The announcement yesterday by Chief Minister Katy Gallagher to establish a needle exchange in the ACT’s Alexander Maconochie Prison is historic. Politicians need votes like the rest of us need oxygen. And they know that there are no votes in prisons. But prisoners are a major concern for public health and human rights.
Despite prison authorities all over the world doing everything in their power to stop drugs entering prisons, they still get in. And they always will. Charles Manson, the most closely-guarded prisoner in the Western world, was still able to obtain illicit drugs behind bars.
But why do prison inmates take drugs despite the huge risks they run? A prisoner once explained to me that “a day off your face is a day off your sentence”. Last year, an inmate in a Jakarta jail told me that drugs were sometimes cheaper in his prison than in the community.
Less than 1% of the community injects drugs. But those who do inject about two to three times a day (or about 60 to 100 times a month). These days people injecting in the community are likely to share needles and syringes with about half a dozen close friends each year. Most of the time, they inject using brand new sterile needles and syringes. Other harm reduction measures are generally readily available. In the community HIV infections, but not hepatitis C infections, are rare.
That’s quite a contrast with the situation in prisons. Up to 25% of prisoners will inject drugs while they are behind bars. Prisoners who inject drugs do so much less frequently than their counterparts in the community – perhaps only half a dozen times a month. But they will often share each needle and syringe with between six and ten other inmates. The needles and syringes used in prison are cut down and will have been used previously, perhaps hundreds of times. They are perfect and efficient vehicles for transmitting viral infections.
Most HIV and hepatitis C infections that occur in prisons are only detected when the former inmate is back in the community. By then it’s almost impossible to prove where the infection was contracted. People who use drugs often serve frequent but short prison sentences and so often move between the community and prison.
It’s difficult explaining this situation to the community. More draconian approaches to prison are always expensive, rarely effective and often have severe unintended negative consequences. But draconian approaches are political viagra while pragmatic and effective approaches are often considered politically suicidal.
That’s why it’s taken more than 20 years before any politician in the English-speaking world has done what Katy Gallagher has had the courage to do. Politicians who stand up for important principles deserve to be strongly supported. Katy Gallagher will be greatly admired for the rest of her life by people who understand that protecting public health and human rights is critical.
Sooner or later, a prisoner or former prisoner who can prove that they acquired HIV or hepatitis C in a correctional system elsewhere in Australia will sue the prison authority for failure to provide duty of care to the level provided in the community for the last quarter century.
A court will then award them a large sum of money. One by one, correctional authorities in other jurisdictions will act either before or after such a court case. But the experience with the introduction of community needle syringe programs in Australia in the late 1980s suggests that it will still be a difficult and protracted battle extending this decision to the rest of the country.
This is a great moment for public health and human rights. The ACT government’s decision reminds us that offenders get sent to prison as punishment, not for punishment. They’re certainly not sent to prison to acquire dangerous infections and then spread them to their loved ones and friends in the community.
Those who like to demonise all politicians should think about Katy Gallagher and the ACT government courageously acting in the best interests of the community. We should remember with gratitude how politicians from all parties in the early years of HIV excelled themselves by ranking the national interest above their short-term political interests. Katy Gallagher is following in this great tradition.