B. Schulte, H. Stover, K. Thane, C. Schreiter, D. Gansefort and J. Reimer
Injection drug use (IDU) and IDU‐related infectious diseases such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are highly prevalent among prisoners…
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Injection drug use (IDU) and IDU‐related infectious diseases such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are highly prevalent among prisoners worldwide. However, little is known about the prevalence of IDUs, HCV/HIV and the availability of respective treatment options in German prisons. Data provided by prison physicians of 31 prisons, representing 14,537 inmates, were included in this analysis. The proportion of IDUs among all prisoners was 21.9%. Substitution treatment was available in three out of four prisons (74.2%). Overall, 1137 substitution treatments were provided annually with a wide range of treatment aims. The prevalence rate was 14.3% for HCV and 1.2% for HIV. Around 5.5% of all HCV‐infected prisoners were in antiviral treatment annually, 86.5% of all HIV‐positive inmates in antiretroviral HIV‐treatment. Generally, substitution treatment, and HCV and HIV testing and treatment are available. However, due to abstinence‐orientated treatment aims, substitution treatment is rarely available as maintenance treatment, and HCV/HIV‐treatment is mainly provided for patients with an existing treatment before imprisonment. The inconsistent data quality necessitates changes in prison‐related policy to improve surveillance and to generate aggregated data in German prisons. The selection process in this analysis might lead to overestimating the provision of substitution and antiviral HCV‐treatment.
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Heino Stöver, Joris Casselman and Laetitia Hennebel
The objective of this study was to examine practices and policies in place for the provision of substitution treatment in prison in 18 European countries. Methodology. Across the…
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The objective of this study was to examine practices and policies in place for the provision of substitution treatment in prison in 18 European countries. Methodology. Across the 15 European member states (prior to 1 May 2004) and Czech Republic, Poland and Slovenia, interviews with ministerial representatives, professionals (i.e. service providers and security officials) working in prisons, and a total of 33 focus groups with a total of 132 male and 52 female prisoners were conducted. Results. Although constraints of access to substitution treatment for specific target groups only (e.g. HIV‐positive opiate users) have largely vanished, substitution treatment is now offered to a broad cross‐section of prisoners. The provision of this treatment still lags behind the standards of substitution treatment in the community (regarding access and continuity). In most countries, this form of therapy is most likely to be discontinued when entering prison. A treatment gap persists between prisoners requiring substitution maintenance treatment and those receiving it. Heterogeneous and inconsistent regulations and treatment modalities appear throughout Europe, sometimes within the same country or region. The concrete provision practice of substitution treatment in prison varies from one country to the other, from one prison to the other, within a medical team, and even from one doctor to another. Although psychosocial care was seen as a valuable additional and necessary part of the treatment to support the medical part of the substitution treatment in prison, it was found that such support was rarely provided. Compared to previous research, this study illustrates that the scope of substitution treatment has extended considerably across Europe. Across the board, a consensus surrounding the need to continue substitution treatment that had already been started in the community was apparent.
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The article will discuss the particular needs of women prisoners, many of which are replicated in prisons throughout Europe, and are also often undetected and underestimated. The…
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The article will discuss the particular needs of women prisoners, many of which are replicated in prisons throughout Europe, and are also often undetected and underestimated. The focus will be on the situation for women in Italian prisons, considering the specific health and social care needs they present, how some needs differ to those of male prisoners, and to what extent the organisation of prison health attempts to meet these needs. The key issue identified is that the organisation of prison health deals predominantly with emergency cases and is not able to provide a preventative healthcare service to women in prison. Also, women prisoners suffer a greater impact on their physical and mental well‐being as a result of poor implementation of healthcare services, as well as from the regime of prison itself.
