The global state of harm reduction in prisons: inadequate, unreliable and unlawful

In this expert blog, Gen Sander of Harm Reduction International states that the global state of harm reduction in prisons is inadequate, unreliable, and unlawful. She argues that the provision of good-quality and accessible harm reduction, both inside and outside of prisons, is a legally binding human rights obligation, not just a policy option.

The Sustainable Development Goals commit the international community to end HIV and combat hepatitis C (HCV) by 2030. The target is unambiguous – if any population continues to be affected after 2030, it will not have been hit. And so goes the mantra: “leave no one behind” in the global HIV and HCV response. But the 2016 Global State of Harm Reduction report by Harm Reduction International (HRI) shows that one population particularly vulnerable to HIV and HCV – prisoners – continues to be wilfully left behind.

At the root of the problem is the widespread prohibitionist approach to drug control, which favours criminalisation and punishment over health and welfare. This has resulted in the mass incarceration of people who use and inject drugs with one in every five prisoners worldwide held on drug-related charges, most for personal use and possession. UNAIDS estimates that up to 90% of people who inject drugs will be incarcerated at some stage in their lives. Unsurprisingly, injecting drug use continues to be documented in prisons in every region of the world and prevalence of HIV and HCV remains significantly higher inside than outside of prisons across the globe.

The best way to reduce the risk of HIV and HCV transmission among people who use and inject drugs is through harm reduction interventions, such as needle and syringe programmes (NSPs) and opioid substitution therapy (OST). NSPs supply sterile needles/syringes and related injecting equipment to people who are actively injecting for safer drug use. OST is prescribed medication, supplied to people who use drugs, as a replacement therapy for opioid dependence which greatly decreases or eliminates injecting practice. Both interventions are evidence-based, highly cost-effective and have been implemented safely and effectively in various prison settings around the world.

Yet findings from HRI’s Global State of Harm Reduction reveal that provision of these services in prisons remains extremely limited, particularly when compared to what is available to the broader community.

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