On 18 November 2004, Merchants Quay Ireland and the Penal Reform Trust launched a report that examined the issue of prison needle exchange based upon the international experience up to 31 March 2004.1 

The authors completed a literature review, visited prisons in four countries, and corresponded with people responsible for administering prison needle exchange programmes. The report provides a comprehensive review of the evidentiary and legal basis for prison needle exchange programmes. 

The need for an effective response to the issues of HIV, hepatitis C, and injection drug use in prisons is a significant international concern. In many countries, including Ireland, rates of HIV and hepatitis C infection in prison populations are much higher than those in the general population. In many countries, the epidemics of HIV and hepatitis C in prisons are linked to injection drug use and to unsafe injection practices. 

Needle exchange programmes have proven to be an effective harm-reduction measure that reduces needle sharing, and therefore the risk of HIV and hepatitis C transmission, among people who inject drugs. As a result, many countries have implemented these programmes within community settings to enable people who inject drugs to minimise their risk of contracting or transmitting HIV and hepatitis C through needle sharing. 

Despite the success of these programmes in the community, only six countries (Switzerland, Germany, Spain, Moldova, Kyrgyzstan, and Belarus) have extended needle exchange programmes into prisons. Other countries, including Kazakhstan, Tajikistan, and Ukraine may follow in the near future. 

Needle exchange programmes have been implemented in some of these prisons since 1992, in each case in response to significant evidence of the risk of HIV transmission within the institutions through the sharing of injecting equipment. 

Needle exchanges in prisons were typically implemented on a pilot basis, and later expanded based on the experience during the pilot phase. Several different methods of syringe distribution are employed, including:

• Automatic dispensing machines;
• Hand to-hand distribution by prison physicians or healthcare staff or by external community health workers;
• Programmes using prisoners trained as peer outreach workers.

 The experience and evidence from the six countries where prison needle exchange programmes exist demonstrate that such programmes:

• Do not endanger staff or prisoner safety and, in fact, make prisons safer places to live and work;
• Do not increase drug consumption or injecting;
• Reduce risk behaviour and disease (including HIV and hepatitis C) transmission;
• Have other positive outcomes for the health of prisoners;
• Have been effective in a wide range of prisons;
• Have successfully employed different methods of needle distribution to meet the needs of staff and prisoners in a range of prisons.

 According to Rick Lines, one of the authors, the goal of this report is to encourage prison systems with HIV andhepatitis Cepidemics driven by injection drug use to implement needle exchange programmes.  He cautions that the failure to provide prisoners with access to essential HIV and hepatitis C prevention measures is a violation of their right to health in international law.  At the launch of the report, he also highlighted that failure to continue needle exchange in prison reduces the effectiveness of needle exchange in the community.

1. Lines R, Jurgens J, Betteridge G, Stover H, Laticevschi D, Nelles J (2004) Prison needle exchange: lessons from a comprehensive review of international evidence and experience. Montréal: Canadian HIV/AIDS Legal Network. 

Copies of this report can be retrieved from the website of the Canadian HIV/AIDS Legal Network at www.aidslaw.ca/Maincontent/issues/prisons.htm, or ordered through the Canadian HIV/AIDS Information Centre; Tel + 1 613 725-3434; Fax +1 613 725-1205; Email: aidssida@cpha.ca.