Transcript At the frontier of drug harm reduction: Corrections Health

At the frontier of drug harm reduction
Prisoners’ rights to health & safety
Presentation to the
Australian Parliamentary Group for Drug Law Reform
Parliament House, Canberra, 2 Dec 2005
David McDonald
Visiting Fellow
National Centre for Epidemiology and Population Health
The Australian National University
Consultant in social research & evaluation
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’
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)
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.’
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
Consequences
NSW prison inmates, 2001
 hepatitis A: females 50%; males 46%
 hepatitis B: females 31%; males 28%
 hepatitis C: females 64%; males 40%
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 selfharm and death in custody puts the entire
community at risk.’
(Levy 2002)
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.’
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
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)
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.
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.
Presenter’s contacts
David McDonald
Social Research & Evaluation Pty Ltd
PO Box 1355
Woden ACT 2606
Phone:
Mobile:
Fax:
Email:
Web:
(02) 6231 8904
0416 231 890
(02) 9475 4274
[email protected]
www.socialresearch.com.au