Summary
This section updates developments since April 2004, when the first edition of Prison needle exchange : lessons from a comprehensive review of international experience and evidence was completed. There have been a number of significant developments, both in Canada and internationally, which support the evidence, analysis and findings presented in the first edition of the report. Internationally, the authors present and review evidence from existing prison needle exchange programs (PNEPs) and report on additional countries that have implemented or are planningto implement such programs. Regarding Canada, the authors review research concerning the association between injection drug use, incarceration and the transmission of blood-borne pathogens. They report on recent recommendations from the medical community and a prison ombudsperson calling for pilot PNEPs, and on initiatives within the Canadian government to study the feasibility of piloting PNEPs.
Contents
Executive Summary – 1. Prisoner Health Is a Public Health Issue – 2. Methodology – 3. HIV and HCV Epidemics in Prison – 3.1 Prevalence of HIV and HCV in prisons – 3.2. Drug use in prison – 3.3. Injection drug use, shared needles and risk of HIV and HCV transmission – 3.4. Harm reduction – 4. Human Rights and Legal Standards – 4.1. International human rights law -- 4.2. International rules, guidelines, principles, and standards – 4.3. Prisoners’ right to health and access to sterile needles – 4.4. Obligations in Canadian law – 5. Review of International Evidence of Prison Needle Exchange – 5.1. Switzerland – 5.2. Germany – 5.3. Spain – 5.4. Moldova – 5.5. Kyrgyzstan – 5.6. Belarus --
6. Analysis of the Evidence – 6.1. Refuting objections 6.2. Increased institutional safety – 6.3. No increase in drug consumption or injecting – 6.4. Part of a continuum of drug-related programming – 6.5. Positive prisoner and public health outcomes – 6.6. Effective in a wide range of institutions – 6.7. Different methods of needle distribution have been effective – 6.8. Common factors in effective prison needle exchange programs – 7. Needle Exchange programs should be implemented in prisons in Canada – 7.1. Needle exchange programs recommended since 1992 – 7.2. Legal obligation to respect, protect, and fulfill prisoners’ right to health – 7.3. Inadequacy of bleach – 7.4. Methadone maintenance therapy a partial solution to the harms of IDU – 7.5. Opinions of prison staff – 7.6. Cost-effectiveness of prison needle exchange programs – 7.7. Time for elected officials and prison authorities in Canada to act – 7.8. Recommendation – Conclusion : a call for leadership on prison needle exchange programs.