Prison-based needle and syringe programmes (PNSP) – Still highly controversial after all these years

Abstract

Aims: In most countries, the spread of HIV and hepatitis C in prisons is clearly driven by injecting drug use with many infected prisoners who are unaware of their infection status. Despite many studies confirming the facts about risk behaviour and the prison setting as a risk environment for maintaining or taking up of risk behaviour, little progress has been made around effective and efficient infectious prophylaxis by means of prison-based needle and syringe programs and associated education. The aim of this contribution is to study why effective and efficient prevention models applied in the community (like PNSP) are very rarely implemented in prison settings. Findings: Only approximately 60 out of more than 10,000 prisons worldwide provide needle exchange in prisons. A United Nations Office on Drugs and Crime (UNODC) handbook on the implementation of prison-based needle exchange has been elaborated to better inform and guide officials in the Ministries of Justice, Health and people in charge of healthcare in prisons. It integrates the views and experiences of many experts throughout the world. Conclusions: The key problem apart from political problems in implementing prison-based needle and syringe programmes (PNSP) remains the lack of guarantee of confidentiality to prisoners. This is hindering prisoners from participating in the programmes continuously. The second problem is that HIV/AIDS and opioid consumption are no longer the key drivers of the debate around drugs and infectious diseases in prisons, but instead new psychoactive substances (NPS) and steroids have become issues. In many countries, the HIV rate among drug using prisoners is lower compared 20 years ago (e.g. Western Europe). While hepatitis C is by far the most prevalent infectious disease, it has been neglected by policy makers. It has been difficult to develop momentum to legitimise concerted action to prevent the spread of infectious diseases. The handbook of the UNODC aims to serve as a basis for the implementation of PNSPs.

• Addiction
• AIDS
• criminal justice system
• drug abuse
• drug injection
• harm reduction
• hepatitis C virus
• HIV
• heroin
• injection drug use

Declaration of interest

The authors declare no conflicts of interests, neither in terms of financial relationships nor in terms of personal relations.

Notes

¹See also ECDC’s report 2012 on the achievements of the Dublin Declaration.

² See also the Spanish Ministry of the Interior and the Ministry of Health and Consumer Affairs, in their 2002 guidelines on the implementation of prison needle exchange programs. Ministerio del Interior/Ministerio de Sanidad y Consumo (2002).

³ Syringes were initially distributed through the medical unit, but this strategy only reached about 25% of prisoners who injected drugs. Distribution subsequently switched to a peer model, reaching 65–70% of known drug injectors and allowing syringe exchange to be available 24 hours a day (Harm Reduction Coalition, 2007).

⁴ UNODC (2015): A handbook for starting and managing needle and syringe programmes in prisons and other closed settings. UNODC. http://www.unodc.org/documents/hiv-aids/publications/Prisons_and_other_closed_settings/ADV_COPY_NSP_PRISON_AUG_2014.pdf (accessed 16 January 2016)