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Just Us September 2005 Vol:2 Issue 1

TIME FOR BLUE AND GREEN TO COME TOGETHER OVER HEP C

Australia’s government and community health organisations have reason to be proud over how they faced the threat of HIV/AIDS together in the 1980s. Officials, health workers and activists worked to provide harm minimisation resources to the stigmatised, vulnerable communities most under threat from the disease. Thousands of healthy Australians are living testimony to the success in limiting HIV transmission in this country.

Prisoners also benefited from the public health revolution sparked by the AIDS crisis.

NSW was first to introduce a prison methadone program in 1986, with other jurisdictions eventually following suit. The provision of condoms, dental dams, bleach for cleaning syringes and, most importantly, peer education programs encouraging prisoners to take responsibility for their own sexual and injecting health would follow over subsequent years. In most cases these innovations were met with initial resistance by prison staff, but their benefits to health and good order would slowly win over the skeptics and attract broad support from officers.

Although the prison harm minimisation measures of the 1980s and 90s seem to have prevented a major outbreak of HIV in the prison system, they have not stemmed the spread of another serious blood borne virus, hepatitis C, which can survive outside the body on microscopic specks of blood and can even withstand bleach sterilization. As needle syringe programs (NSPs) had been shown to significantly reduce hepatitis C transmission among injecting drug users the next step was clearly the provision of clean injecting equipment to prisoners.

But in July 1991, NSW prison officer Geoffrey Pearce was stabbed by a prisoner wielding a HIV infected needle.

Seven years later, Mr Pearce died of AIDS.

If resistance to prison NSPs among prison officers had previously been strong, it was now implacable. The NSW parliament reacted by passing the Prisons Syringe Prohibition Amendment Act of 1991, effectively outlawing clean injecting equipment in prisons and condemning thousands of prisoners to hepatitis C infection.

Hepatitis C is rampant in prisons. Over one third of Australian prisoners estimated to be infected, with rates much higher for women prisoners. There is a 10-20% chance that an uninfected NSW prisoner will contract Hep C per year spent in prison, with upwards of 1000 new infections behind that state’s bars every year. Almost all of those prisoners will eventually be released to carry the virus back to their communities.

Many of those with the disease will suffer from nausea, fatigue, depression, abdominal pain and flu like symptoms, with some going on to develop life threatening liver damage or cancer.

Although the symptoms and progress of the disease can be controlled with careful diets, lifestyles and herbal treatments the only real cure is a powerful combination drug therapy that is expensive and can have severe side effects on health and behaviour. The medication does not work in all cases and some variations of the virus are resistant to it.

Hepatitis C is not transmitted in semen or saliva but is well adapted to spreading through blood-to-blood contact and the virus survives for long periods outside the body. It can spread in invisible blood specks in syringes, on spoons, filters, swabs and tourniquets. It has also spread in prisons through fights, barber’s shears and tattooing equipment. Some studies have cast doubt on the effectiveness of bleach sterilisation in killing the virus, especially when carried out in haste on old, pitted, reused injecting equipment.

As a result, prisons have become incubators for the hepatitis C virus, accounting for a disproportionate number of the 16,000 new infections in Australia every year and facilitating its spread through the country – at a cost of many millions of dollars in healthcare and lost productivity. Prison needle syringe programs would be an extremely cost effective way of reducing the long-term cost of hepatitis C.

While harm minimisation in Australian prisons has barely progressed since the 1990s, other governments have bowed to humanity and sensible self-interest by introducing their own prison NSPs.

Following Switzerland’s pioneering 1992 program, prisons in Germany, Spain, Moldova, Albania, Estonia, Kyrgyzstan and Belarus now have needle syringe programs serving tens of thousands of prisoners.

Contrary to the fears of critics, there has never been a documented case of a needle being used as a weapon in any prison which provides them, nor has there been any increase in drug consumption or injecting. Instead, there have been decreases in HIV and hepatitis C transmission, reductions in risky behaviour such as needle sharing, declines in overdoses, abscesses and injecting related infections and greater use of other drug rehabilitation and harm minimisation services.

After their introduction, prison NSPs has also won the strong support of prison officers.

In 2003 the provincial governments of Berlin and Lower Saxony closed the prison NSPs that had been operating successfully for many years. Among the most vocal critics of the government decisions have been the prison officers’ organisations, which have collected petitions and lobbied parliamentarians calling for the programs to be reinstated. They have come to realise that clean needles are not only important for the health of prisoners, but also to the occupational health and safety of prison staff.

But in Australia, around a quarter of prisoners continue their furtive injecting and hasty cleaning of the hundreds of reused, resharpened, dirty, pitted needles that circulate around the prisons. Some of those needles will inflict accidental needle stick injuries upon the prison officers who eventually discover their hiding places.

Eight years ago Professor Nick Crofts wrote in the Medical Journal of Australia that “prison authorities and governments must realise that the responsibility for the infection of a prisoner with a blood borne virus, because means for prevention were not available within the prison, rests with them”. He might have also reminded authorities of their responsibility to prison staff.

Late last year ACT Parliamentarian Kerrie Tucker warned it was “just a matter of time” before an infected prisoner who had been denied access to clean injecting equipment sued a government for breach of duty of care. It was similar legal action by the HIV infected ex-prisoner, Richard Lynott, which finally forced Australian prison systems to provide condoms.

And in early July, Federal Court Justice Ron Merkel added his own voice to the chorus of legal professionals, health workers, human rights advocates and prison activists calling for the introduction of prison needle syringe programs.

The political will to move forward on harm minimisation in prisons is unlikely to come from the top in this country. Even if it did, it would not succeed without the support of prisoners and prison staff.

The death of Geoff Pearce was a tragedy that was only deepened with the passage of the Prison Syringes Prohibition Act. A more fitting memorial would be a prison needle syringe program that would serve to protect prisoners, staff and the community as a whole from the scourge of blood borne disease.

 

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