How to adopt prison-based needle and syringe programs

research study has concluded that prison-based needle and syringe programs (PNSPs), which provide sterile injection equipment to prisoners who inject drugs and help prevent the spread of HIV and hepatitis C virus (HCV), are indisputably feasible in Canada and should be implemented in Canadian prisons without delay.

"The most significant finding was that all research participants expressed a high level of support for PNSPs," said Professor Emily van der Meulen of the Department of Criminology at Ryerson University, lead author of the study. "Research participants emphasized the need for PNSPs to be accessible, confidential and complemented by ongoing education in order to tackle HIV and HCV transmission behind bars."

In Canada, the estimated HIV and HCV prevalence among federal prisoners is, respectively, 10 and 30 times higher than in the general population.

A recent report outlined the findings of the two-year study, which involved unprecedented consultation with a broad array of stakeholders, including former prisoners, Canadian and international researchers, health-care providers, and representatives from HIV, indigenous, women's health, harm reduction and prisoners' rights organizations, as well as prison site visits in Switzerland.

The six recommendations included in the report for effective PNSP implementation in Canadian federal prisons are as follows:

• Prisoner access to PNSPs and sterile injection supplies should be easy, confidential, and not subject to disciplinary consequences.
• Prisoners should have regular access to information, education and support from trained personnel regarding safer drug injection.
• PNSPs should adopt a hybrid or multi-model approach to distribution within each institution.
• PNSP implementation and delivery should include ongoing and meaningful consultation with, and education for, relevant stakeholders to ensure the accessibility and positive health outcomes of the program.
• Prisoners should have an active role in determining PNSP programming, structure and policy.
• The justice system, including the Correctional Service of Canada, should move toward addressing drug use as a social and health issue.
• Canadian prisons should also adopt a multi-pronged approach to distributing sterile injection equipment.

"To promote access that meets different prisoners' needs, each institution should deliver sterile needles in at least two ways, employing, for example, dispensing machines plus a model that offers support and face-to-face interaction," said Seth Clarke, federal community development co-ordinator at Prisoners with HIV/AIDS Support Action Network (PASAN) and co-author of the report.

Access to PNSPs is an issue that concerns not just health, but also human rights. "People in prison have a right to a standard of health care equivalent to that available outside of prison—a principle recognized in Canadian and international law," said Sandra Ka Hon Chu from the Canadian HIV/AIDS Legal Network.

"Needle and syringe programs have been operating in Canada for almost 30 years, but not in prisons. We are failing prisoners when health care behind bars lags far behind health care in the community. This report offers concrete ways to remedy this wrong."