Suchergebnisse

Needle exchange programs (NEPs) to prevent HIV transmission among injection drug users are accepted in many countries but remain at the center of heated debate in the US. In 1997, the author published a study of injection drug users in Vancouver showing an explosive outbreak of HIV. An incidental finding was higher HIV rates among frequent attendees of the local NEP. While this was expected, because NEPs attract users at highest risk, opponents of needle exchange applied an unsupportable causal interpretation to this finding. If frequent NEP attendees had higher HIV rates, so the interpretation went, NEPs must be responsible for promoting the spread of HIV. Despite the author's admonitions against this misinterpretation of the data, it was used as part of a successful campaign to oppose US federal funding of needle exchange. Regrettably, biased or even misleading interpretations often occur in the volatile interface of imperfect science & ideological debate. 21 References. [Copyright 2002 Sage Publications, Inc.]

While prison needle exchange programs, or prison needle and syringe programs, have existed in different parts of the world since the 1990s, little is known about how currently incarcerated people perceive them—particularly in Canada, where such programs have only recently been implemented. This study explores incarcerated women's perceptions of a recently implemented prison needle exchange program using in-depth, semi-structured qualitative interviews with 56 federally incarcerated women in Western Canada. In particular, we explore the barriers that women perceive in accessing the prison needle exchange program. These perceived barriers contributed to our participants' negative views of the prison needle exchange program as well as their overwhelming lack of support for its implementation. Our participants felt that the prison needle exchange program acts as an obstacle to sobriety and could increase different types of harm—including encouraging injection drug use and contributing to overdoses—within the prison. Participants also identified other barriers to using the prison needle exchange program, including a perceived lack of confidentiality/anonymity for users of the program and that the prison needle exchange program itself is structurally incompatible with the rules and operations of a prison system that continues to criminalize drugs. Using an implementation science framework, we argue that this situation accentuates the need for significant consultations with incarcerated people about the operation of such programs, and for funds to support other programs that target participant-identified root causes of substance misuse, such as programs that address past trauma and victimization. At the same time, we caution that some barriers may be inherent in how prisons are structured.

The purpose of this study was to identify HIV risk factors associated with participants who were HIV seropositive at Needle Exchange Program (NEP) entry. A sample of injection drug users (IDUs) who enrolled in an NEP between 1994–1997 were recruited into a prospective study and tested for HIV antibodies. Demographic and recent drug use characteristics were collected. Logistic regression models were constructed to identify factors associated with HIV-seropositive status at NEP entry. Of 811 evaluation participants, 87% were African American, 67% were male, and 30% were HIV seropositive. The multivariate model indicated that daily cocaine injection (Adjusted OR (AOR)=1.98), daily speedball injection (AOR=2.36), daily heroin injection (AOR=0.55), cohabitation with someone (AOR=0.7), and employment (AOR=0.4) were all significantly associated with HIV seroprevalence at NEP entry (p<0.05). These findings indicate that HIV-seropositive individuals entering NEP practice particularly risky behaviors and are more likely to need help in order to minimize the harm of drugs and HIV infection than their HIV-seronegative counterparts.

The incidence of HIV and Hepatitis C is significantly higher in Canadian federal penitentiaries than among the general public, as are the transmission rates of these two diseases. These disproportionate rates of infection are largely attributed to the sharing of needles among inmates who are addicted to intravenous drugs. This has created a serious public health risk for all federal inmates as well as the general public, since many of these inmates will be released back into society. In response to this risk, the Correctional Service of Canada asked the Public Health Agency of Canada (PHAC) to study the effectiveness and risks of prison needle-exchange programs (PNEPs). In 2006, PHAC's report, "Prison needle exchange: Review of the evidence," concluded that "[n]eedle-sharing practices decrease in prisons where PNEPs are offered." Despite these findings, the federal government has refused to establish a prison needle-exchange program. The harm caused by the federal government's continuing reluctance is compounded by an existing legislative prohibition on sterile needles in federal penitentiaries. In light of current political and legislative barriers, any hope of establishing such a program lies with the courts. This article assesses the ability to challenge the legislative prohibition on sterile needles through a claim under the Canadian Charter of Rights and Freedoms.