At the frontier of drug harm reduction Prisoners’ rights to health & safety

1. At the frontier of drug harm reductionPrisoners’ rights to health & safety Presentation to the Australian Parliamentary Group for Drug Law ReformParliament House, Canberra, 2 Dec 2005 David McDonald Visiting FellowNational Centre for Epidemiology and Population HealthThe Australian National University Consultant in social research & evaluation

2. Underlying principles Nelson Mandela (1994)‘…no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones…’ Paterson’s dictum (1920s)‘[Offenders] are sent to prison as a punishment, not for punishment’

3. Four standards for health care in prisons • Access to a healthcare worker, with hospital support • Health care provided to prison inmates should be of a standard at least as good as that available in the community • Respect for the principles of confidentiality and patient’s consent to treatment • Adequate provision of preventive health care(Levy 2002)

4. UN & Australian standards • UN General Assembly 1990‘Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation’ • Corrective Services Ministers’ Conference 2004‘Every prisoner is to have access to evidence-based health services provided by a competent, registered health professional who will provide a standard of health services comparable to that of the general community.’

5. Drugs and their consequences in Australian prisons Prevalence of drug use in prison (NSW 2001 & 2004) • 48% of inmates report using some type of illegal drug in prison • 59% of prison entrants have a history of injecting drugs • NSW prison inmates- 57% report a history of injecting illegal drugs- 51% of them report injecting while in prison- sharing: 72% of the females and 67% of the males

6. Consequences NSW prison inmates, 2001 • hepatitis A: females 50%; males 46% • hepatitis B: females 31%; males 28% • hepatitis C: females 64%; males 40%

7. Prevention 'It is in the context of preventive health care and, more broadly, provision of a safe environment that Australian prisons most profoundly fail prisoners, their families and the community as a whole. ‘The failure to respond appropriately to substance abuse, communicable diseases and risks of self-harm and death in custody puts the entire community at risk.’(Levy 2002)

8. Harm reduction in prisons WHO Policy Brief: Reduction of HIV Transmission in Prison, 2004‘The evidence shows that [prison harm reduction] programmes should include all the measures against HIV transmission which are carried out in the community outside prisons, including - HIV/AIDS education- testing and counselling performed on a voluntary basis- the distribution of clean needles, syringes and condoms, and- drug-dependence treatment, including substitution treatment. ‘All these interventions have proved effective in reducing the risk of HIV transmission in prisons. ‘They have also been shown to have no unintended negative consequences.’

9. Sterile injecting equipment • Health promotion: providing the means to engage in health promoting behaviour • Prison NSPs in over 50 prisons in 6 nations • Spain: sterile injecting equipment for all inmates • Scotland & Canada • The Alexander Maconochie Centre, Canberra’s new prison

10. Sterile injecting equipment: the next frontier in drug harm reduction in prisons ‘Prison systems and governments can no longer avoid their responsibilities to provide for the health of prisoners by dismissing prison needle-exchange programmes as something new or untested. ‘They are neither.’ (Lines 2005)

11. Notes and sources Slide 1: The subtitle of this presentation is from Levy, M 2002, ‘Prisoners' right to health and safety’, in D Brown & M Wilkie (eds), Prisoners as citizens: human rights in Australian prisons, Federation Press, Annandale, N.S.W., pp. 240-56. Slide 2: Mandela, N 1994, Long walk to freedom: the autobiography of Nelson Mandela, Little Brown, Boston, p. 201; Morgan, R 1994, ‘Imprisonment’, in M Maguire, R Morgan & R Reiner (eds), The Oxford handbook of criminology, Oxford University Press, Oxford, pp. 889-948. Slide 3 & 7: Levy 2002, op. cit. Slides 5 & 6: Butler, T & Milner, L 2003, The 2001 New South Wales Inmate Health Survey, Corrections Health Service, Sydney; Butler, T, Boonwaat, L & Hailstone, S 2005, National prison entrants' bloodborne virus survey report, 2004, CHRCJ Research Report No. 1, Centre for Health Research in Criminal Justice & National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney.

12. Notes and sources, cont. Slide 8: World Health Organization 2004, Policy Brief: reduction of HIV transmission in prison, Geneva. Slide 9: McDonald, D 2005, The proposed needle syringe program at the Alexander Maconochie Centre, Canberra's new prison; an information paper on the evidence underlying the proposal, DirectionsACT, Canberra, online at http://www.socialresearch.com.au/uploads/Prison_NSP_DMcD_upload.pdf Slide 10: Lines, R, Jürgens, R, Betteridge, G & Stöver, H 2005, ‘Taking action to reduce injecting drug-related harms in prisons: the evidence of effectiveness of prison needle exchange in six countries’, International Journal of Prisoner Health, vol. 1, no. 1, p. 61.

13. Presenter’s contacts David McDonald Social Research & Evaluation Pty Ltd PO Box 1355 Woden ACT 2606 Phone: (02) 6231 8904 Mobile:0416 231 890 Fax:(02) 9475 4274 Email:mail@socialresearch.com.au Web: www.socialresearch.com.au