Towards the finish line? Trial of needle and syringe and program announced for ACT prison

HIV Australia | Vol. 10 No. 2 | October 2012

FINN O’KEEFE¹ reports on the overdue announcement of a needle and syringe trial at the AMC prison in Canberra, but finds there is more work to be done.

After many years of advocacy from health and community organisations, the much anticipated trial of a needle and syringe program (NSP) for ACT’s prison, the Alexander Maconochie Centre (AMC), has been given official approval from the ACT government to go ahead.

The program will be the first of its kind in Australia, as a strategy to reduce the transmission of hepatitis C and other blood borne viruses (BBV) within the AMC prison.

The government’s announcement regarding this politically controversial issue came as something of a surprise. It was made by ACT Chief Minister, Katy Gallagher, during a Justice Health Symposium hosted by the Public Health Association (PHAA) in Canberra, on the morning of 15 August. The announcement was met with a standing ovation.

In her speech, the Chief Minister stated that the implementation of the draft Strategic Framework for the Management of Blood-Borne Viruses in the Alexander Maconochie Centre 2012–2014 would involve further ‘targeted consultation’ as part of finalising the framework and the implementation of the equipment exchange program.

The announcement was welcomed by health and community advocates, including the Australian Injecting and Illicit Drug Users League (AIVL), NSW Users and AIDS Association (NUAA), Canberra Alliance for Harm Minimisation and Advocacy (CAHMA), the Australian Medical Association (AMA) and the PHAA.

Nicole Wiggins, CAHMA Manager, described the announcement as ‘an important symbolic moment’, saying that ‘the ACT Government has shown rare political leadership and has openly acknowledged their statutory responsibility for the health and wellbeing of prisoners in the ACT’. However, a number of significant concerns remain.

The first of these is that the consultation process could further delay the program’s commencement, as Nicky Bath from NUAA explains:

‘We support the ACT Government’s approach of including the equipment exchange program as part of a broad based BBV management strategy of prevention, testing, treatment and support. In taking a comprehensive approach to addressing BBVs in the AMC, it is very important however, that the planned ‘targeted consultation’ process does not delay or impede the implementation of the equipment exchange program.

‘There will need to be cooperation across all key stakeholders to ensure access to new injecting equipment in the ACT prison becomes a reality as soon as possible because injecting equipment is being reused repeatedly as we speak.

‘In this regard, we hope other states and territories now follow the ACT’s lead and implement NSP in prisons across Australia.’

Australian research evidence reflects the enormous contribution that access to new injecting equipment has had in the general community in relation to preventing HIV and hepatitis C.

Internationally, NSPs have also been successfully tried or implemented in 50 prisons internationally,² with the first of these programs being introduced in Switzerland in 1992.³

Considering this, the trial of a needle syringe program in an Australian prison setting seems extremely overdue and the continued lack of any such program presents a formidable barrier to BBV prevention in this context.

In the ACT alone, it is estimated that up to 65% of prisoners in the AMC have hepatitis C. This includes nine prisoners who have contracted hepatitis C within the AMC since it opened.

Despite a prison-based NSP trial being evidenced-based policy which is endorsed by the Australian HIV, hepatitis C and the Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections strategies agreed to by all State and Territory Health Ministers, the proposed NSP trial for the AMC is still perceived as controversial.

Over the last few years, the proposed trial has met with continued resistance from the Community and Public Sector Union (CPSU), the union representing Australian prison corrections officers, even after the former ACT Chief Minister, Jon Stanhope, stated in 2010 that he had changed his mind on the issue and would be more likely to accept such a scheme.⁴

The ACT Regional Director of the CPSU, Vince McDevitt, has declared that his members are ‘unanimously’ opposed to any NSP prison trial, citing safety concerns.⁵ The Health Services Commissioner at the ACT Human Rights Commission resigned from the CPSU in September 2011 over the CPSU’s position against NSPs.⁶

The NSP model for the AMC that has been given government approval is ‘one-for-one’, meaning the prisoner only receives clean injecting equipment in exchange for used equipment, under the supervision of medical staff.⁷

A spokesperson for AMA has said he believes that the one-for-one model will be more widely accepted,⁸ but it is not yet clear whether this will be enough to allay the concerns of those seeking to block the establishment of an NSP trial at the AMC.

