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Needle and Syringe Program

Pricking the Bubble Around Prison NSP

Pricking the Bubble Around Prison NSPs

17 January 2012

Introduction

There is an unfounded fear in some sections of the general community and correction centres relating to the risk of both a needlestick attack and of contracting a blood-borne disease from such an injury. These fears have been deliberately aroused and used to block attempts to implement regulated Needle and Syringe Programs (NSPs) in the prison context despite clear evidence dispelling such fears.

This paper will focus on needlestick injuries and their associated risks, as well as the incidence of the hepatitis C virus (HCV) within the community and prison contexts as a result of shared needles. The need for both a regulated NSP and increased access to HCV treatment within prisons will be the core recommendations.

Firstly, the risks associated with needlestick injury will be explored. Then, the low risk of a needle being used as a weapon will be discussed. Thirdly, the prevalence of HCV among groups of people who inject drugs (PWID) both within and outside of prisons will be examined. It will be argued that the high prevalence of HCV within the prisoner population is primarily the result of PWIDs sharing needles. Lastly, the effectiveness of HCV treatment will be explored as well as its availability to prisoners.

Needle Stick Injury Risk

The estimated average risk of contracting hepatitis C from a needle stick injury has recently been revised down from 1.8%[1] to 0.5%.[2] Hepatitis B poses the greatest risk at 22%-31%,[3] however there is a vaccination against it, whereas HIV poses the lowest risk at 0.3%[4]. The occupations where needlestick injuries are most prevalent are in the healthcare sector, service provisions, police and corrective services.

In a study of two Australian prisons it was found that two-thirds of correction officers reported having discovered hidden needles and syringes, generally through cell searches, as a result of their daily work.[5] From the sample of 246 officers, 17 reported to have been injured by a needle for a total of 21 incidents. This suggests that 7% of correction officers have, at some stage of their careers, been accidently injured on one or more occasions by hidden needles and syringes. However as previously discussed, the risk of contracting HCV from a needlestick is very low (around 1 in 200 incidents will lead to a transmission) and a range of treatments are available to treat infection. This risk of a 0.5% transmission rate is much less than other adverse health events that are part of everyday living; for instance the risk of dying in a car accident is 1 in 83 while the lifetime risk of contracting cancer is 44% for males and 37% for females.[6]

Factors Increasing the Likelihood of HCV Transmission via Needle Stick Injuries

-       A hollow-bore needle

-       Deep penetration

-       Visible blood on or in the needle

-       A needle that penetrated a deep artery or vein

-       The amount of dead space at the end of a syringe

Highest-Risk Groups Within Australia of Contracting HCV[7]

-       People who inject drugs

-       Prisoners

Low Incidence of Attacks on Prison Officers Using a Needle

There are many potential weapons available to prisoners other than syringes, making the likelihood of prisoners using needles to attack prison guards very low. In consultations with prisoners, they have argued that they do not view needles, a 1.3 cm piece of wire, as weapons within the prison environment.

The low risk associated with attacks on officers with a needle is evident in the fact that only one fatal attack on a prison officer with an infected needle has ever been documented, worldwide. This single incident was a tragic attack on NSW prison officer Geoffrey Pearce in June 1991 with an HIV infected needle.[8] The attack occurred in a prison without a regulated NSP, using an illegal syringe, at a time prior to effective anti-retrovirals and post-exposure profilaxis, and was perpetrated by a prisoner with AIDS-related dementia. In 2012, the attack on Geoffrey Pearce would be unlikely to be fatal and less likely to have occurred altogether. In the two decades following this incident there has not been one record of another needle stick attack leading to the fatal transmission of HIV or HCV.

An argument raised by some prison officers was that the introduction of an NSP in prison would introduce needles and syringes and thereby create or increase the risk of needles being used as weapons. At first glance this concern might be understandable, however in reality all Australian prisons already have needles and syringes in circulation. In that regard, prison-based NSPs already exist – they are however being run by the wrong people and they circulate used and often infectious injecting equipment. In a Canadian study analysing interventions to reduce HIV transmissions related to injecting drug use in prison, it was found, through its examination of 50 prisons across 12 countries that had a NSP, that not one needle from a regulated NSP was ever used as a weapon.[9] It was also found that NSP programs facilitate more positive relationships between prisoners and correctional officers that, in the long run, would reduce attacks on correctional officers.[10]

In fact there is strong evidence indicating that NSPs make prison environments safer for correctional officers. Firstly, by reducing the amount of infected needles in circulation, the risk of infection due to needlestick injury falls after the introduction of an NSP. Secondly, without the need to hide needles, there is a reduced risk of infection during cell searches.[11]

Prevalence of HCV Within PWID Groups

A 2007 study examining HCV in Australia suggests that 80% of new HCV cases can be attributed to people who inject drugs.[12] The sharing of needles within PWID groups is the chief factor increasing the risk of seroconversion, through sharing infected needles and drug equipment contaminated by needle use.[13]

