal in each prison and jail discussed in this report. The authors write, "While harm-reduction policies do not condone illegal drug use, they do recognize that reducing the transmission of bloodborne diseases and overdose deaths in society is a more urgent and achievable goal than is ending illegal drug use." A prison director in Switzerland concurs, "Given that all we can do is restrict, not suppress, the entry of drugs, we feel it is our responsibility to at least provide sterile syringes to inmates. The ambiguity of our mandates leads to a contradiction that we have to live with."

The report can be viewed on line at: www.aidslaw.ca/Maincontent/issues/prisons.htm. It may be ordered from the Canadian HIV/AIDS Information Center 1565 Carling Avenue Suite 400 Ottawa K1Z8R1, Canada. (phone: 1-877-999-7740). The report is free but shipping & handling (based on location) will be charged.

[Julie Falk is the former co-editor of Southland Prison News. She is currently the Executive Director of CorrectHELP, the Corrections HIV Education & Law Project, a national advocacy organization for prisoners with HIV based in Los Angeles ]

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