Following the announcement of the trial, Vince McDevitt said: ‘We welcome of course any sort of involvement by medical professionals such as doctors but we need to see the detail.’⁹Although it is hoped other States and Territories will follow the ACT’s lead, South Australia’s Department of Correctional Services has already stated that it will not support such a program under its jurisdiction because it fears that syringes would be used as weapons.¹⁰

AIVL sees a number of other concerns relating to the proposed model of one-for-one needle exchange at the AMC prison. As Jude Byrne, Senior Project Officer at AIVL, explains: ‘One-for-one needle exchange is hardly easy access. What happens to all the people sharing that one syringe? That [practice] continues, obviously. Having to make an appointment to make the exchange is not only not confidential, it’s incriminating.’

These issues are just some of the problems Jude Byrne sees with the NSP model that has been proposed. She also says that the proposed scheme is in direct conflict with the UN International Labour Organisation (ILO) guidelines that state ‘prisoners who inject drugs should have easy and confidential access to sterile drug injecting syringes and paraphernalia and should receive information about the programmes.’¹¹

Annie Madden, AIVL Executive Officer, says it is critical that we implement the correct model: ‘We need to recognise the real, human impact that NSPs have. Quite simply, NSPs save lives. To this end, it is critical that when we implement NSP in the prison context, we need to get it right.

‘What we know from NSPs in prisons overseas is that how programs are implemented and the way they are delivered is critical and can make the difference between an effective and ineffective outcome. Prisoners are a highly marginalised population and we have a responsibility as a community to ensure their health and human rights are protected.

As the ACT Government moves forward on this ground-breaking initiative, representatives of people who inject drugs will be willing partners in making sure this new program is given every chance to be effective and in doing so, save lives,’ Annie Madden concludes.

It is anticipated that the first trial of an NSP within an Australian prison could commence as soon as 2013, however this is subject to the timetable of the consultation process.

Although there are still a number of significant hurdles to overcome, hopefully the finish line will soon be in sight.

References

1 With thanks to Annie Madden, Jude Byrne and Sam Liebelt from AIVL for their input and feedback. See Also: AIVIL, CAHMA, NUAA Joint media release. (2012, August). Injectors say putting the health of prisoners first is what really matters. Retrieved from: healthequitymatters.org.au (PDF)

2 ABC News. (2012, 16 August). SA rejects ACT’s prison drug program. ABC News [online]. Retrieved from: www.abc.net.au/news

3 Jürgens, R., Lines, R., Cook, C. (2010). Out of Sight, Out of Mind: Harm reduction in prisons and other places of detention. In: Global State of Harm Reduction 2010: Key Issues for Broadening the Response. International Harm Reduction Association, London. Retrieved from: www.ihra.net (PDF)

4 Costello, S. (2011). Support for prison NSP trial HIV Australia. HIV Australia, Volume 8, number 4. Australian Federation of AIDS Organisations (AFAO), Sydney. Retrieved from: healthequitymatters.org.au/library/hiv-australia

5 Costello, op. cit.

6 Mary Durkin is the Health Services Commissioner at the ACT Human Rights Commission and was a 30 year member of the CPSU. She resigned specifically over her support for an NSP in the AMC and her opposition to her union’s position on this issue. This indicates that there may not be the ‘unanimity of views’ that Mr McDevitt is suggesting. A report about her resignation is available here: Francis, A. (2011, September 29) Union member quits over need exchange stance. ABC news. Retrieved from: www.abc.net.au/news

7 Willis, L. (2012, 15 August). Needle exchange trial ‘bold move’. ABC News. Retrieved from www.abc.net.au/news

8 ibid.

9 ibid.

10 ABC News. (2012, 16 August.) SA rejects ACT’s prison drug program. ABC News [online]. Retrieved from: www.abc.net.au/news

11 United Nations Office on Drug and Crime (UNODC) (2012). Policy brief. HIV prevention, treatment and care in prisons and other closed settings: a comprehensive package of interventions. HIV prisons advance copy. Retrieved from: www.unodc.org

Finn O’Keefe is Communications Officer at AFAO.