These conclusions are representative of the consensus in academic literature and various organisational reports regarding the relationship between the sharing of needles and the transmission of blood borne viruses. In prisons where needles are scarce, forbidden and treated as a commodity, prisoners must share, borrow or buy the use of needles in order to have a fix. In a significant piece of research it was found that a quarter of prisoners at the Alexander Machonochie Centre had injected in the previous month and a third in the previous year.[14] Alarmingly, between 23% to 47% of male prisoners and 50% to 70% of female prisoners currently have hepatitis C.[15] These facts, in combination with prisoners having to share needles, means that people who inject are 60 times more likely to contract hepatitis C than those in the general community.[16] A study conducted in Berlin supports these conclusions in their findings that the highest single causal factor of contracting HCV was injecting drugs in prison. [17]

Tattooing

An Australian report has found that the highest risk factor in prisons for HCV transmission, second to sharing needles, is tattooing.[18] 42% of male prisoners receive tattoos in prison. The tattoo equipment is makeshift and sometimes unsterile resulting in a high risk of transmitting HCV among prisoners. Without access to proper sterilisation equipment or processes, some prisoners are becoming infected with HCV through tattooing.

Treatment

Unlike hepatitis B, there is no current vaccination for HCV. Because of this, prevention strategies that target behavioural change backed by services such as a NSP are vital.[19]Current treatment for chronic HCV is effective in between 50% to 85% of cases. However, without an increase in treatment, the amount of people with HCV-related liver cirrhosis will increase to between 7,000 and 10,000 by 2025.[20] An important part of reducing the prevalence of HCV within the community is to tackle its prevalence within the Australian prison system.

The rate of prisoners testing positive to HCV antibodies is 40 times higher than the general community.[21] Furthermore, reports have estimated that one third of male and two thirds of female prisoners are or have been infected with HCV.[22] This equates to half the prisoner population,[23] Thus, with between 5,000 and 10,000 prisoners being released into the community each year and half potentially having HCV, it is essential that effective treatment and preventative measures are provided to prisoners from both corrections and public health sectors.[24] One treatment issue within the prison system that requires immediate attention is that 60% of HCV infected prisoners are refused access to treatment due to having an imminent release.[25]

Conclusion

The risk of a needle being used as a weapon by a prisoner is extremely low. A fatal needle attack has not occurred worldwide in over two decades. Furthermore, no record of an attack has ever been documented in 50 prisons across 12 countries that have regulated NSPs. Through prisoner consultations prisoners have rejected the notion of using a needle as a weapon within the prison environment. It is considered to be a poor weapon, as a sharpened toothbrush is a much more effective weapon. Furthermore, as a NSP would reduce the number of infected needles in circulation, it would reduce the risk of infection from any needlestick injuries.

The risk HCV needlestick transmission is miniscule (1 in 200). A regulated NSP would remove the incentive to hide needles making cell-searches safer and prison officers less likely to injure themselves on needles through their everyday work.

The primary cause of HCV transmission is when blood-to-blood contact is made through sharing injecting equipment. This explains why PWID groups in prisons are the most at risk of contracting HCV in Australia. This is Australia’s most significant HCV issue. Improved access to treatment and the adoption of regulated NSPs within the prison system is required in order to reduce the prevalence of HCV within prisons and the community.

Recommendations

  • Governments must implement regulated Needle and Syringe Programs within prisons immediately. This will ensure that the same health standards within the community are received by prisoners and will help counter the hepatitis C epidemic.
  • A tattooing sterilisation program must also be implemented.

References

Australian Government Department of Health and Ageing (2010) Third national hepatitis C strategy 2010-2013.

Australasian Society for HIV Medicine (2008) Correctional officers and hepatitis C.

Bailey, R (2006) Don’t be terrorized, http:// reason.com/archives/2006/08/11/don’t-be-terrorized <accessed 17 January 2012>.

Bell, D (2005) Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview, American Journal of Medicine, 102.

Boonwaat, L, et.al., (2010) Establishment of a successful assessment and treatment service for Australian prison inmates with chronic hepatitis C, Medical Journal of Australia, 192(9).

Centers for Disease Control and Prevention, http://www.cdc.gov <accessed 2nd December 2011>.

Dolan, K, et al., (2009) Presence of hepatitis C virus in syringes confiscated in prisons in Australia, Journal of Gastroenterology and Hepatology, 24.

Dolan, K, et al., (2010) Incidence and risk for hepatitis C infection during imprisonment in Australia, Eur J Epidemiol, 24.

Jagger, J, et al., (2002) Occupational transmission of hepatitis C virus, JAMA, 12.

Jones, P, (1991) HIV transmission by stabbing despite zidovudine prophylaxis.,Lancet.

Jurgens, R, Ball A, & Verster, A, (2009) Interventions to reduce HIV transmission related to injecting drug use in prison, Lancet Infect Dis, 9.

Lanphear, B, et al.,(1994) Hepatitis C virus infection in healthcare workers: risk of exposure and infection, Infect Control Hosp Epidemiol, 15.

