Drug Use in Prisons

David Shewan, John B. Davies, Shewan

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781138180581
• eBook ISBN: 9781134432417
• Topic: Social Sciences
• Subtopic: Criminology
• Index: Social Sciences

First Published in 2000. In this title, the author argues that drug users end up in gaol for many reasons, but in the most general terms they divide the drug-using part of a prison population along three lines. Those incarcerated because of their use or possession of drugs with intent to supply, those gaoled for offences other than drug use, but who happen to be involved in drug use and those who acquired their drug habit whilst in gaol. They argue that whilst prisons offer the opportunity to influence drug habits in a positive way, it can also produce exactly the opposite effect.

Chapter 1

HIV/AIDS and Drug Use in Prisons: Moral and Legal Responsibilities of Prisons

Ralf Jürgens

A prisoner retains all civil rights which are not taken away expressly or by necessary implication.

Lord Wilberforce in Raymond v Honey (1982), cited in Shaw, Prisoners’ Rights, in Sieghart, 1988, p. 40

A sentence of imprisonment should not carry with it a sentence of AIDS.

Note, 1988

This chapter briefly reviews what is known about HIV/AIDS and hepatitis C in prisons. It then presents some of the evidence of the prevalence of high-risk behaviours, in particular, injecting drug use, and resulting HIV transmission behind bars. It discusses what is being done in prisons to prevent HIV infection and to reduce harm from drug use, and shows that where harm reduction measures — such as allowing access to condoms, bleach, sterile injection equipment and methadone maintenance treatment — have been introduced, such measures have been successful, have not created any problems, and are being supported by prisoners, staff, prison administrations and the public. The chapter then briefly discusses why other measures, such as the war on drugs being waged in prisons in many countries, are counterproductive and harmful. Some of the reasons why many prison systems still oppose introduction of harm reduction measures are also addressed. The chapter concludes by arguing that harm-reduction measures in prisons are necessary to prevent the further spread of HIV in prisons, and that prison systems have a moral and legal obligation to implement them.

HIV/AIDS in Prisons: an Overview

HIV and Hepatitis C Seroprevalence

Worldwide, rates of HIV infection in inmate populations are much higher than in the general population. They are, in general, closely related to two factors: (1) the proportion of prisoners who injected drugs prior to imprisonment; and (2) the rate of HIV infection among injection drug users in the community. The jurisdictions with the highest HIV prevalence in prisons are areas where HIV infection in the general community is ‘pervasive among IV drug users, who are dramatically over-represented in correctional institutions’ (Hammett, 1988, p. 26). Commenting on the situation in the United States, the US National Commission on AIDS (1991, p. 10) stated that ‘by choosing mass imprisonment as the federal and state governments’ response to the use of drugs, we have created a de facto policy of incarcerating more and more individuals with HIV infection.’

Particularly high rates have been reported from countries in southern Europe; for example, 26 per cent in Spain and 17 per cent in Italy. High figures have also been reported from France (13 per cent; testing of 500 consecutive entries), Switzerland (11 per cent; crosssectional study in five prisons in the Canton of Berne) and the Netherlands (11 per cent; screening of a sample of prisoners in Amsterdam). In contrast, some European countries, including Belgium, Finland, Iceland and some Lander in Germany, report low levels of HIV prevalence. Relatively low rates of HIV prevalence have also been reported from Australia. In the United States and in Canada, the geographic distribution of cases of HIV infection and AIDS is remarkably uneven. In the United States, many systems continue to have rates under one per cent, while in a few rates approach or exceed 20 per cent. In Canada, rates range between one and 7.7 per cent (seroprevalence data are from Correctional Service Canada (CSC), 1994a, pp. 15–19; CSC, 1994b, pp. 47–79; Jürgens, 1996, appendix 2, with references).

Hepatitis C seroprevalence rates in prisons are even higher: studies revealed rates of between 28 and 40 per cent in three Canadian prisons (Ford et al., 1995; Pearson et al., 1995; Prefontaine and Chaudhary, 1990; Prefontaine et al., 1994); 39 per cent in prisons in Victoria, Australia, and 50 per cent in New South Wales, Australia (Crofts et al., 1995; Brown, cited in Zinn, 1995); 38 per cent among male inmates in prisons in Maryland, US (Vlahov et al., 1993); and 74.8 per cent among IDUs in a prison for women in Vechta, Lower Saxony (Germany), compared to 2.9 per cent among non-IDUs (Keppler, Nolte, and Stover, 1996).

While most hepatitis C positive inmates come to prison already infected, the potential for intramural spread is high: hepatitis C is much more easily transmitted than HIV, and transmission has been documented in prisons in Canada (Jürgens, 1996, at 46), Germany (Keppler, Nolte, and Stover, 1996), and the US (Vlahov et al., 1993).

Evidence of High-Risk Behaviours

Drug Use

An increasing number of scientific studies is providing evidence of the existence and extent of injection and other drug use in prisons. The following is an overview of some of these studies.