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Since the early 1990s, various countries have introduced HIV prevention programmes in prisons. Such programmes include education on HIV/AIDS, HCV and on drug use for prisoners and…
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Since the early 1990s, various countries have introduced HIV prevention programmes in prisons. Such programmes include education on HIV/AIDS, HCV and on drug use for prisoners and for staff, voluntary testing and counselling, the distribution of condoms, bleach, and needles and syringes, and substitution therapy for injecting drug users. Other forms of drug‐dependence treatment, as well as drug demand reduction and drug supply reduction measures may also be relevant to managing HIV/AIDS and HCV in prisons, and may facilitate HIV prevention measures ‐ or have unintended negative consequences for such measures. Prison systems in a growing number of countries are implementing such programmes. However, many of them are small in scale and restricted to a few prisons. Provision of care and treatment for people living with HIV or AIDS has become a priority worldwide, and it is considered to be a basic human right. This includes the provision of antiretroviral therapy (ARV) in the context of comprehensive HIV/AIDS care. Providing access to ARV for those in need in the context of correctional facilities is a challenge, but it is necessary and feasible. Studies have documented that, when provided with care and access to medications, prisoners respond well to ARV. Part 3 of the select annotated bibliography on HIV/AIDS and HCV in prisons contains selected “essential” articles and reports that provide information about (1) substitution treatment and other forms of drug‐dependence treatment; (2) other drug demand and drug supply reduction measures; and (3) care, treatment, and support for prisoners living with HIVor AIDS and/or HCV. Each section also contains a brief review of the evidence, based on recent work undertaken by the World Health Organization (WHO).
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Bertrand Fincoeur and Jessica Rullo
While steroid use in the sports context has already been extensively studied by academic researchers, its patterns and implications in the prison context have received scant…
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While steroid use in the sports context has already been extensively studied by academic researchers, its patterns and implications in the prison context have received scant attention. Why do inmates use androgenic–anabolic steroids (AAS)? How does this use relate to sports activities, in particular fitness training, and what does it mean vis-à-vis the body image that is promoted in this environment? Does it even relate to fitness or sport? How do prison authorities regulate or prevent prisoners' AAS use? This empirical study is based on 28 interviews with 19 inmates and nine staff members (guards, managers) of four Belgian prisons. We showed that steroid use is largely connected with fitness activities and that it has an instrumental, goal-oriented dimension. AAS are used for athletic/performance purposes, e.g. increasing muscular strength. They also help gain or maintain a satisfactory body (self-)image, which has implications on the own identity, prestige and power relations within the prison community. In jail, the body is a major type of symbolic capital that is intended to reinforce status and cope with the difficulties and actual conditions of incarceration. We also observed differences in the perceived legitimacy of the various drugs that are used in prison. While guards are more tolerant towards AAS than other drugs, prisoners are less prone to openly confess to using AAS. Admitting to using AAS would damage the inmate's reputation, the legitimacy of his muscled body, and the subsequent goals of individual power and prestige.
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Rick Lines, Ralf Jürgens, Glen Betteridge and Heino Stöver
This article examines the issue of prison needle‐exchange programmes (PNEP) based upon the international experience and evidence in six countries. A review of existing literature…
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This article examines the issue of prison needle‐exchange programmes (PNEP) based upon the international experience and evidence in six countries. A review of existing literature was undertaken together with original research comprising site visits to prison needle‐exchange programmes in four countries operating such initiatives in October 2002. During the course of the research, prison needle exchange programmes were initiated in two other countries, Kyrgyzstan and Belarus. Site visits were not possible in respect of these two countries, and data was gathered via conversations with staff and funding organisations involved and by the examination of documentary evidence. The paper presents an overview of the PNEP initiated and a commentry on the outcomes. Based upon the evidence emerging from the investigation, the paper concludes that while prison syringe‐exchange programmes have been implemented in diverse environments and under differing circumstances, the results of the programmes have been remarkably consistent. Improved prisoner health and reduction of needle sharing have been achieved. Fears of violence, increased drug consumption, and other negative consequences have not materialised. Based on the evidence and experience, it can be concluded unequivocally that prison needle‐exchange programmes effectively address the health‐related harms associated with needle sharing in prisons and do not undermine institutional safety or security.