Larney, S, & Dolan, K, (2005) Needlestick Injuries Among Prison Officers in Two Australian States, Australiasian Journal of Correctional Staff, 3(1).

Larney S, & Dolan K, (2008) An exploratory study of needlestick injuries among Australian prison officers, International Journal of Prisoner Health, 4(3).

Maher, L, et al., (2006) Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia, Addiction, 101.

Morgan Alexander Consultancy, AIDS, hepatitus and sexual health, www.aidshep.org.au <accessed 25 November 2011>.

National Cancer Institute, Lifetime Risk (Percent) of Being Diagnosed with Cancer by Site and Race/Ethnicity, http://seer.cancer.gov/csr/1975_2007/results_merged/topic_lifetime_risk_diagnosis.pdf <accessed 28 Novermber 2011>.

Prisoners Working Group of the hepatitis C Subcommittee of the Ministerial Advisory Committee on AIDS, Sexual Health and hepatitis, (2008) Hepatitis C prevention, treatment and care: guidelines for Australian custodial settings.

Public Health Association of Australia, (2011) Balancing access and safety: meeting the challenges of blood-borne viruses in prison, Report for the ACT Government into implementation of a Needle and Syringe Program at the Alexander Maconochie Centre.

Razali, K, et al., (2007) Modelling hepatitis C virus in Australia, Drug and Alcohol Dependence, 91.

Stark, et al.,(1997) History of Syringe Sharing in Prison and Risk of hepatitis B Virus, hepatitis C Virus, and Human.



[1] Lanphear, B, et al., (1994) Hepatitis C virus infection in healthcare workers: risk of exposure and infection, Infect Control Hosp Epidemiol, 15, pp. 745–750.

[2] Jagger, J, Puro, V, & DeCarli, G, (2002) Occupational transmission of hepatitis C virus, JAMA, 12, pp. 1469–1471.

[3] Centers for Disease Control and Prevention, http://www.cdc.gov <acessed 2nd December 2011>.

[4] Bell, D, 2005) Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview, American Journal of Medicine, 102, pp. 9–15.

[5] Larney, S & Dolan, K, (2008) Needlestick Injuries Among Prison Officers in Two Australian States. Australiasian Journal of Correctional Staff Development, 8.

[6] National Cancer Institute, Lifetime Risk (Percent) of Being Diagnosed with Cancer by Site and Race/Ethnicity, http://seer.cancer.gov/csr/1975_2007/results_merged/topic_lifetime_risk_diagnosis.pdf <accessed 28 November 2011>; Bailey, R, (2006) Don’t be terrorized, http://reason.com/archives/2006/08/11/dont-be-terrorized <accessed 4th August 2016>.

[7] Morgan Alexander Consultancy, AIDS, hepatitis and sexual health, www.aidshep.org.au <accessed 25 November 2011>.

[8] Jones, P, (1991) HIV transmission by stabbing despite zidovudine prophylaxis, Lancet, pp. 338-884.

[9] Jurgens, R. Ball A, & Verster, A, (2009) Interventions to reduce HIV transmission related to injecting drug use in prison, Lancet Infect Dis, 9, pp. 57-66.

[10] Ibid.

[11] Larney, S, & Dolan, K, (2008) An exploratory study of needlestick injuries among Australian prison officers, International Journal of Prisoner Health, vol. 4 (3) pp. 164-8.

[12] Razali, K, et al., (2007) Modelling Hepatitis C virus in Australia, Drug and Alcohol Dependence, 91, pp. 228-235.

[13] Maher, L, et al., (2006), Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Addiction, 101, pp. 1499-1508.

[14] Public Health Association of Australia, (2011) Balancing access and safety: meeting the challenges of blood-borne viruses in prison,Report for the ACT Government into implementation of a Needle and Syringe Program at the Alexander Maconochie Centre.

[15] Ibid.

[16] Ibid.

[17] Stark, et al., (1997) History of Syringe Sharing in Prison and Risk of Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiciency Virus Infection among injecting drug users in Berlin, International Journal of Epidemiological Association, 26(6), pp. 1359-1366.

[18] Australasian Society for HIV Medicine, (2008) Correctional officers and hepatitis C.

[19] Prisoners Working Group of the Hepatitis C Subcommittee of the Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis, (2008) Hepatitis C prevention, treatment and care: guidelines for Australian custodial settings.

[20] Ibid.

[21] Australian Government Department of Health and Ageing, (2010) Third national hepatitis C strategy 2010-2013.

[22] Prisoners Working Group of the Hepatitis C Subcommittee of the Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis, (2008) Hepatitis C prevention, treatment and care: guidelines for Australian custodial settings.

[23] Ibid.

[24] ibid.

[25] Boonwaat, L, et al., (2010) Establishment of a successful assessment and treatment service for Australian prison inmates with chronic Hepatitis C, Medical Journal of Australia, 192(9), pp. 496-500.

