NDARC Technical Report No. 34 (1996)
This study follows an earlier study, Bleach Availability and Risk Behaviours in Prison in NSW, conducted in 1993 (see Appendix 1 for summary). That study also investigated access of NSW prisoners to disinfectants for syringe cleaning and the prevalence risk behaviours but it differed in that respondents were drawn from AIDS Education courses in prison.
The current study
This study recruited consecutive inmates nearing release from six prisons in 1994 thus enabling a representative sample to be drawn. However, data collection was deferred until after release from prison so as to reduce the likelihood of under reporting. It was possible for respondents to remain anonymous and to participate even if they had returned to country locations as interviews were conducted over the phone.
The aims of this study were to monitor:
- the access inmates had to disinfectants
- the methods used to clean syringes
- any negative consequences of bleach provision, and
- risk behaviours in and out of prison.
The study was reasonably successful in the recruitment of respondents: approximately half (45%, n=229) of all inmates recruited in prison telephone the Research Office for an interview within the allotted time after release from prison.
The sample was similar to the prison population as recorded by the Prison Census in 1992 (Eyland, 1993) in terms of mean age, proportion male and proportion who had committed Robbery, Fraud, Break and Enter, Other Theft and Drug Offences as their Most Serious Offence. The sample differed from the prison population on mean sentence length and proportion with a prior imprisonment, but this was to be expected as recruiting at exit would over represent those who experience shorter terms and more frequent incarcerations. However, the sample was compared to a discharge cohort from the Prison Census in 1992 (Kevin, 1992) and was found similar on median sentence length.
Background of sample
Approximately half (54%, n=102) of respondents reported that the offences for which they were imprisoned were committed to support a drug habit. Three quarters (76%) of respondents reported having a drug or alcohol problem prior to incarceration. It was encouraging that over half (61%) of these had received some sort of help for their drug and alcohol problems when last incarcerated.
Two thirds (64%, n=102) of the sample reported a history of drug injecting. Among those who identified as IDUs, two thirds (63%, n=65) reported sharing syringes in the community. Two thirds (66%) of IDUs reported injecting in prison at some time, and virtually all (91%, n=43) of these reported having sharing syringes in prison. Almost half (46%) of the sample had been in methadone treatment in prison at some time. As expected, most (85%) respondents had contact with the prison medical service and, in general, they rated the service as fair or better (60%, n=86).
Bleach availability in prison
About half (54%) of the inmates surveyed reported they were aware that bleach was provided to prisoners as a policy of the NSW Department of Corrective Services. Just over half (52%) of the sample attempted to obtain bleach while in prison. About half (42%, n=50) of these found that Milton tablets were easier to obtain than liquid bleach (26%, n=49). Overall, 56 percent of respondents found it easy to obtain one of the two forms of bleach available in prison. There was a significant improvement in easy access to bleach from 38% in 1993 (n=171) to 54% in 1994 in prisons.
Drug use, injecting and sexual behaviour before prison
In the three months before prison, three quarters (77%) of respondents reported using drugs, with cannabis (75%, n=102), heroin (41%, n=102) and amphetamines (36%, n=102) being the three most commonly used. Over half of all respondents (54%) reported injecting in the three month period prior to prison. The most common drug injected was heroin (40%, n=102) followed by amphetamines (26%) and cocaine (25%). Most injectors (64%, n=66) reported injecting at least daily yet few reported syringe sharing (11%, n=55) before prison. Of the six people who shared injecting equipment before entering prison, four cleaned syringes with bleach on about one third of sharing occasions (30%). Several different cleaning methods were used but none approximated the new cleaning guidelines (ANCA, 1993) which involve soaking equipment. The mean number of sharing partners was one. Virtually all of the sample (91%) was sexually active prior to being imprisoned. Most respondents reported having engaged in vaginal sex (89%), with one third (31%) and two thirds (59%) not using condoms with regular and casual partners respectively. Prostitution (2%) and sexual assault (2%) were rarely reported by respondents prior to prisons.
Drug use, injecting and sexual behaviour in prison
Over two thirds (69%) of respondents reported using drugs while in prison. The most commonly used drug was cannabis (66%, n=102), followed by heroin (34%), and prescribed methadone (27%). Over one third (37%) of the sample reported injecting in prison. Among the injectors, most (50%, n=60) reported injecting heroin.
The most commonly reported frequency of injecting in prison was monthly or less. Approximately one in three respondents (37%) injected in prison and most reported sharing syringes (82%). The mean number of sharing partners was 6.5. However, virtually all who shared syringes reported cleaning the syringes with bleach (97%, n=31). A variety of cleaning methods was used, with the most common ones being variations on the now discredited ‘2x2x2’ method. Few respondents reported soaking (10%) or filling the syringe with bleach (13%) which approximated the revised method of cleaning which is considered necessary to decontaminate injecting equipment of HIV.
Many respondents (58%) were aware of instances of sexual assaults in prison. Most male respondents (79%) supported condom provision in prison. Five percent of respondents reported having sex in prison. No one reported using condoms. One respondent reported he was sexually assaulted in prison.
Drug use, injecting and sexual behaviour since prison
Over half (57%) of respondents had used drugs since being released from prison. Again the most commonly used drug was cannabis (47%), followed by heroin (19%). Almost half (42%, n=66) of the injectors had resumed injecting and some on a daily basis (21%). Only one IDU reported sharing syringes since release but bleach was not used to clean the injecting equipment. Two thirds (68%) reported that they were sexually active after release. About half (52%) had engage in sex with new partners. Sexually active respondents reported no condom use with regular (68%, n=59) and casual (36%, n=24) partners while only one person reported paying for sex.
The level of partner change in and out of prison was examined. Respondents (n=120) reported sharing syringes with three new and three known IDUs. They engaged in sex with a total of 227 sexual partners, of whom 55% were new partners before prison. In prison, respondents reported that 87 percent of 136 sharing partners were new while five of the six sexual partners were new. After prison the only person who reported sharing syringes shared with an old sharing partner. Of the 101 sexual partners respondents reported since release, 52% were new sexual partners.
Self reported levels of infection
Most respondents had been tested for hepatitis B (78%, n=98), hepatitis C (73%, n=94) and HIV (95%, n=102). Self reported infection levels were 26 percent, 29 percent and 0 percent respectively.
This study was reasonably successful in obtaining a representative sample. Bleach was easier to obtain in NSW prisons in 1994 than in 1993. Inmates have started to adopt the new syringe cleaning guidelines. However, many respondents reported engaging in risk behaviour – primarily injecting inside prison and sexual behaviour outside prison. If HIV transmission was to occur in prison, this study indicates that it would mainly be through injecting drug use. HIV might then spread through heterosexual contact in the community after prisoners have been released.