Three strategies to address a recent public health issue that is related to drug use
Prisons have become a high risk environment for transmission of HIV due to the high predominance of HIV, drug dependence and sharing of injecting needles among the inmates (Jurgens, Ball and Verster, 2009). However, there are a number of ways that can help prisons prevent the transmission of HIV linked to injecting drug use. These interventions include, opioid substitution therapies, needle and syringe programmes. The programs are very vital in countries with increased epidemic of HIV infection among injecting drug users. There is massive evidence of behaviors that put prisoners at risk of contracting blood borne diseases like AIDS through injecting drug use. Much of the data come from high income countries. According to the studies, injecting drug use is a reality in many prison systems and most drug users share the needles and syringes. As a result, the prison creates a favorable environment for transmission of many of the blood -borne illness. In many countries, a good number of prisoners are drug users. The comprehension of the HIV risk behaviors in prisons provides three effective interventions that address HIV transmission in prisons among drug users.
The first strategy to address the risks related to drug use is through needle and syringe programmes (NSP). One of such programmes was introduced in Switzerland in 1992. Following then, NSPs have been introduced in over 12 countries in both Western and Eastern Europe (Jurgens, Ball and Verster, 2009). Although in some countries only a few countries have NSPS, in Spain and Kygyzstan the programmes have been leveled up and function in many prisons. Moreover, there have been countries in which the programmes have been closed due to political decisions of newly elected governments like in Germany. The programmes entail a number of models for the distribution of sterile injecting needles and syringes. It also involves automatic dispensing machines, hand to hand issuing by prison health care personnel, drug counselors or community health workers. Moreover, prisoners are trained to act as peer out reach workers. The systematic evaluations of the effects of NSPS on HIV transmission reveals that sharing of needles and syringes either ceased after establishment of the NSPS or substantially decreased. In the ten projects conducted, there were no new cases of HIV reported. In five of the six prisons where blood tests were done for HIV infection, there was no seroconversion discovered.
According to Dolan and Wodak (1998) another approach for curbing HIV transmission among drug users in prisons is through bleach and decontamination strategies. Bleach and other disinfectants for sterilizing injecting equipment should be provided in a wide range of prison systems. Studies show that most prisoners will sterilize syringes with bleach if it is available. However, research examining prisoners’ use of bleach affirms that only a small percentage of prisoners adopt the recommended syringe cleaning guidelines and that sterilizing of the equipment does not take place consistently. In addition, most of the prisoners who clean the needles do it hurriedly.
Lastly, opioid substitution therapies prevent the risks associated with drug use. For many years, there has been a raise in the number of prisons systems giving substitution therapy to prisoners. The therapy is usually in form of methadone maintenance therapy that resembles the situation in the community. Studies involving methadone maintenance therapy programmes reveals that inmates who inject heroin and other opioid and receive MMT inject considerably less often than those who do not use the therapy at all( Heimer et al, 2005). However, an adequately large amount of methadone is required and the programmes need to allow for adequately long treatment duration so as to reduce drug usage. Assessments of prison based MMT have also shown other benefits like reduced mortality among inmates held in MMT. In addition, MMT also lead to development of a positive effect on criminal recidivism and re-imprisonment. When given in high dosages and for long durations with additional support, MMT reduce the drug seeking behavior of inmates.
From the above discussion, it is clear that there is enough evidence for effective prevention of the transmission of HIV through drug use in prison. Since many, prisoners are in prison due to drug related crimes, preventing their drug use is a form of their rehabilitation. Therefore, instead of condoning drug use in prisons, providing the means that can protect them from contracting HIV is a clear indication that prisoners’ health needs are well safeguarded.
References
Dolan KA, Wodak AD.(1998). A bleach program for inmates in NSW: an HIV prevention strategy. Aust N Z J Public Health ; 22: 838–40.
Heimer R, Catania H, Zambrano JA, Brunet A, Marti Ortiz A, Newman RG (2005). Methadone maintenance in a men’s prison in Puerto Rico: a pilot program. J Correctional Healthcare; 11: 295–305.
Jurgen R, Ball A and Verster, A .(2009). Interventions to reduce HIV transmission related to injecting drug use in prison. Lancer Infect Dis. Retrieved on 2nd November, 2010. From :< http://www.who.int/hiv/topics/idu/InterventionsReduceHIVIDUinPrisons.pdf>
