BETWEEN 2008 and 2010 the government of Iran ran trials of Needle and Syringe Prisoner Programs (NSPP) in three prisons in its country. This was at a time when the Canberra Liberals were putting in every effort to stop such a process in Canberra.
The outcomes of the Iranian experience should give courage to the ACT Government. As in other countries, there was a reduction in the spread of HIV and other blood-borne viruses. However, it was not achieved without similar challenges as the government is facing.
At a meeting last week in Tehran with Iranian health and prison officials along with representatives from the UN Office on Drugs and Crime, I listened with interest to an evaluation of the programs by an academic from the Global Fund to Fight AIDS, Tuberculosis & Malaria. As co-ordinator of the evaluation, he explained the challenges and outcomes of the project in three Iranian prisons. They were Ghezelhesar prison in Tehran province, and central prisons in Hamedan and Esfahan.
Like so many people in Iran, the officials at the meeting were helpful, friendly and concerned. They were also keen to understand the three pillars of the Australian approach to illicit drug policy which is based on supply reduction, demand reduction and harm minimisation.
Iranian drug use has been influenced by the level of drug trafficking that crosses their country – particularly through its borders with opium-growing countries. It should not be surprising that their problem with injecting drug use has increased markedly over the last decade. Like Australian jurisdictions, most drug users avoid prison and are referred to treatment centres unless there is another drug-related crime.
Prison warders, government officials and the public generally were wary of the provision of needles and syringes in the prison. However, according to Dr Shahbazi, the spread of blood-borne viruses outweighed such concerns as “condoning drug use”, “tempting” prisoners, “syringes as weapons” and “undermining abstinence and methadone programs”. These are largely the same concerns that have been expressed in the ACT.Additionally, many of the prison wardens and health-care providers such as physicians, nurses and counsellors, who were interviewed before the commencement of the program, believed that there was inadequate infrastructure to support implementation of an NSPP.
The Iranian authorities made the needles widely available in the selected prisons. Detainees in the trial wings of the prisons could request as many needles as they wanted. There was not even the demand for a 100 per cent return of the needles. Despite the concerns and such an open system, there was not even a single incident of needles being used as weapons or of an infected needle creating a needle-stick injury. Prisoners were identified as users and the health staff were able to counsel them towards abstinence and substitution programs – with positive results.
There was a reduction in the spread of blood-borne viruses. The evaluation showed an increasing percentage of needles being returned and needle sharing virtually ended – 8.1 per cent of needles were unreturned in the original six months with this figure dropping to 2.8 per cent in the last six months of the trial as trust increased.
Prisoners involved in the trial had a significantly improved interest in their own health with increased testing and participation in education and other harm-reduction programs.
The reality is that the ACT is not alone in looking for lateral solutions to prevent the spread of blood-borne viruses. Australia was amongst the most successful countries in the world in reducing the spread of HIV/AIDS. This was because brave politicians across the political spectrum recognised the importance of disease prevention as more important than ideological commitment.
Hopefully, in the new term of the Assembly, the Canberra Liberals will be able to shed this part of their ideological commitment and support an NSPP in the Alexander Maconochie Centre.
Michael Moore was an independent member of the ACT Legislative Assembly (1989 to 2001) and was Health Minister. As CEO of the Public Health Association of Australia, he was responsible for a report on an NSP in the Alexander Maconochie Centre in 2011.