ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

“When will it ever end?” The Provision of Regulated Injecting Equipment to Australian Prisoners.

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Professor Michael Levy, Australian National University, ACT, Australia

Within this session, Professor Michael Levy discussed harm minimisation strategies within the prison environment, including the controversial provision of a needle exchange program in Alexander Maconochie Centre (Prison), Australian Capital Territory (ACT), Australia and achievements in reaching global targets for hepatitis C treatment.

Prof. Levy, a tireless advocate for prison needle and syringe programs, led us through the session by providing a background on the situation and the barriers encountered.

His passion was clear as he spoke about the frustrations of being so close yet so far from achieving the ultimate goal of implementing a needle exchange program in the ACT. Prof. Levy expressed the challenges faced in getting Corrective Services to share the same enthusiasm.

The event that occurred in 1990 in New South Wales, Australia where a detainee living with HIV used a blood-filled syringe to stab an Officer who subsequently died still remains a major barrier to moving forward in the harm reduction response. This case, he states, is nested within Professor Kate Dolan’s PhD thesis on HIV transmission in Australia. Since this time, agitation among Corrective Services has remained.

While Switzerland is recognised as the leader, commencing the first needle exchange program in prison in the world, various other countries have progressed, implementing programs since. However, this progression is yet to follow in Australia, where we sadly lag behind other countries in the global response.

The ACT had an aspirational plan to comply with the human rights of prisoners, advocating for the equivalence of healthcare by recommending a needle exchange pilot to minimise the transmission of disease, however their efforts were to no avail.   

While there is Government commitment from the Greens, the ACT Human Rights Commission, the Australian Medical Association and Public Health Association, the battle continues. While harm minimisation programs such as needle exchange services are yet to be implemented, other strategies such as therapeutic prevention, such as hepatitis C treatment, have been adopted as an alternative to managing the within prison risk behaviours of the sharing of syringes.

Prof. Levy discusses the remarkable achievements in reaching global targets of a reduction in hepatitis C prevalence. From a HCV Ab prevalence of 48% in 2010, to 20% in October 2016, an impressive reduction was achieved in just 18 months.

What we can be assured of is that while passionate leaders in global health such as Prof. Levy continue to be at the forefront, striving for improved public health outcomes, there is still hope. The dream may one day become a reality, where we see prison needle exchange programs, achieving universal health for all as we know ‘good prison health is good public health’.

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