International Harm Reduction Conference 2013 - Making the case for needle and syringe programmes in prisons


Vilnius , 12 June - Yesterday delegates attending the 2013 Harm Reduction Conference were convened to a satellite session organized by UNODC. The session, entitled "Needle and syringe programme in prisons: 20 years of evidences, 20 years of advocacy - It's time to scale-up!" was chaired by Mr. Rick Lines, Executive Director of Harm Reduction International.  It highlighted the need for such programmes and the criteria for efficacy and success. A panel of stakeholders enabled participants to explore, from various perspectives, the pra ctical aspects of programme implementation.

Ms. Irina Teplinskaya (Andrey Rylkov Foundation for Health and Social Justice) and Mr. Kestutis Butkus (Community Representative) brought the  unique perspective of the community as they provided insight on the world of drug use in prison, a practice that is often denied by prison officials. With convincing arguments, they reminded participants that the absence of harm reduction services, such as needle syringe programmes and opioid substitution therapy, needlessly increased HIV and other risks of both prisoners.  We heard how the absence of harm reduction services in prisons jeopardises the health of those living and working in prisons and how, from the public health perspective, it is detrimental to the entire wider community.

Dr.Svetlana Doltu (Ministry of Justice, Republic of Moldova), presented the Moldovan harm reduction programme in prisons - a programme jointly introduced in 1997 by prison staff and civil society organisations. In 2013, the programme was expanded and taken over by the Department of Penitentiary Institution; she explained how currently twelve of the fifteen HIV interventions recommended by the UN for prison settings were implemented partially or fully. Services included, among others, needle syringe programmes, condom programmes, post-exposure ,VCT, and other services such as conjugal visits. Describing the participative model adopted, one whereby prisoners are recruited as volunteers to distribute the injection equipment, it became clear that such collaboration was a best practice in the field.  As she described the peer-driven model, she explained how it also generated positive results in other areas, such as a decrease in stigma, an increase in self-esteem of prisoners living with HIV/AIDS, and an increase of HIV transmission awareness.

Dr. Xavier Majó i Roca, (Public Health Agency, Government of Catalonia), presented the findings of the evaluation of the programme in Catalan prisons providing his views on what works, for whom and in what circumstances. In Spain the first pilot project was started in 1997, but it was in 2003 that Catalonia saw its first pilot project at the Tarragona prison;  the programme was later extended to the rest of the prisons between  2005 to 2007. Results clearly indicated that the keys for successes are easy access, confidentiality and anonymity.  Some of the findings hinted that the programme conditions were too strict and that greater flexibility was needed to ensure accessibility. A model whereby distributing machine or one where peers provide injecting equipment to fellow prisoners were discussed. Finally, he underlined the need to have greater buy-in from prison officials to ensure success.

Dr. Fabienne Hariga (UNODC), provided a brief overview of the current situation and provided some startling figures. We heard that people who inject drugs can represent up to 80% of prison population in some countries and HIV prevalence can be up to fifty times higher than that of the general population- Why is the case for the provision of clean injecting equipment so hard to make?  

She went on to present the state of needle and syringe programmes globally - While over eighty countries worldwide offer needle and syringe programmes as part of their comprehensive harm reduction and HIV responses in the community, only a hand full of countries offer equivalent services in their prisons.

Understanding the overwhelming evidence of their effectiveness, we also heard that peer-based programmes tend to be the most suitable and effective. Dr. Hariga pointed out that in order to scale up services, there was a need to strengthen the advocacy and a need to include HIV in prisons in national strategies, such as harm reduction, HIV, prison, drugs, and to include in the law the principles of equivalence of health care for prisoners 

She also announced that UNODC is currently developing a guidance document to support efforts of the country to implement needle and syringe programmes in prisons.

20 years after the first needle and syringe programme was opened in prisons, and despite the evidence and needs progresses are too slow. Efforts are urgently needed.