Justice Action Report AMC PRISONERS' CONSULTATION: November 8, 2011

Justice Action Report

AMC PRISONERS' CONSULTATION: November 8, 2011

pre-consultation

This Report was prepared following an all day Consultation with Alexander Maconachie Centre(AMC) prisoners. It was conducted by community members with special experience and standing in the prisoner and general community. Participants were: Kat Armstrong, Robert Barco, Brett Collins, Kiki Korpinen, Christopher Puplick, and Julie Tongs.

 

We acknowledge ACT Corrective Services for supporting the Consultation and distributing the Notice and Questions during the weekend before. Those documents are attached. We were disappointed that an observer remained in the room, and that the management of the prison didn't meet with us. We were very pleased to meet with the AMC prisoner delegates and the prison officer union representatives.

 

We were concerned that the consultation process may have been affected by being overseen by a Corrective Services employee, and by the limited participation of representatives of the male prisoners, especially given that it wasn’t clear whether those individuals had direct experience of injecting drug use. For those and other logistical reasons we decided not to formally quantify responses from the delegates. In developing its previous report, PHAA chose to consult with people who had direct experience of injecting drug use that had recently left the AMC.  The message from those consultations was overwhelming support for a Needle and Syringe Program (NSP).

 

Nine male prisoner delegates presented the views of those in the nine areas. We met four of the five female prisoners as a separate group earlier in the day.

 

There was significant support expressed for the introduction of an NSP in the AMC, as well as some opposition.

 

Participants in the consultation emphasised the importance of prisoner participation and involvement in the development of operational policies, procedures, protocols, standards and evaluation processes, which would need to be established to address the widespread infection, and broader health issues.

 

There were a variety of views expressed, with different levels of support and opposition for the NSP for diverse reasons. Those consulted agreed that there were too many unresolved issues for a general consensus to be reached. It is a complex personal and social health issue. There are many questions to resolve including the legal status of possession of equipment, targeting of people through urinalysis, anonymity, privacy and parole decisions.

 

It was agreed that prisoners wouldn't prevent other prisoners from getting the benefit of clean equipment, or getting proper health support.

 

It was agreed that in practice a sharpened toothbrush is a much more effective weapon than a used syringe. It was agreed that there is a substantial fear factor associated with the latter, despite the likelihood of transmission of blood-borne viruses from needlestick injury being low.  Medical advances with infection control have reduced the potential consequences of an attack with a used syringe, even if you could gain access to the HIV virus, which is almost absent in prison. They acknowledged that Hepatitis C in particular currently poses a high risk of infection from shared injecting equipment. Some said they would be prepared to issue a statement that they reject the use of a needle as a weapon, for a whole range of reasons. 

 

Prisoner delegates said that there are a number of immediate issues requiring attention if the ACT Government is really interested in their health, human rights and not re-offending upon their release. 

 

Delegates are currently preparing detailed material around several headings. Key issues include the incentive of remission to change their behaviour rather than being helpless waiting for time to pass. This would enable them to earn their release – based on the successful principles of Alexander Maconochie. His ‘marks’ system gave some control of the length of the sentence to the prisoners and their actions, and a recidivism level of 2% was the result. 

 

Other issues raised were access to relevant education and training so they could prepare for release; improved gym equipment and access; and better food to regain their health.

 

Recommendations

1.    Implementation of health programs should ensure continued involvement of prisoners in the development of implementation processes; with prisoners themselves sharing responsibility for both uptake of and compliance with new programs.

2.    Prisoners should have direct input to the direction of health policy and programs within the AMC. Prisoners should be involved in the development and oversight of implementation and evaluation processes designed to achieve agreed policy outcomes.

3.    Implementation of legislative change to enable the introduction of a Needle and Syringe Program (NSP) in the AMC for those who wish to use it.

4.    Development and implementation of enhanced education and vocational training programs for prisoners with a view to facilitating engagement with community-based education, training and employment options on release and reducing rates of recidivism.  Opportunities to develop new skills and undertake education would also contribute to enhanced mental health outcomes for prisoners.

5.    Improved access to nutritious food and various forms of physical activity with a view to promoting positive health and rehabilitation outcomes for prisoners, including provision of improved equipment and access to the gym.

6.    Development and implementation of a remission system based on the principles of Alexander Maconochie’s “marks” system, to encourage prisoners to engage with health, education and other rehabilitation programs designed tofacilitate transition to community and reduce rates of recidivism post-release.  Such a measure would also help to address the demand for drugs within the prison, which are often used as an escape mechanism by those facing an otherwise helpless and hopeless situation.

 

November 11, 2011

 Read as PDF

Report Extracts

EXTRACTS FROM PRISON REPORTS ON SMUGGLING OF CONTRABAND AND ATTITUDE OF PRISONERS TO A PRISON NSP

Burnet Report:
External component of the evaluation of drug policies and services and their subsequent effects on prisoners and staff within the Alexander Maconochie Centre Final Report, April 2011

(Burnet Institute Report) at http://www.health.act.gov.au/c/health?a=sendfile&ft=p&fid=1302161190&sid=

These quantitative data on drug use histories accord with responses from interview participants. Prison staff and other service providers consistently reported that they believed that drug use issues were prevalent among the prison population, as was drug use at the AMC.

