The Australian prison needle program story: from Geoffrey Pearce to Alexander Maconochie

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The Australian prison needle program story: from Geoffrey Pearce to Alexander Maconochie

With the ACT government currently initiating a trial of controlled prison needle exchange, the question becomes, when will other Australian states and territories do likewise?

In 1997 Geoffrey Pearce, a NSW prison officer, died from an AIDS-related illness. Seven years earlier he had been stabbed by a prisoner with a needle containing HIV-infected blood. It was the only documented case of a deliberate needle attack resulting in transmission of HIV, inside or outside of a prison setting. Then, as now, drugs are not allowed in prisons. Then, as now, drugs are used in prisons. People use drugs in prisons for many reasons and in many ways. Drugs and drug injecting equipment get into prisons despite the efforts of prison authorities to keep them out. Because drugs are easier to smuggle into prisons than injecting equipment, needles are kept hidden and shared. When they begin to wear out, they may be repaired and re-used, making them even more unsafe. Needles and syringes are often used many times and by many people, and this sharing of equipment can spread HIV and hep C among the prison population. Cleaning needles with bleach, which is available in prisons in most states and territories in Australia, is not always effective, especially if it is not done thoroughly; prisoners often do this hastily to avoid being caught. What happens in prisons is not isolated from the rest of society; people leave prison and return to their families, friends and social contacts. The health of people in prisons has an impact on the health, and the health care system, of Australia. Prison authorities spend a lot of time and money trying to stop drugs and equipment from entering prisons, and on searching for drug equipment within prisons. “The fact is, the more money spent on detecting drugs in jail and the more severe the penalties for drugs in jail, the higher the price and the more profitable drug trafficking into jails becomes,” says Alex Wodak, Director of the Alcohol and Drug Service at St Vincent’s Hospital. A different model could see a better focus on protecting people in prisons from blood-borne viruses. Some needle exchange models could also help prevent overdoses and direct people into drug rehabilitation programs, hep C treatment programs and health education services. It is easier to reach people in prisons than in the wider community so this presents good opportunities for health education programs. Jenny Heslop knew Geoffrey Pearce from her past work as a convenor of health and infection prevention training courses. Geoffrey attended a course in his role as a prison officer, and spoke at later courses about his experience of becoming infected with HIV. Jenny, now Manager HIV and Related Programs Mid North Coast Local Health District and Northern NSW Local Health District, remembers him as a pragmatic man, who accepted that drug use exists in prisons. “He believed that in prison or not, whether illegal or not, drug use occurs,” says Jenny. “He saw a need to reduce the infection pool for HIV and hep C within prisons. I saw him as an advocate for controlled needle exchange in prison.” Several countries have introduced controlled needle exchange programs in prisons. In some countries health care workers distribute new needles through medical units, some use dispensing machines, and some use a peer exchange model; some are open to all prisoners and others have exclusions. Outcomes show that there is a decrease in needle sharing, an increase in referrals to substance misuse treatment programs, no security or violence issues, and no increase in drug use. Prison officers in these countries reported positive experiences and supported the programs.

The right to health

The United Nations’ International Covenant on Economic, Social and Cultural Rights recognises the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, including the prevention, treatment and control of epidemic, endemic, occupational and other diseases. Simply, this means that signatory countries, including Australia, agree that all people have the right to good health, and will be protected from disease. Prisoners have been removed from larger society as punishment for their crimes; this punishment should not include removal from access to the health protection other citizens have. “Australia is a signatory to international conventions that commit to providing health services for prisoners that are equivalent to those available for the broader community,” says Stuart Loveday, CEO of Hepatitis NSW. “Sadly, no Australian government currently allows equivalent health protection services in prisons that protect prisoners and custodial staff from BBV infection.” Measures to prevent transmission of bloodborne viruses have been effectively introduced in Australia: blood is screened before transfusion; health professionals have safety procedures and protective equipment; and needle exchanges help prevent needle sharing – except in prisons. A person who protected themselves from HIV and hep C by always using a new needle would not be able to do so in prison; this same person, however, would be carefully protected from contracting a blood-borne virus if they needed a blood transfusion while a prisoner. In Victoria, where the Victorian Charter of Human Rights and Responsibilities reinforces the state’s duty of care and obligation, a prisoner is preparing to sue the state government for not protecting him from hep C while in jail. A successful suit would cause all state and territory governments to reconsider their stance on this issue.

Image via http://tychobrown.blogspot.com.au/2011/02/razor-wire.html

Opposition to needle exchanges in prisons

Prison officers’ unions across Australia are against introducing needle exchanges. As part of their Stop the Cell-off campaign, the Public Service Association of NSW, the trade union representing NSW public prison officers, is opposing needle exchanges in prisons. The website for the campaign, referring to Geoffrey Pearce, states: “We’ve already had one death of a prison guard from a needle stick injury in NSW after he was stabbed and infected with HIV. This outrageous and absurd program increases the chance of more.” “Introducing a needle exchange program in prisons arms criminals with a weapon that can be used to attack prison guards or other prisoners,” says Matt Bindley, Chairman of the Prison Officers Vocational Branch, Public Service Association NSW.

