Why do we need Needle and Syringe Programs in Australian prisons?
Tuesday, June 18, 2024.
Long Bay Correction Centre in Sydney. Photo courtesy: Wikimedia Commons.
The Federal Government has made a big show of its commitment to eliminate hepatitis C by 2030. In NSW, the timeline is even shorter. Our aim is elimination by 2028. Generally, we appear to be on track. But there’s one big blind spot in Australia’s response to hepatitis C: an ongoing failure to ensure people in custody receive the same level of healthcare as those not locked up. While there are over 4000 needle and syringe programs (NSPs) across the entire country, there is not a single NSP within an Australian prison, which is a problem because estimates suggest that almost half of people detained in Australian jails report that they shoot up while inside. While Corrective Services NSW may not want to admit that people use drugs in jail, no amount of invasive strip searching and surveillance has ever halted the flow of illicit drugs and trade of prescriptions inside jails.
We know that the exchange and reuse of handmade injecting equipment under the radar is rife in prisons. It’s a huge health risk because these DIY needles and syringes are often unsanitary. It’s not just the fact they’re made from items of questionable cleanliness in the first place – pens, kitchen equipment and lollipop sticks, for example – it’s the fact that they get shared around extensively. Individuals will also store them in places where the priority is not hygiene but keeping them hidden from screws.
Other methods of obtaining injecting equipment are equally concerning. Reports from harm reduction media outlets in the US indicate that incarcerated people across the pond are stealing used and discarded syringes from biohazard bins or buying them cheaply from medical orderlies, while Australian studies suggest that similar practices occur here – one notable difference being the shockingly high price of illegal injecting equipment in Australian prisons. Of course, it’s hardly news to our community members who have spent stints inside. They don’t exactly need university professor boffins to tell us the bleeding obvious!
This all to say: bloodborne viruses are far more of a threat for those in prison than outside prison. Roughly 30 percent of people in custody test positive for hep C and that number rises to 60 percent for those who inject. In short: it’s a far far higher proportion than among Australia’s general population. While hep C treatment has remained free and fairly accessible for those inside, the provision of vital harm reduction services in prisons is limited and underwhelming. As a result, many people are experiencing multiple reinfections of the virus while inside.
As medical bodies, harm reduction organisations and experts have long suggested, we cannot eradicate hep C without establishing NSPs inside Australian prisons. Recognition of this fact is even creeping into industry reports and government policy statements. It’s a giant first leap for the harm reduction sector. If you’re curious, sus the Federal Government’s Sixth National Hepatitis C Strategy 2023–2030 (still a draft).
When it comes to NSPs in prisons, we’re yet to see these strategic visions become reality, so we don’t want to get ahead of ourselves. But there are signs that popular opinion is changing. Advocacy pressure from harm reduction organisations, such as NUAA, is playing a part.
The stigmatisation of drug use, particularly injecting drug use, the strength of “law and order” politics and “moral” agendas have meant that governments (from both sides of politics) continue to take a conservative stance on drug law reform. While some states are ahead of NSW on issues such as drug checking and cannabis decriminalisation, the concept of NSPs in jails seem to be off the agenda for now. Yet the Federal Government’s own Hepatitis C Strategy, produced in partnership with every state and territory government, says that NSPs in prisons are essential. On face value therefore the NSW government’s opposition to prison NSPs doesn’t seem to make a whole lot of sense.
As evidence rolls in from overseas – currently a handful of countries have at least one prison NSP – it is becoming indisputable that these services reduce the prevalence of bloodborne viruses within prisons.
If we are serious about hep C elimination, getting NSPs inside is a total no brainer. To some, it may seem like a daunting idea or a recipe for chaos but supplying sterile injecting equipment and providing safe-injecting advice in prisons is the only way we will ever achieve complete elimination. The evidence is there, and incarcerated people have a right to adequate healthcare, just like everyone else.