In Canada, a study on HIV transmission among injection drug users in Toronto found that ‘[o]ver eighty per cent [of the participating injection drug users] had been in jail overnight or longer since beginning to inject drugs, with twenty-five per cent of those sharing injecting equipment while in custody’ (Millson, 1991). In a recent survey, almost 40 per cent of 4,285 federal inmates self-reported having used drugs since arriving in their current institution (CSC, 1996a, pp. 144–148), and eleven per cent reported having injected an illegal/non-prescription drug; of these, only 57 per cent thought that the equipment they used was clean (CSC, 1996a, p. 138 and 1996b, pp. 348–349).

In Australia, ‘[a]ll commentators agree that it [injection drug use] occurs and that needle sharing is almost always associated with IV drug use in prisons because of the lack of availability of syringes’ (Heilpern and Egger, 1989, p. 38 with many references). In an early survey of ‘HIV Risk-Taking Behaviour of Sydney Male Drug Injectors While in Prison,’ approximately 75 per cent of respondents reported having injected drugs at least once while in prison. Of these, two thirds provided data on the frequency of sharing of injection equipment in prison, with 75 per cent reporting sharing (Wodak, 1991, pp. 240–41). Other more recent studies have confirmed that HIV risk behaviours are frequent in Australian prisons (Dolan, 1994b; Dolan, et al., 1996d).

In the United Kingdom, a number of surveys found that the use and availability of injectable drugs greatly exceeds official estimates and that needles and syringes are commonly shared out of necessity (Thomas, 1990, pp. 7–10; Pickering and Stimson, 1993; see also Bird et al., 1995, and Gore, 1995). One study found that injecting drug use decreased in prisons among inmates who had been injecting drug users on the outside. However, inmates were more likely to inject in an unsafe manner when they did inject. The study concluded that imprisonment increased the risk of contracting HIV infection (Turnbull, Dolan and Stimson, 1992). This is consistent with the results of two other studies of drug using behaviour in Scottish prisons. In the first study, 32 per cent of a purposive sample of 234 prisoners had injected in the community prior to imprisonment. Of this same sample, 11 per cent were injecting during their current sentence. However, whilst the sharing rate in the community had been 24 per cent, it was 76 per cent in prison. (Shewan, Gemmell and Davies, 1994). In the second study, 76 of 227 prisoners (33 per cent) had injected drugs at some time in their lives, and 33 (15 per cent) admitted to injecting in prison. While injectors tended to use drugs on a daily basis outside prison, they would normally inject only weekly or monthly while in prison. However, all those who had injected in prison had shared equipment at least sometimes. Twenty prisoners had always shared it, compared to only two prisoners who had always shared outside (Taylor et al., 1995).

In Germany, nearly 20 per cent of injection drug users who participated in a large epidemiological study were HIV-positive, and about 60 per cent of them had served a prison sentence. While only 10 per cent of participants with no prison experience tested HIV-positive, 26 per cent of those with prison experience tested HIV-positive, and 67 per cent of participants indicated that they continued to inject while in prison (CSC, 1994c, p. 60).

Sexual Activity

Although in prisons sexual activity is generally considered to be a less significant risk factor than sharing of injection equipment, it also puts prisoners at risk of contracting HIV infection. Homosexual activity occurs inside prisons, as it does outside, as a consequence of preferred sexual orientation. In addition, prison life produces conditions that encourage the establishment of homosexual relationships within the institution (Thomas, 1990, p. 5). The prevalence of sexual activity in prison is difficult to estimate, but is based on such factors as whether the accommodation is single-cell or dormitory, the duration of the sentence, the security classification and the extent to which conjugal visits are permitted (Heilpern and Egger, 1989, p. 40 with reference). Studies of sexual contact in prison have shown ‘inmate involvement to vary greatly’ (Saum, 1995). In a recent study in state prisons and city jails in New York (Mahon, 1996), prisoners and former prisoners reported frequent instances of unprotected sex behind bars. One woman summarized the prevalence and range of sexual activity described by participants in the study when she stated:

Male CO’s are having sex with females. Female COs are having sex with female inmates, and the male inmates are having sex with male inmates. Male inmates are having sex with female inmates. There’s all kinds, it’s a smorgasbord up there.

In Canada, six per cent of federal inmates self-reported having had sex with another inmate; of these, only 33 per cent reported using condoms (CSC, 1996c).

Tattooing and Piercing

It has been said that ‘[o]utside tattooing is not thought to present much of a risk of HIV transmission because the needles are sterilised, but in prison tattooing is a social activity and involves sharing needles which may make it risky’ (Curran, McHugh and Nooney, 1989, at 35). Similarly, Heilpern and Egger (1989) stated:

It is difficult to estimate how much tattooing occurs in prisons although the visible evidence is often quite striking. Because the activity is illegal it is almost certainly conducted with non-sterile equipment.

