Harm reduction behind bars: Prison-based needle and syringe programs

Harm reduction behind bars: Prison-based needle and syringe programs By Emily van der Meulen and Sandra Ka Hon Chu HIV and hepatitis C are serious public health issues in Canadian prisons. Rates of these infections in federal institutions are considerably higher than in the general population. The Correctional Service of Canada (CSC) currently provides prisoners with condoms, methadone maintenance treatment, and bleach to reduce the spread of HIV and hepatitis C. However, CSC has yet to permit the introduction of prison-based needle and syringe programs (PNSPs). Needle and syringe distribution programs have been deemed a successful harm reduction measure and are considered best practice in the wider non-prison community. In this article, we review current international PNSP best practices, different models and approaches, and suggest ways that service providers and others can support the introduction of PNSPs in Canada. How many prisoners in Canada have HIV or hepatitis C? Rates of HIV in Canadian federal prisons are at least 10 times higher than in the general population, while rates of hepatitis C are at least 30 times higher. , , More concerning is that these rates are even greater among incarcerated Indigenous peoples and people who inject drugs. More than one in 10 of the Indigenous women in federal institutions, for example, are reported to be living with HIV and almost one in two is living with hepatitis C. Among people who inject drugs, almost three times as many are living with HIV relative to other prisoners upon admission to federal prisons. There is evidence to support that HIV and hepatitis C transmission is occurring within federal prisons and not just before incarceration. , Research suggests that prisoners who use injection drugs are at an increased risk for transmission. How often do prisoners participate in behaviours that can lead to HIV and hepatitis C transmission? Despite security procedures to block the flow of drugs into prison, drugs can still enter institutions. One study of federal prisoners found that in the previous six months, 34% of men and 25% of women had used non-injection drugs (snorting, sniffing, smoking or swallowing) and 17% of men and 14% of women had injected drugs while they were incarcerated. A lack of sterile needles/syringes and injecting equipment means that people who inject drugs while incarcerated often share injecting equipment. In a study of federal prisoners, 55% of men and 41% of women who injected 1 2 3