‘We’ve got probably 65%-70% of our prisoners are in here because of a drug related offence.’ (key informant) ‘We’ve got them incarcerated but we’re still not reducing their usage.’ (key informant)

‘There’s an enormous amount of drugs in this jail. I’m absolutely blown away.’ (key informant)

The inevitability of drugs entering the AMC routinely underpinned notions of nterdiction interrupting rather than preventing drugs entering the prison.

‘It’s a game of chess. They will try and find a way to introduce it and we will be on top of it. They’ll find another creative way. It is a game. One minute

we’ll be on top of the introduction and they’ll find some other way. Recently something as simple as lobbing a tennis ball over with a supply in the tennis ball over the actual perimeter. So we will now go to the next level of having a heightened level of perimeter security.’ (key informant) (p. 124).

[p.125] ‘I’ve had several offers of marijuana in here and the possibility of heavier drugs even but that’s sort of a bit more quieter because you don’t see much of the heavier stuff getting around.’ (key informant)

‘We’ve had whistleblowers to tell us that there are syringes and drugs in places… We’re advised that marijuana can come over the fence in tennis balls on to the oval.’ (key informant)

Trafficking of drugs by prison staff was considered to be an issue by many interviewees.

‘If you’ve got plenty of money I’m sure you can find a guard and give them $5-10 grand to and they’ll bring you the gear.’ (key informant)

‘There was staff bringing it in which I saw which is quite common in all the jails

I’ve been told as well.’ (key informant)

‘One of the biggest challenges is to, because we have so many staff coming and going every day in this correctional centre, one of the biggest challenges is

to guard against trafficking [by staff]. I believe we have some of that.’ (key informant)

‘There are guards bringing in drugs.’ (key informant)

Drugs entering the AMC and the subsequent availability of drugs to AMC inmates are supported by responses to the Inmate Health Survey. Table 11 shows responses on a range of in-prison drug use questions. More than half of respondents that reported lifetime use of cannabis reported using cannabis in prison and more than one-quarter of lifetime users reported speed use in prison.

Of those that reported lifetime injecting drug use, nearly one third reported ever injecting drugs at the AMC and approximately one quarter reported injecting drugs in the past four weeks and that the last time they injected drugs was in prison. Of those that reported injecting in the past four weeks, approximately equal proportions reported injecting less than weekly or weekly or more often.

There was no consensus among survey respondents about the availability of drugs at the AMC, with slightly less than half of respondents describing drugs as “easy” or “very easy” to obtain at the AMC (Table 11). (pp. 124-25)

Consultations with prisoners:

Despite these conflicts, among prisoners, ex-prisoners and community-based service providers there was overwhelming support for an NSP to be implemented at the AMC. Health staff from the prison also strongly supported the introduction of NSP services.

‘There should be a needle exchange program there definitely. Some of the contraptions I’ve seen in there used as syringes, they’re unreal you know.

They’re used by so many people you know.’ (key informant)

‘They should have a needle exchange program.’ (key informant)

‘What we need to talk about is this going to be the prison where we’re going to trial an NSP. Why not, everyone is behind it, where’s the problem? It’s with the Unions. It’s not with the Health Minister, it’s not with the workers, it’s not [p. 47] with anybody else but the unions here and that’s a really great example of you’re in this place where you can do it and it’s not being done because there

hasn’t necessarily been the analysis of the issue yet.’ (key informant) Custodial officers were, for the most part, strongly opposed to the notion of a

prison-based NSP. Many cited a lack of consultation and dialogue as partly influencing their opposition. (pp. 146-47).

Report for the ACT Government into implementation of a Needle and Syringe Program at the Alexander Maconochie Centre by Michael Moore CEO, Public Health Association of Australia

(Moore Report) (July 19 2011)

(http://www.health.act.gov.au/c/health?a=sendfile&ft=p&fid=1311820623&sid=):
Approximately one third of prisoners reported having injected in prison and a quarter to having done so in the previous four weeks (Burnett 2011 pg 126). These statistics are a matter of significant concern regarding the spread of infection in the prison context. The reality is that an unregulated needle and syringe program does operate in the prison at the moment. The problem is that it is controlled by prisoners rather than health workers. The priority for those running the illicit NSP is therefore associated with financial and power advantage of the illegal commodity. Needles and syringes are traded and used in the least safe manner with regard to the spread of disease, the nature of the equipment and the power of those controlling the commodity. (p. 10).

In addition to the disposal mechanisms outlined in each of the models, secure syringe disposal bins (that prevent the extraction of used injecting equipment) should also be placed in discreet locations of the prison in areas accessible to prisoners who may be using injecting equipment either provided by the NSP, or old injecting equipment that has previously been smuggled into the prison.

