Can recent advances in prevention and treatment of occupational blood-born enfections bring NSP in prisons a step closer

Abstract

Australia has been debating the introduction of Needle Syringe Programs in prisons since the first national HIV/AIDS in Prison Conference in November 1990. However, discussion on NSP stalled after a prison offi cer contracted HIV from an infected syringe and subsequently died of AIDS. While policy makers see many advantages of introducing this evidence based harm reduction intervention local government, unions and correctional industry do not seem to share that opinion. The debate does not focus on the irrefutable benefi ts of the intervention, but on the risks associated with needle stick incidents in the work environment. Recent developments in prevention and treatment of HIV and Hepatitis C warrant a new look at how risks and benefi ts of NSP in prisons are weighed. The levels of HIV and Hepatitis C infection in the general prison population but especially in the incarcerated indigenous population are extremely high when compared to the general population. So the question is: for correctional offi cers which risk is higher? Working in the current situation with the high prevalence of blood-borne viruses among prisoners using homemade or recycled syringes or working in an environment where NSP is available. Notably in both scenarios there are now additional prevention and treatment options available. Needle stick incidents can occur in either situation, but major advances have been made in managing post occupational exposure since the unfortunate death of the prison offi cer. The consequences of a needle stick incident now have changed from potentially lethal to manageable. This paper will focus on the changed consequences for correctional workers and a reassessment of the balance of risk to determine suitability of NSP in prisons. This risk appraisal will include a consideration of Hepatitis C and HIV prevalence; national and international responses including human rights considerations and workers rights and the advances in treatment and prevention.