Pubdate: Sat, 24 Apr 2010
Source: Australian, The (Australia)
Copyright: 2010 The Australian
Author: Alex Wodak
Note: Alex Wodak is a physician, director of the alcohol and drug 
service at Sydney's St Vincents Hospital and president of the 
Australian Drug Law Reform Foundation.


TWENTY-NINE years after the announcement of a new pandemic, the world
still struggles to come to terms with HIV. Sometimes logic,
rationality and compassion have prevailed in our responses, but all
too often emotion has triumphed over evidence.

Earlier this month in Sydney the National Centre for HIV Social
Research held its biennial conference to review responses to this
infection. Former High Court judge Michael Kirby spoke about a recent
meeting he attended in The Netherlands where leaders of the world's
religions discussed this challenging epidemic.

Kirby described how most participants were moved by compassion for
vulnerable minorities, but a few steadfastly refused to approve any
declaration that acknowledged the minority groups at highest risk in
the West.

One of the speakers at the Sydney conference wept while describing her
two decades of hard work spent trying to achieve more humane responses
to drug users. Kirby, noting her tears, rejoiced that there were some
among us who still felt great passion about this epidemic at a time of
growing HIV fatigue and the increasing dominance of newer

The number of people in the world newly infected with HIV has started
declining. But an estimated 2.7 million people are expected to get
infected this year.

Complacency is a problem. When authorities in Queensland and Victoria
relaxed their vigilance, decreasing education campaigns and high-level
committees, it didn't take long before HIV infection rates started

Given the volatility of this epidemic, wherever possible we should act
decisively with effective programs.

Australia's first needle syringe programs started almost a
quarter-century ago. The community owes a great debt of gratitude to
the courageous politicians who took the long-term view.

Needle syringe programs have proved highly effective in cutting HIV
without increasing injecting drug use. For every dollar spent, they
save up to $27 in total costs.

Needle syringe programs have been endorsed by the UN and even
controversial Salvation Army figure Brian Watters, former chairman of
the Australian National Council on AIDS. Yet there are still critics
of these programs, just as there are still sceptics who question the
link between smoking and lung cancer.

One area where needle exchange programs have not been permitted in
Australia is our jails. Yet if we are to experience an epidemic of HIV
starting among injecting drug users and spreading to the community,
chances are that's where it will begin.

Australia has more than 29,000 prisoners, with about half serving
sentences for drug-related offences or having a history of injecting
drug use. Half of these inmates will inject drugs while in jail.

While in the community they'd share their injecting equipment each
year with an average of six people from a small social network. But in
jail they'll share their injecting equipment with many more inmates
every time they inject. It would not be hard for an inmate serving a
one-year prison sentence to have more than 100 sharing partners drawn
from diverse social, demographic and geographic networks.

Moreover, in the community needles and syringes are used only a few
times. But in jail inmates use the same needle and syringe perhaps
thousands of times. As the rubber plungers wear out, they're replaced
by a piece carved from the sole of a thong. Jails are a very efficient
- -- and very expensive -- way to spread an HIV epidemic.

Why not just keep drugs out of jails? If it was as easy as that, all
jails would be drug-free by now. 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.

Authorities don't like to admit it, but keeping drugs out of jails
unfortunately is not achievable.

Jail staff are at risk, working in a correctional environment where
drugs and injection equipment are available but the same prevention
strategies accepted in the community are not accepted there.

This means the loved ones and families of jail staff are also at risk.
Consequently, this isn't just a public health concern. It's also an
important occupational health and safety issue.

Yet the prison officers' unions have been implacably opposed to jail
needle exchange programs. So far no state or territory government has
been willing to take them on.

The unions argue that a NSW prison officer was stabbed with a needle
and syringe containing HIV-infected blood. Tragically, in 1990 prison
officer Geoffrey Pearce contracted HIV and later died from this infection.

All this is true. But the missing fact is that this happened in a jail
where there was no needle exchange program.

If Pearce had been stabbed in a jail with a needle exchange program,
it's possible he might still be alive.

Today, 77 countries have needle exchange programs and programs are
provided in more than 60 prisons in 11 countries.

The same sorts of benefits have been reported in jails as in community
programs. No serious adverse complications have been reported from any
jail needle exchange program.

How can Australia ensure that rationality prevails over emotions in
deciding how to protect jail inmates, prison officers, their loved
ones and the general community?
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