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Needle exchange program is a health care necessity

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Australia has more than 1000 new HIV infections a year. For the sake of future generations of Australians we should be doing everything we can to reduce the number of new HIV infections. In several countries, HIV epidemics starting among prison inmates sharing injecting equipment have sparked severe epidemics in the general community. Australia also has about 10,000 new hepatitis C infections a year. The overwhelming majority of old and new hepatitis C infections occur among people who inject drugs.

Many new hepatitis C infections occur inside prisons. Hepatitis C is a time bomb ticking for the Australian health care system. A good measure of a country's fairness is how it respects the human rights of its most disadvantaged populations. Prisoners are among our most disadvantaged. Professor Jon Stanhope (''Rights exist behind the wire'', March 13, p15) is right to emphasise the need to respect the human rights of prisoners. Australian governments have a responsibility to minimise the number of new HIV and hepatitis C infections. Who runs the Alexander Maconochie Centre? The government or the CPSU?

Mr Alistair Waters and Mr Michael Doyle (Letters, March 15) have not brought up any cogent reasons for denying a health protection readily available for the past 25 years to citizens in the community to citizens behind bars. Does the CPSU deny the effectiveness of needle syringe programs in the community or in prisons to reduce HIV and hepatitis C infections?

Dr Alex Wodak, , Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, NSW

Finally the CPSU is showing signs of removing its head from the sand in the prison needle exchange trial debate. Alistair Waters (Letters, March 15) rightly points to ''a duty of care''. He is right, and according to the considered advice we have, this means that provision of sterile injecting equipment needs to go ahead. Mr Waters correctly states that members have a right to make a valuable contribution to the debate. That therefore requires members to be fully informed of the evidence-base from abroad, which shows that where controlled programs have been established there have been no recorded instances of syringes being used as weapons against prison staff. We have developed the world's first set of protocols that can guide establishment of a safe controlled needle exchange model (see www.anex.org.au/prisons). It factors in his concerns and the need to design an intervention for situation-specific environments that Mr Waters alluded to.

If the CPSU, with support from Government and public health agencies, was prepared to enable an informed discussion with its membership, then I am sure the workable solution Mr Waters hinted at could be found.

John Ryan, CEO, Anex

The ACT Hepatitis Resource Centre sees some hope in CPSU spokesperson Alistair Waters' call for ''a workable outcome among myriad competing issues'' (''Disagreeing with Stanhope on the needle exchange program'', March 15, p16); though we do not agree with his characterisation of this as a ''workplace matter''. Far beyond workplace politics the spread of blood-borne viruses such as hepatitis C within prison, and then from prison to the general community, has our prisons as incubators for these preventable, serious, expensive-to-treat, and for some life-threatening conditions.

The very worst model of a needle and syringe program is operating at the AMC right now. It is unregulated, circulates a limited supply of unsterile equipment, and fails to connect its ''clients'' with health professionals. Sadly there are other gaps in the current approach to BBV prevention. For the sake of detainees, prison staff and community health, the ACT Hepatitis Resource Centre calls for the development and implementation of a comprehensive, evidence-based blood-borne virus management strategy.

John Didlick, executive officer, ACT Hepatitis Resource Centre

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