These additional measures would further reduce the potential for accidental needle-stick injury to both prisoners and staff, and given the current availability of illicit (smuggled) injecting equipment in the AMC, would be worthy of consideration even without the implementation of an NSP. (p. 46).

Consultations with prisoners:

- AIVL and CAHMA conducted two further Focus Group Workshops with ex-prisoners and injecting drug users to provide further input to PHAA re barriers/challenges and possible models:

a) a generic focus group workshop for male and female ex-prisoners & illicit drug users (Mon 30 May); and

b) an additional focus group workshop specifically for Indigenous ex-prisoners and illicit drug users (Tues 31 May). (p. 61).

JA submission re Needle and Syringe Program (Moore Report)

Submission regarding Moore Report – Implementation of a Needle and Syringe Program (NSP)

 (read as pdf)

Justice Action is a community-based organisation of criminal justice activists. We are consumers, prisoners, academics, and victims of crime, ex-prisoners, lawyers and general community members dedicated to making a change. We believe that meaningful change depends upon the free exchange of information, community involvement and the taking of responsibility by all members of the community. Operating for over 25 years, Justice Action has worked with inmates regarding issues of prisoners’ rights, education, women in prisons and health. We represented all Australians held against their will at the 2009 Consultation for the UN Optional Protocol to the Convention against Torture (OPCAT) Treaty and defended the right of prisoners to vote in the Senate in 1997 and 2006.

Engaging in campaigns for the improvement of prisoner health and consistently pressuring the government to control the spread of blood-borne communicable diseases in prisons through the immediate availability of condoms, clean syringes and dental dams, Justice Action has:

-       Served as a founding member of the NSW Justice Health Consumer and Community Group

-       Represented Australian prisoners to the United Nations Special Rapporteur on Health in 2009

-       Held membership of the Blood Borne Communicable Diseases group at ACON for 10 years

-       Initiated ex-prisoner Richard Lynott’s case against the government for negligence due to their failure to supply clean needles and syringes in prison (1996).

-       Published JUST US newspaper (distributed to prisoners across Australia and New Zealand ) with full page, front cover feature article regarding HCV issues

We at Justice Action applaud ACT Health in recognising and taking seriously the extent of blood-borne communicable diseases and the role that needle sharing in greatly contributing to this issue. With rates of HCV in correctional facilities up to sixty times greater than the general population, it is imperative that some form of NSP must be implemented to ensure that the duty of care that prison authorities owe to prisoners to protect them from foreseeable harm is fulfilled. With the first case with evidence demonstrating transmission of HCV while incarcerated within the Alexander Moonachie Centre documented, it becomes essential that recognition be granted to the constant accessibility of illicit substances within prisons and the occurrence of injected drug use.

The National Drug Strategy approaches drug policy from the position of harm minimalisation, including the reduction of demand, supply and harm. Yet the strategies employed in prisons are highly inconsistent with approaches to illicit drug use in the community. The rates of HCV infection, transmission and the use of shared needles in correctional facilities also serve to highlight these inconsistencies with rates in the wider community. Why do so few choose to address this?

Prisoners want to feel positive about their futures and to build new lives during their period in prison. Feeling hopeless and helpless with no incentive or opportunity to make these constructive changes to their lives, they look for ways to distract their pain. Drug use serves this purpose, providing a way out. Reducing the demand of illicit drugs by offering incentives and opportunities to undertake health based and other forms of education is a primary necessity of ACT Corrections.

In 1990, the United Nations adopted the Basic Principles for the Treatment of Prisoners, at its core is the “principle of equivalence” which ascertains that prison health services must be of the same quality and meet the same standards as those of the outside community. As such, as highlighted by the World Health Organisation and the Joint United Nations Program on HIV/AIDS, the higher the rates of injected drug use and associated risk behaviours becomes in prisons, the greater the urgency for the introduction of needle and syringe programs becomes.

Much to the disgust of certain forms of media commentators, the battle to completely halt the flow of drugs into prisons is one that is akin to trying to contain a flood in a fish tank. Drugs in prisons are a reality that must be addressed. Justice Action applauds the Moore Report’s recommendations to adopt the ‘least-worst’ option in a circumstance where, if the status quo is maintained, no gains can be achieved.

Justice Action concurs with the recommendations drawn by the Public Health Association of Australia’s report into the Implementation of a Needle and Syringe Program at the Alexander Moonachie Centre and favours the preferred option of the Report (Model 3B: Contained NSP operated by an external agency within Health Centre) due to its potential for health promotion and education. However, we are quick to highlight that any of the proposed models are favoured over the current policy of inaction and feigned ignorance. Justice Action acknowledges the concern of some groups within prison officer organisations, yet contend that prison officers will achieve greater safety from a properly implemented NSP, due to less tension with prisoners and less risk on the job due to reduced infection levels. The successes of implementation in prisons across Europe speak for themselves in addressing queries as to the potential effectiveness of NPS.

