1. Harm Reduction International
Harm Reduction in Prisons An overview of international policy and practice
Rick Lines
Harm Reduction International

2. What do we know about blood-borne infections in prisons?
Rates of HIV/HCV infection in prisons related to two factors. 2

3. What do we know about blood-borne infections in prisons?
1. Rates of infection in the community outside prison, especially amongst vulnerable populations (i.e., people who use drugs) 3

4. What do we know about blood-borne infections in prisons?
2. Prevalence of high risk behaviours inside prisons (i.e., sharing injecting equipment)
Home-made prison syringe 4

5. Barriers to Harm Reduction in Prisons
Zero-tolerance/abstinence based approaches to drug use, often more entrenched than outside prisons
Security ethos of prisons: Admission of sex and drug use seen as an admission of security failure
Discrimination against prisoners, people who use drugs and MSM
Lack of legal framework (i.e., for syringe exchange or methadone therapy)
Staff safety concerns
Funding and resources
Poor and overcrowed prison conditions 5

6. Examples of Harm Reduction in Prisons
Needle/Syringe Programmes
Condoms and safer sex measures
Bleach and disinfectants
Methadone and other substitution treatment
Safer tattooing
Peer Education
Alternatives to prison for people who use drugs
Broader prison reforms that improve conditions and reduce overcrowding 6

7. Harm Reduction in Prisons: Needle/Syringe Programmes
Switzerland: First programme 1992/93
Today – PSEP in 7 prisons
Germany: Pilots in 1996
Today – PSEP in 1 prison (down from a high point of 7 prisons)
Spain: Pilot in 1997
Today – PSEP approved for all 69 prisons, and programs operating in over 30 prisons
Moldova: Pilot in 1999
Kygyzstan: Pilot in 2002
Today – PSEP in all 11 prisons
2007 – NSP also operating in Armenia, Belarus, Iran and Luxembourg. 7

8. Prison Syringe Exchange: Models of Distribution – machines
Anonymous Syringe Dispensing Machines
Lichtenberg Prison Berlin
Saxerriet Prison Switzerland 8

9. Prison Syringe Exchange: Models of Distribution – hand-to-hand
Harm Reduction Kit
Soto de Real Prison, Madrid 9

10. Prison Syringe Exchange: Models of Distribution – peer workers
Prison Colony Branesti, Moldova 10

11. Syringe Exchange Evaluations
Scientific evaluations conducted in 11 prisons with syringe distribution programmes
The provision of syringes did not lead to an increase in drug consumption or an increase in injecting
Syringes were not used as weapons, and safe disposal of used needles was not a problem
Syringe sharing disappeared almost completely
In prisons where blood testing was performed, no new cases of HIV or Hepatitis infection were found
Other positive health outcomes 11

12. Harm Reduction in Prisons: Substitution Treatment
Substitution treatment available in approximately 40 prison systems worldwide
Most western European systems and some central and eastern European systems
Canada and Australia
Iran
Heroin maintenance available in two Swiss prisons since 1995. 12

13. Prescription Heroin Programme Obershöngrün Prison Switzerland13

14. Prescription Heroin Programme Obershöngrün Prison Switzerland14

15. Methadone Evaluated: Correctional Service Canada 2001
Participation in a MMT programme had positive post release outcomes
Opiate users accessing MMT during incarceration were less likely to be readmitted to prison after release and less likely to have committed new offenses than those not accessing MMT
MMT cost effective 15

16. Substitution Treatment in Prisons: Good Practice & Limitations
Prison policy vs. community policy? Effects on intake and discharge
Detox only? Continuation only? Initiation of MMT?
Perceptions of prisoners and staff are important
One component of a broader harm reduction and drug policy
Limitations
Often limited spaces; limited qualified physicians and participating prisons
Not an effective harm reduction option for occasional/recreational heroin users or cocaine users
No legal framework in many countries 16

17. Advocating for Policy Change
Zero-tolerance/criminalisation has failed
Harm Reduction programmes are safe
Harm Reduction is evidence-based
Harm Reduction is cost-effective
Promote legal, ethical, human rights
Collaboration
Between prisoners and health professionals
Between organisations
Between countries 17

18. Kamiti Prison
Nairobi, Kenya 18

19. Harm Reduction International
Rick Lines
Harm Reduction International 19