In Canada, 45 per cent of federal inmates reported having had a tattoo done in prison, and 17 per cent reported having been pierced (CSC, 1996a).

Evidence of HIV Transmission

Until recently, few data were available on how many prisoners become infected while in prison, and the data that were available – mostly from studies undertaken in the United States (for a review of five studies, see Parts, 1991) – suggested that ‘transmission does occur in correctional facilities, but at quite low rates’ (Hammett et al., 1993, p. 43). This was sometimes used to argue that HIV transmission in prisons is rare, and that consequently there is no need for increased prevention efforts.

However, most of the studies that have reported relatively low levels of HIV transmission in prison were conducted early in the HIV epidemic and sampled long-term prisoners who would have been at less risk of infection than short-term prisoners (Dolan, 1997/98). The extent of HIV infection occurring in prisons may have been underestimated. In more recent years, evidence of HIV transmission in prisons in the United States (Mutter et al., 1994), Australia (Dolan et al., 1994a; Dolan et al., 1996a), and other countries (Wright et al., 1994) has been published. In 1994, a study undertaken in Glenochil prison for adult male offenders in Scotland provided definitive evidence that outbreaks of HIV infection can and will occur in prisons unless HIV prevention is taken seriously. Following the diagnosis of two apparently recent seroconversions to HIV infection among prisoners, prisoners were offered confidential counselling and testing for HIV. Of 227 inmates counselled, 76 had a history of injecting; 33 of these admitted injecting in Glenochil, while 43 admitted having injected at some point in their lives, but not in Glenochil. Of the latter, 34 were tested, but none tested positive. In contrast, of the 33 inmates who declared that they had injected in Glenochil prison, 27 were tested and 12 were found to be HIV-positive; the remaining 15 tested negative but were still in the window period. A further two Glenochil injectors had been diagnosed HIV-positive two months previously, giving a total of 14 HIV-positive drug injectors. Of the 14 HIV-positive inmates, definitive evidence of HIV transmission in prison existed for eight inmates. Another six infections also possibly occurred in prison, but acquisition of infection outside prison could not be ruled out. The true number of infections was probably even higher: it has been calculated that the total number of prisoners infected in prison during that period could lie between 22 and 43 inmates (Taylor et al., 1994; see also Christie, 1995; Taylor et al., 1995). Following the outbreak, 12 HIV-positive inmates and 10 other drug injectors were interviewed about their risk behaviours in prison. From the interviews emerged a vivid description of random sharing with a limited number of needles and syringes, which were mostly blunt, broken, or fashioned out of a variety of materials (Taylor and Goldberg, 1996).

HIV Prevention

Initially, responding to the issues raised by HIV/AIDS and drug use in prisons was very slow. Only small steps were made to develop policies and to provide educational programmes for staff and prisoners. In many systems, prisoners with HIV infection or AIDS were segregated from the rest of the prison population and were subject to a variety of discriminatory measures. Neither condoms nor bleach were made available to prisoners, and educational programmes often appeared inadequate or insufficient.

However, in recent years a growing number of prison systems have started undertaking efforts to address HIV/AIDS and drug use in prisons. Often this was done only after they were confronted with sharp increases in the numbers of prisoners with HIV/AIDS in their custody. Some systems have made condoms, bleach, and even sterile injection equipment and methadone maintenance treatment available, abandoned segregation policies, and introduced better educational programmes delivered or supplemented by community-based outside organizations and/or peers.

The following section describes some of the harm reduction measures introduced behind bars.

Condoms

According to the World Health Organization’s network on HIV/AIDS in prison, 23 of 52 prison systems surveyed late in 1991 allowed condom distribution (Harding and Schaller, 1992, p. 767). Significantly, no system that has adopted a policy of making condoms available in prisons has reversed the policy, and the number of systems that make condoms available continues to grow every year.

In some systems, however, making condoms available in prisons is still opposed on the grounds that sexual activity is illegal in public and that prisons are public spaces. O...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Figures
• List of Tables
• Preface
• List of Contributors
• 1. HIV/AIDS and drug use in prisons: Moral and legal responsibilities of prisons
• 2. Reduction of drug and HIV related harm in prison: Breaking taboos and applying public health principles
• 3. HIV, drug use, crime and the penal system: Competing priorities in a developing country — the case of Brazil
• 4. Drug use, drug control and drug services in German prisons: Contradictions, insufficiencies and innovative approaches
• 5. Substance abuse treatment services in US prisons
• 6. Drug use and HIV/AIDS in sub-Saharan African prisons
• 7. HIV, hepatitis and drugs epidemiology in prisons
• 8. Development of HIV/AIDS policy in the Dutch prison system
• 9. Drugs and prisons: A high risk and high burden environment
• 10. A review of risk behaviours, transmission and prevention of blood borne viral infections in Australian prisons
• 11. The macro and micro logic of drugs and prisons
• Appendix
• Index