Justice Action urges the ACT Health Directorate to implement the recommendations of the Moore Report in combating the HCV epidemic that continues to spread across the prison population. Prisoners have highlighted the need for the introduction of a NSP to us for decades as they would prefer to avoid infection rather than undertake expensive post-infection treatment strategies and should have the right to control their own health care. As the report highlights, none of the goals of the NDS or the right to adequate healthcare should be lost because a person is incarcerated.

Just Us article

 

Just Us September 2005 Vol:2 Issue 1

TIME FOR BLUE AND GREEN TO COME TOGETHER OVER HEP C

Australia’s government and community health organisations have reason to be proud over how they faced the threat of HIV/AIDS together in the 1980s. Officials, health workers and activists worked to provide harm minimisation resources to the stigmatised, vulnerable communities most under threat from the disease. Thousands of healthy Australians are living testimony to the success in limiting HIV transmission in this country.

Prisoners also benefited from the public health revolution sparked by the AIDS crisis.

NSW was first to introduce a prison methadone program in 1986, with other jurisdictions eventually following suit. The provision of condoms, dental dams, bleach for cleaning syringes and, most importantly, peer education programs encouraging prisoners to take responsibility for their own sexual and injecting health would follow over subsequent years. In most cases these innovations were met with initial resistance by prison staff, but their benefits to health and good order would slowly win over the skeptics and attract broad support from officers.

Although the prison harm minimisation measures of the 1980s and 90s seem to have prevented a major outbreak of HIV in the prison system, they have not stemmed the spread of another serious blood borne virus, hepatitis C, which can survive outside the body on microscopic specks of blood and can even withstand bleach sterilization. As needle syringe programs (NSPs) had been shown to significantly reduce hepatitis C transmission among injecting drug users the next step was clearly the provision of clean injecting equipment to prisoners.

But in July 1991, NSW prison officer Geoffrey Pearce was stabbed by a prisoner wielding a HIV infected needle.

Seven years later, Mr Pearce died of AIDS.

If resistance to prison NSPs among prison officers had previously been strong, it was now implacable. The NSW parliament reacted by passing the Prisons Syringe Prohibition Amendment Act of 1991, effectively outlawing clean injecting equipment in prisons and condemning thousands of prisoners to hepatitis C infection.

Hepatitis C is rampant in prisons. Over one third of Australian prisoners estimated to be infected, with rates much higher for women prisoners. There is a 10-20% chance that an uninfected NSW prisoner will contract Hep C per year spent in prison, with upwards of 1000 new infections behind that state’s bars every year. Almost all of those prisoners will eventually be released to carry the virus back to their communities.

Many of those with the disease will suffer from nausea, fatigue, depression, abdominal pain and flu like symptoms, with some going on to develop life threatening liver damage or cancer.

Although the symptoms and progress of the disease can be controlled with careful diets, lifestyles and herbal treatments the only real cure is a powerful combination drug therapy that is expensive and can have severe side effects on health and behaviour. The medication does not work in all cases and some variations of the virus are resistant to it.

Hepatitis C is not transmitted in semen or saliva but is well adapted to spreading through blood-to-blood contact and the virus survives for long periods outside the body. It can spread in invisible blood specks in syringes, on spoons, filters, swabs and tourniquets. It has also spread in prisons through fights, barber’s shears and tattooing equipment. Some studies have cast doubt on the effectiveness of bleach sterilisation in killing the virus, especially when carried out in haste on old, pitted, reused injecting equipment.

As a result, prisons have become incubators for the hepatitis C virus, accounting for a disproportionate number of the 16,000 new infections in Australia every year and facilitating its spread through the country – at a cost of many millions of dollars in healthcare and lost productivity. Prison needle syringe programs would be an extremely cost effective way of reducing the long-term cost of hepatitis C.

While harm minimisation in Australian prisons has barely progressed since the 1990s, other governments have bowed to humanity and sensible self-interest by introducing their own prison NSPs.

Following Switzerland’s pioneering 1992 program, prisons in Germany, Spain, Moldova, Albania, Estonia, Kyrgyzstan and Belarus now have needle syringe programs serving tens of thousands of prisoners.

Contrary to the fears of critics, there has never been a documented case of a needle being used as a weapon in any prison which provides them, nor has there been any increase in drug consumption or injecting. Instead, there have been decreases in HIV and hepatitis C transmission, reductions in risky behaviour such as needle sharing, declines in overdoses, abscesses and injecting related infections and greater use of other drug rehabilitation and harm minimisation services.

After their introduction, prison NSPs has also won the strong support of prison officers.

In 2003 the provincial governments of Berlin and Lower Saxony closed the prison NSPs that had been operating successfully for many years. Among the most vocal critics of the government decisions have been the prison officers’ organisations, which have collected petitions and lobbied parliamentarians calling for the programs to be reinstated. They have come to realise that clean needles are not only important for the health of prisoners, but also to the occupational health and safety of prison staff.

