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The aim of this report is to summarize available evidence on the effectiveness and cost- effectiveness of needle exchange programs to reduce harm associated with injection drug use in prisons, to facilitate the evaluation of the benefits of the program in correctional settings. [...] Summary of Critical Appraisal The strengths and limitations of the individual studies are summarized and presented in Appendix 3. It is unknown whether the included studies were planned a priori or they were post hoc evaluations following the implementation of the needle exchange programs in the various reasons. [...] The study also found a decrease in the rate of abscesses among IDUs during the exchange program, and reported that the general mood of female prisoner had improved along with their weight and other laboratory values.1 Three of the studies1,3,8 reported that evidence of harm related to the needle/syringe exchange program in prisons such as an overall increase in injection drug use, or violence invo [...] Therefore, in the absence of a control group, it is The investigators had no conflicting interests not possible to conclude that the outcomes of the study were solely due to which could be a source of potential bias in the the provision of sterile injection equipment, since the impact of intensified study. [...] Summary of Findings of Included Studies Main Study Findings Author's Conclusions Ferrer-Castro, 20127 There was a significant decreased in the prevalence of HIV "After ten years of development of the NEP, there was a and HCV at the 10-year follow-up (from 21% and 40% at significant decrease in the prevalence of HIV and HCV in the baseline to 8.5% and 26.1%, respectively; P
This paper analyses current trends in prison drug use, the prevalence of HIV/AIDS and HCV in prisoner populations and other information relevant to assessing the need for prison-based needle exchange programs in Canada. The first part presents background information on (1) the role of injection drug use (IDU) in the HIV and HCV epidemics, (2) prevalence of substance users and levels of substance use in Canadian prisons, (3) levels and patterns of injection drug use and needle sharing in Canadian prisons, (4) the prevalence of HIV and hepatitis C infections among Canadian prisoners, (5) evidence of cases of disease transfer from sharing needles in prisons, and (6) existing harm reduction policies and programs in provincial and federal correctional systems in Canada. The next section reviews international experience with prison-based needle exchange programs, emphasizing evaluations of their effects on behaviour and their effectiveness in reducing harms among prisoners who use drugs by injection. The third part provides a review of the legal/constitutional and moral/ethical rationales for providing sterile needles to prisoners and a brief summary of the previous calls for piloting prison-based needle exchange programs in Canada. The last part discusses several possible courses of action available to the Canadian government as it considers its options on prison-based needle exchange programs.
This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.