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Heike Zurhold and Christian Haasen
Problematic drug use in prison remains a pervasive and increasing concern throughout the European Union (EU) in terms of costs to the individual, community and the state…
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Problematic drug use in prison remains a pervasive and increasing concern throughout the European Union (EU) in terms of costs to the individual, community and the state. Drug‐related problems in prison seem to be more prominent among female prisoners, as a high proportion of them are problematic drug users whose use continues in prison. Assuming that women’s drug use is an indication of need for treatment and health care, it becomes increasingly interesting how the European penal institutions differ in their response to this need. For this reason, a survey of the prison drug services for adult female drug users has been carried out among the Ministries of Justice of all 25 EU member states. The main purpose of the survey was to gain comprehensive and systematic information on the prevalence of female problematic drug users in European prisons and the availability of treatment and healthcare services. Altogether, 27 European countries and autonomous regions completed the questionnaire developed for this survey. The results of the data analyses indicate that there is poor availability and quality of data relating to the extent of problematic drug use in women’s prisons and, where it is available, it seems to underestimate the proportion of female problematic drug users in prisons. However, most of the European countries provide a range of different harm‐reduction and drug treatment services to respond to the reported health and rehabilitation problems of female problematic drug users. At the same time, however, it is evident that there is a need for further action in some countries, due to their low provision of prison drug treatment and healthcare services for this group. This article is based upon the European research project ‘Female drug users in European prisons’, which was conducted between 2003 and 2004 and funded by the AGIS Programme, Directorate General Justice and Home Affairs, of the European Commission.
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Caren Weilandt, Heion Stöver, Josef Eckert and Gregor Grigoryan
The prevalence of hepatitis B, hepatitis C and HIV in a representative sample of the Armenian male adult prison population has been determined and prisoners and staff were…
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The prevalence of hepatitis B, hepatitis C and HIV in a representative sample of the Armenian male adult prison population has been determined and prisoners and staff were anonymously asked on risk behaviours (542 prisoners) and on knowledge, attitude and behaviour towards infectious diseases (348 staff members) Prisoners’ knowledge about the sources of transmission of HIV is quite poor, most of the wrong answers relate to activities in the daily prison life. The acceptance of HIV‐infected inmates tends towards extremely negative attitudes. The reported rate of intravenous drug use was 13.3%, and 51% among those are current injectors. Of the ‘ever injectors’, between 15% and 30% reported high‐risk behaviour. Of particular interest was the fact that the self‐reported HIV test results did not correlate at all with the results of the saliva tests. In the study the prevalence of HIV was 2.4%, a rate which is 27 times higher than in the general population. The prevalence rate for hepatitis B among prisoners is 3.7% and for hepatitis C 23.8%. The most important risk factor for contracting an HCV infection was drug use and the second, time spent in prison within the last 10 years, which is an independent risk factor. A substantial number of prison employees perceive their working condition as risky and themselves as at risk for TB, hepatitis B/C or HIV, but large groups had no idea about infection rates. Regarding HIV and hepatitis, knowledge is poor and patchy. While staff show quite good knowledge regarding the main transmission routes via blood and unprotected sex, a low level of knowledge becomes obvious when considering everyday‐life situations, which may cause fears in such a closed setting like prison. Standards including confidentiality and non‐segregation are not accepted in respect of HIV positive prisoners. Here, attitudes range between ‘inclusion’ and ‘exclusion’, which might express uncertainty and insecurity about the risks HIV‐positive persons carry. The provision of sterile needles for tattooing and sterile syringes and needles for injecting drugs users to prevent the spread of infectious diseases are not agreed by the majority of prison staff.
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Linsey Ann Belisle and Elia Del Carmen Solano-Patricio
As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to…
Abstract
Purpose
As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs.
Design/methodology/approach
This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution.
Findings
A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community.
Originality/value
Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations’ rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.