However, in countries where prison needle exchanges have been introduced, there have been no cases of needles being used as weapons against staff or prisoners. The campaign also argues that the government should concentrate on keeping drugs out of prisons rather than administering their use. “We need to work towards making it harder for prisoners to get their hands on drugs, not easier,” is the association’s position. Needle exchange programs in prisons would not make it easier to get drugs, just safer to use them. Presumably, prison authorities would continue with the same measures to prevent drugs from entering prisons. Prison officer unions are also reluctant to have their members seen to be involved in any way with illegal activities, such as the use of drugs; this leads to the debate about operational models and the option of programs being operated by medical professionals within a prison.

The Alexander Maconochie Centre

Named after a 19th century penal reformer, the Alexander Maconochie Centre in the ACT was planned and built to meet Australia’s human rights obligations for prisoners, with inmates living in a setting as close to a community setting as practical. After years of debate and inaction by the ACT government, Katy Gallagher, the Labor Chief Minister of the ACT announced on 15 August that they plan to introduce a needle exchange program in the centre by next year. To do this, they will need the support of the union which represents prison officers, the Community and Public Sector Union. The union, while previously strongly opposed to needle exchange in the prison, has said it is looking at the proposal and will be open to discussing the issue. The model proposed would be a one-for-one needle exchange, alleviating one of the fears of prison officers that it would lead to a large increase in needles within the prison. The ACT Greens Party supports the program, while the ACT Liberal Party is opposed; it is one of the issues that was taken into the ACT election in October. As the peak community-based hepatitis organisation in NSW, Hepatitis NSW advocates that needle exchange programs in prisons are essential to protecting the health of everyone. “We applaud Katy Gallagher for placing public health and pragmatism before politics,” says Stuart Loveday. “Prison needle exchange is a vital missing link in Australia’s response to hepatitis C and HIV transmission among people who inject drugs. With prison needle exchange, not only will we help protect the health of prisoners, but the occupational health and safety of corrections staff will be enhanced.” Jenny Heslop believes that when Geoffrey Pearce died we lost an advocate for controlled needle exchange in prisons; someone with insight and understanding of prison settings and the will to protect the health of prisoners and prison officers – a bridge between opposing sides in this debate. • Adrian Rigg is a freelance health writer who regularly contributes to Hep Review magazine: adrian.j.rigg@gmail.com

For more information about prison needle exchange and other harm reduction initiatives, contact the Hepatitis Helpline.

Also see this edition, pages 9 and 32.

“He believed that whether in prison or not, whether illegal or not, drug use occurs.” “He saw a need to reduce the infection pool for HIV and hep C within prisons. I saw him as an advocate for controlled needle exchange in prison.” Jenny Heslop commenting on prison officer, Geoffrey Pearce.

It’s been a very exciting few months since our last edition. Prison needle exchange is now openly on the table. What was once a dream is now very close to reality. These breakthrough developments remind us to never give up on our goals. We’ve recently attended the 8th Australasian Conference on Viral Hepatitis. These conferences are held every two years and for the first time since 1999, was held in New Zealand. The trip gave us a chance to talk to lots of different health workers across Australia and New Zealand but I was especially interested in catching up with staff from a particular NSP in Christchurch about their quite amazing successes at client education. Additionally, Hepatitis NSW has launched our C Me community advocacy project. Although we introduced the project in our previous edition, it’s been really exciting watching the project take off. Projects can come and go but I’ve got a very good feeling that C me is here to stay and is going to deliver big outcomes for us all. Additionally, we’ve seen Hepatitis NSW move to new premises at 414 Elizabeth St, Surry Hills. The move gives us great potential and having a lift and a properly designed mailing room is making things even more effective (and easier). I haven’t yet mentioned what you’ll find in this edition. As always I hope you find lots of interesting stuff. My favourites include our “Geoffrey Pearce” and “Dealing with change” articles and it’s good to hear back again from Wayne, one of our readers. Paul Harvey Editor/Production

C Me Community Advocacy Project;

Hepatitis NSW has received funding to develop a new and exciting peer advocacy project. C me seeks to empower, skill and equip people living with hepatitis C to become community champions. We are recruiting 15 individual volunteers for the project, one in each of the Local Health Districts. We provide training and ongoing support to them. Our community advocates are learning how to represent affected communities, consult and advocate on behalf of them as well as recruit other champions to become involved in campaigning and lobbying. These Expert Community Champions are advocating with local policy makers, MPs, attending meetings and helping us push for change in prevention, treatment and care services for people living with hep C. Alongside this we run a series of community events and a series of annual campaigns based around our organisational advocacy manifesto “Our 20 Asks – what we want to happen in the next four years”.

Online Chat

Hepatitis NSW recently launched a new online chat service. Our clients can now chat instantly with one of our Helpline workers via www.hep.org.au To use the service, clients click the blue “Live Support” button at the top of the site, answer some

Weblink of the month

The Hepatitis SA library webpage has a catalogue that lists over 500 free-to-access online resources from reputable national and international sources. New resources, including documents, online videos and audiocasts, are being added on a weekly basis. Topics include: diagnosis, treatment, nutrition, mental health, drug issues, discrimination, information for different cultures and settings as well as educational, policy and statistical documents. The catalogue, and other information about the library, can be found at www.hepsa.asn.au/library

Hepatitis NSW is proud to acknowledge Aboriginal people as the traditional owners and custodians of our lands and waters.

Cover image by Paul Harvey. Unless otherwise stated, people in our images are not connected to hep C.