I read with interest the article by Alistair Waters, the deputy national president of the Community and Public Sector Union in relation to the ACT Government's intention to implement a needle and syringe program in the Alexander Maconochie Centre ("Needle exchange at AMC a fatally flawed proposal", Times, September 17, p5). However, the arguments put forward by the CPSU simply don't stand up to scrutiny. As the CEO of the Public Health Association of Australia – and co-author of the 2011 report to the ACT Government on the implementation of a NSP in the prison – I think it's important that I address some of the myths and misconceptions in Wednesday's article.
Firstly, the idea that a NSP could increase the spread of blood-borne viruses (BBVs) in the prison flies in the face of all the evidence. Many countries have already established NSPs in prisons. The first such program was established in Switzerland in 1992 and NSPs have since been established in more than 50 prisons in 12 countries in Europe including in Spain, Portugal and Germany where the programs are supported by trade unions as well as in central Asia. Numerous studies have shown that such programs do not compromise security or detainee/correctional staff safety and they effectively reduce spread of infection and needle sharing. Further, there have been no reports of syringes having been used as weapons in any prison within an operating NSP.
If used injecting equipment can easily be traded for clean equipment, the need to share and reuse equipment will be removed. Detainees actually don't want to contract BBVs that can kill them, so the incentive to trade used for new equipment if at all possible is very effective – as demonstrated by the evidence.
The notion that an NSP "sends mixed messages about institutional support for rehabilitation and the ACT Government's approach to illicit drugs" is also not supported by either the evidence or practical experience in the broader community. Since 1985, Australia's National Drug Strategy has been based on the three equally important pillars of demand reduction, supply reduction and harm reduction. This provides for a comprehensive approach that incorporates education, prevention, treatment, aftercare, law enforcement and harm reduction strategies all working together simultaneously.
This approach is just as applicable in the prison setting. Custodial officers will continue to seek to prevent illicit drugs from entering the prison. Staff will continue to encourage and support detainees to engage with drug treatment and rehabilitation programs. However effective these efforts are, the evidence shows that a small amount of drugs will continue to slip through the net and be used by a small number of detainees. For these people, we want to ensure that they don't contract and pass on BBVs – either within the prison, or in the community when they are released.
The idea that there is broad opposition to the implementation of a NSP is also incorrect. The majority of submissions to the ACT Government on this issue were supportive of the introduction of a NSP. It is also inaccurate to say the Australian Nursing and Midwifery Federation was against the concept. There was one submission from an individual who worked with ex-prisoners claiming that his clients were against the idea, but there were numerous other submissions from other organisations who work with prisoners indicating resounding support. The CPSU has been the primary objector to the proposal throughout.
The CPSU constantly uses the tragic case of Geoff Pearce – a NSW custodial officer who died in 1998 after being assaulted by a detainee with a blood-filled syringe – as rationale for its continued opposition to NSPs. However, Mr Pearce was assaulted in a prison that had no NSP and there have been no reports of syringes having been used as weapons in any prison within an operating NSP. Mr Pearce's death was an absolute tragedy, but it actually illustrates the case for controlled NSPs, rather than the current unregulated, illicit ones that operate in Australian prisons.
Mr Waters goes on to state that "the government has framed the debate around the human rights of prisoners". While that factor is one consideration, from a public health perspective, the primary issue is about preventing the spread of BBVs, both within the prison and the broader community. It is worth remembering that most detainees spend relatively short periods in prison before returning to the community. Hence allowing BBVs to continue to spread through the use of shared injecting equipment in the ACT prison – as has been demonstrated – poses a significant risk to the broader community and undermines efforts to reduce rates of BBVs in Australia.
The article is however absolutely right about one thing – a NSP alone will not halt the spread of BBVs in the ACT prison. It needs to be part of a comprehensive and integrated approach that incorporates education, prevention, testing, treatment and aftercare initiatives as well. The ACT Government should be congratulated for developing the Strategic Framework for the Management of Blood-Borne Viruses in the Alexander Maconochie Centre 2013–2017, which outlines a comprehensive and multifaceted plan for tackling BBVs. The Strategy notes that further consideration of the merit and feasibility of a professional tattooing and piercing program at the AMC also continues. ACT Corrective Services and ACT Health management and staff should also be congratulated for their ongoing efforts to progress the priorities outlined in the strategy.
So all in all, the position outlined and arguments contained in Mr Water's article don't stand up to scrutiny. Further, the particular models and arrangements currently being discussed for the implementation of a NSP in the AMC reflect the particular circumstances and requirements of the ACT's prison and other jurisdictions will have their own issues and requirements to consider. It is not useful to apply a series of "one size fits all" myths and misconceptions, particularly without regard to the nature of the specific models under consideration in the ACT.
PHAA continues to support the ACT Government's approach to the management of BBVs in the AMC, because it's comprehensive, evidence-based and it simply makes good sense.
Michael Moore is chief executive officer of the Public Health Association of Australia.