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Prison needle exchange in the UK - why not?
Susan Wighton, Senior Lecturer Addictive Behaviours, Glyndwr University, Wrexham
Abstract
Research undertaken as the final part of PhD study investigating the continuing transmission of Hepatitis C virus within the injecting drug population in the United Kingdom, and in particular the association with imprisonment. Whilst introduction of needle and syringe exchange as a public health measure for the purpose of HIV AIDS control in 1987 was a noticeable success in the context of infection control compared to other European drug using populations, similar containment of hepatitis C has failed. With the legalisation of supply of drug injecting paraphernalia [indicated as possible vehicles of viral transmission] since 2003 it would have been expected that incident infection rates of hepatitis C in injecting populations would decline, however this has not been the case. One reason for this might be the lack of needle exchange within the prison population and repeated viral exposure for prisoners who continue to inject in prison, in the absence of
facilities available externally.
A cascade series of interviews with senior national and international experts concerned with offender health policy was undertaken between September 2008 and April 2009. Several points of interest emerge from these including policy divergence between the Scottish and English and Welsh prison estates; the influence of the Prison Officers Association; and what might be interpreted as ambivalence on the part of some to harm reduction measures.
The findings illustrate the historic and continuing tension evident in British drug policy delivery between criminal justice and drug treatment programmes ultimately answerable to the Home Office and the Department of Health. Several of the responses indicate that relatively recently constructed societal perceptions of addiction may be influencing an area of expertise that ultimately resides within the clinical context of psychiatry, public health and infection control. .Additionally the current approaches taken to the national infection risk and overly punitive UK interpretation of international drug policy requirement for control and punishment of drugs offences since the implementation of the Misuse of Drugs Act [1971] may provide indications of why hepatitis C infections continue to emerge from the national prison estate in England and Wales.
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