Australia: Hepatitis C outbreak ignites debate on needle exchange in Queensland correctional centres

Pressure is mounting on the Queensland Government to implement Needle and Syringe Programs (NSPs) in the state’s correctional centres amid an outbreak of hepatitis C at a Far North Queensland prison.

Health authorities in Cairns have recorded 61 newly acquired cases of the blood-borne disease to date in 2020 — more than four times the year-to-date average over the last four years, and more than any other Queensland region.

Darren Russell from the Cairns and Hinterland Hospital and Health Service said most of those cases were linked to the Lotus Glen Correctional Centre.

“What we are seeing is increasing amounts of injecting drug use (at the prison) and that is occurring particularly in a group of young Aboriginal and Torres Strait Islander men who haven’t injected before,” Professor Russell said.

A spokesperson for the Department of Corrective Services said the average prison sentence for male prisoners in Queensland was about eight months, meaning there was a significant turnover of prisoners. That, combined with the rise in hepatitis C infections, has raised concern about the disease being transmitted in Queensland’s remote Indigenous communities when prisoners are released.

“People that revolve through the system are reservoirs of infectious diseases that get back out to our communities,” said Apunipima Cape York Health Council’s Mark Wenitong.

Needle and syringe programs a human right¶

Section 37 of Queensland’s Human Rights Act, which came into effect on January 1, 2020 stated that every person had the right to health services without discrimination.

Katelin Haynes, the chief executive of Hepatitis Queensland, said this section of the act meant people incarcerated in the state’s prisons should be given access to NSPs just as people in wider society were.

“People in prisons have a right to equality of health services and that includes harm reduction measures, health promotion measures and education, as well as more traditional medical approaches like testing and treatment of hepatitis C,” Dr Haynes said.“Under the Queensland Human Rights Act everyone has a right to health services and we see NSPs as a health service”

The Australian Injecting and Illicit Drug Users League (AIVL) has long campaigned for the introduction of NSPs in Australian prisons. AIVL chief executive Melanie Walker said more than a dozen countries had implemented NSPs in prisons “without the sky falling in”.

“There’s not been a single incident of someone being attacked with a needle and catching any blood-borne viruses as a result of those programs overseas,” Ms Walker said.

“In fact, quite the opposite. What it has meant is that there’s regulation of needle and syringe use in prisons and what we know is that in any given country injecting equipment is getting into prisons — where there is a will there is a way.”

Practicality holding NSPs back¶

The introduction of NSPs in custodial settings is recommended in the Australian Government’s national strategies for blood-borne viruses and sexually transmitted infections. The Queensland Offender Health Services Review 2018 also recommended Queensland Corrective Services investigate its policy on needle exchange.

Despite this, no Australian jurisdiction currently provides NSPs to prisoners. Ms Walker said evidence from international experiences of NSPs was in and policy decisions had been made, so it was now the practicalities of implementing NSPs in Australian custodial settings that were up for debate.

“Now that there are a number of countries that have moved forward with this, there are different models in different contexts and we can look at those and see what combination of models, or what type of model, will work in any given circumstance in Australia,” she said.

“It’s not about whether we should do it, it’s about how we do it, and those are the challenges that governments face moving forward.”

Safety must come first¶

The Together Union, which represents correctional officers in Queensland prisons, says NSPs in custodial settings presented an unacceptable risk to staff.

“We’re at the point in Queensland now that we’re almost getting an assault a day in prisons,” said the union’s director of industrial services Michael Thomas.

“And we’re deciding to put a range of what are effectively dangerous weapons into prisons during that time — that’s the concern of our members.”

Mr Thomas said more funding was needed to stem the flow of drugs and injecting equipment into prisons, rather than condoning illegal activity within them.

“Drug use is a health issue,” he said.

“But if you think of the amount of crime that comes from it, and we’ve got the opportunity in a controlled environment to try and end the drug habit and end the health problem, then we should be doing that — not just condoning the ongoing use of drugs.”