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Prison-based syringe exchange: a review of international research and program development

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Author: Scott Rutter, Kate Dolan, Alex Wodak, Hans Heilpern

Resource Type: Technical Reports

NDARC Technical Report No. 112 (2001)


The Government of the Australian Capital Territory commissioned this review. Few papers have been published reporting evaluation of Prison Syringe Exchange Programs. Only some of this material has been published in English or has been previously translated into English. This review has been based on a comprehensive search of electronic databases, contact with experts in this field to identify any missed publications and the existing published literature and material which was translated specially for this review. Some of this review is based on the ‘grey literature’ of reports and other official documents.

The first prison syringe exchange program in the world was established in Switzerland in 1992. A total of 19 prison syringe exchange programs were operating as of December 2000 (7 in Switzerland, 7 in Germany and 5 in Spain). A further three countries (Italy, Portugal and Greece) were also seriously considering the introduction of prison syringe exchange programs. Prison regulations have been modified to allow these facilities to operate under certain conditions. Most programs are in small prisons with fewer than 200 inmates. Programs operate in both male and female prisons. In some prisons, injecting equipment is provided by health professionals while in other prisons, automatic vending machines exchange sterile injecting equipment for used needles and syringes.

Evaluation of pilot prison syringe exchange programs in Switzerland, Germany and Spain has been favourable in all cases. Drug use patterns reported at interview were stable or decreased over time (six prisons). Reported syringe sharing declined dramatically and was virtually non-existent at the conclusion of most pilot studies. No cases of inmates seroconverting for HIV, hepatitis B or hepatitis C have been reported in any prison with a prison syringe exchange program. No serious unintended negative consequences have been reported. There have been no reported instances of initiation of injecting. The use of needles or syringes as weapons has not been reported. One inmate (in Germany) is reported to have been injured by a discarded used needle. The number of needles and syringes distributed correlated with increased quantities of drugs detected in prisons and also when inmates receive payment.

Staff attitudes were generally positive but response rates to these surveys varied. Attempts were made in all prisons to involve staff in planning. Staff from prisons where programs had been successfully established were involved in planning new programs in different prisons. In each country, negative attitudes of prisons staff to these programs reflected similar attitudes to harm reduction programs in the community.

The rationale for establishing syringe exchange programs in prisons is even stronger than in communities. This rationale is accepted by an impressive number of prestigious bodies. Because of the rapid turnover of inmate populations, spread of blood borne viral infections among prisoners cannot be considered to remain for long within the confines of correctional facilities. There is increasing evidence that experience of incarceration is a strong predictor of HIV and hepatitis C infection.

Overall, this review confirms that prison syringe exchange programs are feasible. Based on the data available and extrapolating from the vast literature on community-based programs, prison syringe exchange programs appear to be effective in reducing blood borne viral infections. At this stage, there is no evidence to suggest that these programs have serious unintended negative consequences.