The furthest left behind: the urgent need to scale up harm reduction in prisons

• DOI: https://doi.org/10.1108/IJPH-08-2016-0044
• Pages: 185-191
• Date: 11 September 2017
• Published date: 11 September 2017
• Author: Gen Sander,Fionnuala Murphy
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

The furthest left behind: the urgent need

to scale up harm reduction in prisons

Gen Sander and Fionnuala Murphy

Abstract

Purpose –Raise awareness about the disproportionate impact of HIV and hepatitis C (HCV ) on prisoners

worldwide and the need for key harm reduction services such as needle and syringe programmes and opioid

substitution therapy in prisons offer practical recommendations to assist policy makers in implementing or

scaling up these services. The paper aims to discuss these issues.

Design/methodology/approach –This study is a desk review of existing data and evidence on HIV, HCV

and harm reduction in prisons, analysis of political barriers and formulation of key policy recommendations.

Findings –Harm reductionworks, yet serviceprovision in prisons remainsextremely limited.There is an urgent

need for governments to enhance political leadership and funding for harm reduction in prisons. Authorities

must also workto remove obstacles to the implementation of harm reductionservices in prisons, enhancethe

monitoringand evaluation of laws, policiesand programmes relating to HIV,HCV and drugs in prison settings,

and recognise access to harm reduction in prisons as a fundamental human right. Until these obstacles are

addressed, the worldwill not meet the Sustainable Development Goal of eradicatingHIV and HCV by 2030.

Originality/value –More than just a desk review, this policy brief provides a political analysis of the harm

reduction crisis in prisons and offers clear-cut recommendations for policy makers.

Keywords HIV, Harm reduction, Prison, Opioid substitution therapy, HCV, Needle exchange

Paper type General review

Introduction

With a pledge to end HIV and hepatitis C (HCV) by 2030 included in the Sustainable

Development Goals (SDG), the catch phrase “leaving no one behind”is increasingly punctuating

the sentences of bureaucrats and politicians. In reality, however, prisoners continue to be wilfully

left behind in the fight against these epidemics.

A large body of evidence demonstrates that harm reduction interventions such as needle and

syringe programmes (NSPs) and opioid substitution therapy (OST) are effective in reducing HIV

and HCV transmission among people who inject drugs. Numerous studies have also shown that

these interventions can be safely and effectively implemented in prison settings, and are

extremely cost effective. Policy makers and prison authorities, however, have been slow to act on

the evidence and harm reduction services continue to be extremely limited in prison settings.

The provision of harm reduction in prisons comes up against several obstacles, chief among

them a lack of political leadership or outright political opposition, and closely related to this, a

major shortage of funding. Until these obstacles are addressed, these two entirely preventable

epidemics will continue to have a grossly disproportionate impact on prisoners, with serious

human rights and public health implications.

Background

A recent comprehensive review of the global disease burden in prisoners found that of the

approximately 10.2 million people incarcerated at any given time, an estimated 3.8 per cent are

living with HIV and 15.1 per cent with HCV (Dolan et al., 2016). Prevalence of these infections in

Received 26 August 2016

Revised 9 December 2016

12 April 2017

Accepted 17 May 2017

This research was co-funded by

the European Commission under

the Criminal Justice Programme.

The contents of this publication

are the sole responsibility of the

authors and can in no way be

taken to reflect the views of the

European Commission.

Gen Sander is a Human Rights

Analyst and Fionnuala Murphy

is the Head of Advocacy, both

at Harm Reduction

International, London, UK.

DOI 10.1108/IJPH-08-2016-0044 VOL. 13 NO. 3/4 2017, pp. 185-191, © Emerald Publishing Limited, ISSN 1744-9200

j

INTERNATIONALJOURNAL OF PRISONER HEALTH

j

PAG E 18 5