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Making prison needle exchange programs work in Canada – Part 4

This is the fourth of four unique perspectives on prison needle and syringe programs. It explains why such programs are essential, what is happening in Canadian and international prisons and how such a program can work. All were part of a Canadian Harm Reduction Network panel discussion in support of prisoners’ rights and justice at Toronto’s Ryerson University.

Switzerland’s Hindelbank prison: A case study in how syringe exchange can work

By Daniela De Santis

The authorities say that drugs do not enter prisons. But insiders know better. Drug addicts are individuals who have gone to considerable illegal lengths outside of prison to get their drugs, and we cannot stop them when they’re in prison.

The fact is, when drug addicts are incarcerated, drugs will enter the prison, and many of them will be injected.

Essentially, syringes are in prison, they are shared, diseases such as HIV, HCV and HBC are transmitted, abscesses occur often, there are sometimes fatal overdoses, and hidden syringes can be a danger to staff.

These are facts that are common knowledge around the world.

Background on Hindelbank prison

In 1994, Hindelbank, a penitentiary for women located 20 kilometers north of Bern, became the first prison, worldwide, to introduce a syringe exchange program to inmates.

This prison can house110 prisoners in six divisions, and most have been sentenced for narcotic law offenses. One prisoner in three reports consuming heroin or cocaine before incarceration.

Clandestine drug consumption had been a problem at Hindelbank for many years. According to data gathered from the prisoners, legal and illegal drugs ranging from tobacco, alcohol and cannabis to tranquillizers, painkillers and sedatives, to heroin and cocaine, were all more or less frequently consumed.

The exchange of used syringes between prisoners was mentioned in the prison’s annual report in 1987, and an informal poll in 1991 carried out by the penitentiary physician revealed alarming statistics about needle-sharing and transmission of infectious diseases.

It took four years of legal and political clarification, but in July 1994, with the financial support of the Swiss Federal Office of Public Health, we began a program that included a prevention program for all prisoners and, where suitable, for relevant prison staff.

Goals and strategies

Our primary goal was, and is, a syringe exchange that could ultimately achieve inmate abstinence from drug use. Our strategies to achieve this goal include measures of control over prisoners, cell control, urine testing and control of all incoming posts and packages. Any irregular findings lead to sanctions such as suspension of holidays.

To support the goal of abstinence, we provide a comprehensive and extensive prevention program that includes information to all incoming inmates, harm reduction events, regular information evenings and regular visits with the prevention coordinator.

Our secondary goal was, and is, harm reduction. Our strategies to achieve harm reduction are our syringe exchange program, regular counselling and ongoing support from me, the prevention coordinator.

How the program works

I meet personally with all new inmates upon entry to the prison. I provide information on HIV and other STDs, review their history of drug use and, if they have such a history, provide them with information about our syringe exchange program.

Drug injecting addicts get, if so desired, a maximum of one complete syringe with filter, plus five more needles, sterile swabs and a spoon, all in a transparent box. They have to keep their syringe and supplies in this box so staff can immediately identify its contents.

Inmates can exchange used syringes at distributing machines located throughout the prison in relatively private areas, such as cupboards in recreational areas and in storage areas for cleaning inmate equipment.

Inmates are not sanctioned for possessing the injecting equipment we provide, as long as it is stored in accordance with the rules of the syringe exchange program. They are sanctioned for consumption of drugs. These contradictions were subject to numerous discussions. But to this day, after 19 years of prevention, these rules are a normal and accepted part of the day-to-day running of the prison.

I visit each section at least once a week. My responsibilities are not connected to any other role at the prison, which enhances the confidentiality of my contacts with inmates. It is important to the success of the program that there is someone with whom the inmates can be absolutely honest, without the risk of any sanction.

Results

In May 1994, before installation of the distribution machines, eight intravenous drug-users out of 19 said they had exchanged syringes with other users. One year later, only one individual continued this practice. Today, after 19 years, only two inmates have reported using dirty syringes.

As demonstration that the distribution of sterile needles is purely a health measure, and does not encourage consumption, the number of syringes we have distributed over the years has dropped steadily—from 5,335 in 1995/6 to 1,129 in 1997 and to 421 in 2013.

External evaluations in 1995 and 1996 have found:

  • increase in drug abuse was not confirmed
  • sterile needles do not influence the amount of available drugs
  • no more needle sharing among prisoners
  • no prisoner has started to use drugs in the prison setting
  • no dirty needles in the garden or departments
  • substantially fewer injection abscesses
  • no more overdoses (none over the past 17 years)
  • needles have never been used as a weapon in the entire 19 years.

Conclusions

The amplitude of drug consumption, the risk behaviour due to drug abuse and sexual relations as well as the prevalence of HIV and hepatitis infections in the Hindelbank prison reflect the existing situation on an international level.

The results of our prevention program support continuation of the distribution of sterile syringes. They also support keeping the consumption of hard drugs in the prison illegal, punishable by sanctions.

Programs such as ours are very cost-effective. The cost for all our prevention measures is 0.3 per cent of the prison’s budget. Avoiding even one new infection would pay my salary for at least two years!

Almost all our inmates return to the community. This means preventing HIV and hepatitis transmission in prison not only avoids further infection among injecting drug users and the larger prison population, it ultimately protects the community outside prison.

Go to the Prison Health Now website to hear Daniela’s full presentation.

Daniela De Santis

Daniela De Santis is the prevention coordinator at Hindelbank Prison in Bern, Switzerland. She has been working on harm reduction issues for prisoners since the 1990s, and has met with Correctional Service Canada and the Public Health Agency of Canada to discuss prison syringe exchange programs.



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