NDARC Technical Report No. 22 (1995)
This study investigated the access of NSW prisoners to disinfectants for syringe decontamination and the prevalence of injecting drug use, syringe sharing, tattooing and sexual activity in prison. Self completion surveys were administered to all prisoners in AIDS education courses from May to December 1993.
The sample compared closely to the prison population as recorded by the 1991 National Census of Prisoners. The mean age in the census population and the sample was 30 years (sd=8.4 yrs; n=180). Half of the prisoners in the census (49%) were in prison for the first time, compared to 43 percent of those in the study sample. Reports of the most serious offences were similar in the census and the study sample: robbery (12% in census vs 28% in sample); break and enter (17% vs 11%); assault (12% vs 15%); sex offences (8% vs 11%), drug dealing (8% vs 7%), drug possession (1% vs 1%) and homicide (8% vs 11%). The mean duration of prison sentence (5 years) was identical and the proportion serving more than ten years (14%) in the sample was similar to the census (19%). Therefore we believe that our sample was representative.
Over one third (38%, n=171) of respondents reported having easy access to either disinfecting tablets or liquid bleach in the four weeks before the survey, with disinfecting tablets (33%, n=144) being more accessible than liquid bleach (22%, n=172). In eight of the 12 prisons surveyed, less than half of the respondents reported that access to disinfectants was easy. Although it was difficult for some respondents to obtain disinfectants, over two thirds (71%, n=150) reported that they could obtain disinfectants when needed. Indeed, the second most common use of disinfectants was cleaning injecting equipment. Respondents were aware of a mean of 10 injectors but only aware of a mean of four syringes on their wing - a strong indication that inmates were sharing syringes. Two thirds of respondents reported a history of drug injecting (64%, n=177) and almost half (45%, n=170) of all respondents had injected in prison at some time. One quarter (26%, n=176) of respondents reported that they had injected in the prison where they were surveyed, one fifth (20%, n=176) reported sharing syringes and just under one fifth (19%, n=177) reported cleaning syringes with a disinfectant when sharing.
Although less than one third of respondents who had injected (30%, n=46) reported that disinfectants were easy to obtain, most (96%, n=24) of the respondents who shared syringes in prison had used disinfectants to clean injecting equipment. Nearly two thirds of respondents who shared syringes (62%, n=35) followed the cleaning method they had been instructed to use - the `2x2x2' procedure. One sixth (16%, n=176) of respondents reported sharing tattooing equipment in prison and two thirds (63%, n=27) of these cleaned the equipment with bleach. Only a few respondents (4%, n=178) reported having had anal sex in prison. Overall 40 percent of respondents reported having engaged in one of three HIV risk behaviours in prison: one quarter reported injecting, one sixth reported sharing tattooing implements and one twelfth reported having engaged in oral or anal sex while in prison.
Nearly half (48%, n=181) of the respondents reported that they had committed an offence in order to support their drug use and many respondents (69%, n=181) reported having a drug or alcohol problem prior to imprisonment. Some respondents reported having hepatitis B (9%, n=172), hepatitis C (16%) and HIV infection (3%, n=150). A mathematical model was developed and estimated that the potential for HIV to be transmitted within a prison environment is considerable.
The study found that three years after the distribution of disinfectants began, most (62%) inmates still found it difficult to gain easy access to them. Even if an acceptable and effective form of disinfectant was identified, operational problems may still compromise the effectiveness of a syringe cleaning program for prisoners in NSW. The study was unable to identify any single reason for the difficulty prisoners faced in accessing disinfectants as a range of reasons emerged. Some of these reasons appeared to be related to the change over from disinfecting tablets to the liquid bleach formula.
Although there were problems with the bleach availability program, it should be noted that the NSW Department of Corrective Services was the first in the world to allow the independent monitoring of a such a program for prisoners. Research to develop more effective syringe decontamination is urgently required and alternative methods of distributing disinfectant are needed. A new method of distributing bleach via dispensing machines was introduced in some prisons in early 1994.
Despite low levels of unprotected anal intercourse, condoms should be provided to inmates to reduce the potential of sexually transmissible diseases. Alternatives to custody may need to be considered for offenders with drug and alcohol problems. Serious consideration needs to be given to a pilot strict one-for-one syringe exchange program in a NSW prison evaluated against specific pre-determined objectives. However, the occupational and safety implications must be addressed before such a scheme is implemented.
Several problems were encountered during the course of the study. One problem was the inability to recruit a comparison group of prisoners. Therefore, analysis was confined to 181 prisoners enrolled in AIDS education courses. Another more serious problem was that the effectiveness of bleach as a decontaminant came under serious questioning during the course of the study.
This report was submitted to the New South Wales Department of Corrective Services, which was a condition of access to inmates, in April 1994. A new study, funded by the Commonwealth AIDS Research Grants Committee, examining the risk behaviours and distribution of bleach in prison in NSW commenced in March 1994.