But in Australia, around a quarter of prisoners continue their furtive injecting and hasty cleaning of the hundreds of reused, resharpened, dirty, pitted needles that circulate around the prisons. Some of those needles will inflict accidental needle stick injuries upon the prison officers who eventually discover their hiding places.

Eight years ago Professor Nick Crofts wrote in the Medical Journal of Australia that “prison authorities and governments must realise that the responsibility for the infection of a prisoner with a blood borne virus, because means for prevention were not available within the prison, rests with them”. He might have also reminded authorities of their responsibility to prison staff.

Late last year ACT Parliamentarian Kerrie Tucker warned it was “just a matter of time” before an infected prisoner who had been denied access to clean injecting equipment sued a government for breach of duty of care. It was similar legal action by the HIV infected ex-prisoner, Richard Lynott, which finally forced Australian prison systems to provide condoms.

And in early July, Federal Court Justice Ron Merkel added his own voice to the chorus of legal professionals, health workers, human rights advocates and prison activists calling for the introduction of prison needle syringe programs.

The political will to move forward on harm minimisation in prisons is unlikely to come from the top in this country. Even if it did, it would not succeed without the support of prisoners and prison staff.

The death of Geoff Pearce was a tragedy that was only deepened with the passage of the Prison Syringes Prohibition Act. A more fitting memorial would be a prison needle syringe program that would serve to protect prisoners, staff and the community as a whole from the scourge of blood borne disease.

Implementation of a Needle and Syringe Program at the Alexander Maconochie Centre

Implementation of a Needle and Syringe Program at the Alexander Maconochie Centre (pdf)

The Public Health Association of Australia (PHAA) was engaged by the ACT Government in May 2011 to investigate and report on models for the implementation of an NSP in the AMC. The project also entailed an assessment of barriers to implementation and broad consultations with key stakeholders. The emphasis of the project has been on seeking to develop a model that ensures optimal health and safety outcomes for everyone impacted upon by a custodial sentence. This includes not only the person being detained in custody but all prison staff and the broader community. This report outlines outcomes and recommendations from the project and proposes a way to meet this challenge.

The terms of reference for the work are as follows:

1. Investigate models for the delivery of needle and syringe programs in custodial settings, including existing programs in other jurisdictions, their applicability to the AMC and evidence for the effectiveness of different models.

2. Consider the views of staff at the AMC, and relevant stakeholders to better understand their knowledge, beliefs and perceptions about needle and syringe programs in custodial settings and in the context of the AMC in particular.

3. Identify barriers and enablers for the implementation of a trial needle and syringe program at the AMC. Where barriers are identified, provide advice on specific strategies to overcome these.

4. Consider and advise on the potential impact of a trial needle and syringe program on services for prisoners post-release.

5. Provide analysis on the feasibility and likelihood of successfully implementing a trial needle and syringe program at the AMC.

6. If appropriate, provide recommendations on implementing a preferred model of a trial NSP at the AMC.

Recommendations

Recommendation 1: Requirement Under Law

The ACT Corrections Management Act 2007 be amended to require the establishment of an NSP at the AMC.

 Recommendation 2: Rules, Procedures and Protocols

 A clear set of rules, procedures and protocols be established through an appropriate process guided by the ACT Corrections Management Act.

 Recommendation 3: Implementation through a Flexible Contingency Process

 Adopt a contingency process for the implementation of appropriate model/s for a needle and syringe program at the AMC. If the initially preferred model does not meet the needs of stakeholders the procedure should be to move to the next preference. The order should be as follows:

 Preferred Initial Model: NSP Model 3 (Contained NSP)

 -       Model 3B: Contained NSP operated by external agency (within Health Centre)

 Should an external provider fail to deliver the necessary outcomes, Model 3 could alternatively be operated by ACT Health.

 -       Model 3A: Contained NSP operated by ACT Health/Nursing Staff (within Health Centre)

Contingency Step 1: NSP Model 2 (Equipment provision from Health Centre)

 -       Model 2B: NSP operated by an external agency

 Should an external provider fail to deliver the necessary outcomes, Model 2 could alternatively be operated by ACT Health.

 -       Model 2A: NSP operated by ACT Health/Nursing Staff

 Contingency Step 2: NSP Model 1 (Vending Style Machines)

 -       Model 1: ‘One for one’ Exchange Vending Style Machines

 Recommendation 4 Aboriginal Health Worker

 Recruitment of a dedicated Aboriginal Health Worker position in an NSP and related service provision would be worthy of consideration.

 Recommendation 5 Secure Syringe Disposal Bins

The installation of secure syringe disposal bins would further reduce the potential for accidental needle-stick injury and be worthy of consideration even without the implementation of an NSP.

Recommendation 6 Retractable Syringe Technology

 Future developments in retractable syringe technology will need to be considered as part of the ongoing development of an NSP in custodial settings.

 Recommendation 7: Civil and Criminal Liability

Legislative amendments be considered to protect all staff from potential civil and criminal liability.

 

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