Almost 30 years ago I accompanied two senior doctors on a visit to Sydney's Long Bay jail. The purpose of the visit was to assess the risk of HIV spreading among prison inmates.
I was already doing research in the community on the risk of HIV among people who inject drugs so my colleagues asked me to conduct the interviews. We were taken by corrections guards to a wing of the prison. About 20 prison inmates from that wing were assembled for us. We held our discussion out of earshot of the correctional officers.
I asked how many inmates were gathered in that wing. ''Two hundred,'' was the reply. I then asked, ''How many needles and syringes do you have in this wing?'' One of the inmates started counting on his fingers, ''One, two, three, four, five, six, no, five. They found one yesterday.''
I asked, ''Suppose I had the only needle and syringe in this wing and you knew I had AIDS and you had managed somehow to get hold of some heroin? Would you use my needle and syringe?'' One of the prisoners said, ''Mate, when I am out of here I rob banks. Now that's really dangerous. Do you think I would be scared of just a virus?''
It's hard for prisoners to admit to having male-to-male sex so I said, ''We hear all sorts of stories in the community about whether or not lots of prisoners have sex in prisons. What do you guys think?'' One of the prisoners looked at me and said, ''Mate, just because you're in here doesn't mean the lower part of your body goes to sleep.'' I then asked whether there was a system for sex in prison. ''Well, some of us older blokes keep an eye on the young ones entering the wing. We look out for the ones who are OK looking and aren't too cut up and that. Then we work out whose turn it is.'' It was as brutal and frank as that.
That was when I realised Australia faced a significant problem of HIV spreading among prisoners. After the prisoners had been released, the same HIV would spread in the community. In contrast to prison inmates who have never used drugs, people who inject drugs generally serve more frequent and shorter sentences. Less than 50per cent of prison inmates in Australia have used drugs, about half of these will continue to inject drugs while in prison.
About 10per cent of prison inmates who inject heroin say that they started injecting drugs in prison. The frequency of injecting in prison is much less than in the community but each injecting episode is much more dangerous and for several reasons. Prisoners have many more sharing partners than people who inject drugs in the community. Also, the sharing partners in prison come from a much more diverse geographic and demographic network. The very worn and much repaired injecting equipment used in prison is also much more conducive to HIV spread than the sterile needles and syringes readily available in the community.
A few weeks ago I saw a patient in the terminal stage of cancer related to HIV infection. He is now just skin and bone, grey and in constant severe pain. ''Bill'' had been a senior and highly respected member of the community but had been forced to retire early because of AIDS. I saw ''Bill'' wince as he slowly and painfully made his way into a car.
These are the reasons why I want to see the Alexander Maconochie Centre start exchanging needles and syringes to slow the spread of HIV. I don't want to see one more person like ''Bill''. The less HIV spread in prison, the less there will be in the community. We have to face the fact that prison authorities around the world face an uphill battle trying to keep drugs out of the prison.
The Serenity Prayer of Alcoholics Anonymous reminds us to have the courage to change what we can, the serenity to accept what we cannot change and the wisdom to know the difference. We can slow the spread of HIV and hepatitis C inside prisons (and then in the community). We have to accept the fact that we cannot make much more difference to the availability of drugs in prisons. We have to have the wisdom to separate these two conclusions.
It's time we got real about this problem and made the protection of the community our highest priority.