(Session 3)

Presentations: Ms Petra Paula Merino, European Monitoring Centre for

Drugs and Drug Addiction, Lisbon: "Barriers and challenges for Harm

reduction in prison - experiences from EU countries". Ms Claire Delorme,

European Network for AIDS and Hepatitis Prevention in Prison: "Objectives

and activities of the network". Mr Steve Rossell, European Network of Drug

and HIV/AIDS Services in Prison: "Working towards a co-ordinated response".

Under the title: "Barriers and challenges for harm reduction in

prison", Petra-Paula Merino, EMCDDA, presented information from the member

States of the European Union. Because of differing definitions, comparable

data on the number of drug users in prison was not available, but

individual countries estimated the rates from 15% up to 80% of inmates.

She reviewed in which countries drug-free wings, mandatory or voluntary

drug-testing, therapeutic communities or counselling services were

available, and where substitution treatment was being offered to prisoners.

The introduction of demand reduction activities in prisons was seen as a

unique opportunity for help and treatment.

She said that interventions, which could be classified as harm

reduction were not yet very common within EU prisons. She suggested that

this was because this type of approach raises particular dilemmas for those

who work with drug using offenders in the criminal justice system. Only in

nine of the 15 EU States, prisoners nowadays have free access to condoms,

as recommended by WHO as early as 1991. She mentioned also syringe

exchange pilot programmes that had been implemented in German prisons and

whose first results sounded encouraging; the evaluation reports are

expected to be published very soon.

For the successful introduction of harm reduction practices, she

concluded, endorsement at the highest level of an official policy, was

essential and a systematic preparation at the prison and local levels as

well. To implement health promotion and risk reduction strategies in

prisons, various practical problems have to be solved - in order not to

leave this issue in a no-man's land between the Ministries of Justice and

Health and between prison service staff and health care staff. Training of

senior prison managers and other levels of staff were key-issues in this

process.

Claire Delorme presented the work of the European Network on

HIV/Hepatitis Prevention in Prison, which is composed by scientists from

all 15 EU States. The Network works in co-operation with ENDHASP, with the

WHO European Office in Copenhagen (Health in Prison Network) and with

UNAIDS, Geneva. Its objectives are to collect and compare information on

HIV/AIDS and Hepatitis epidemiology and prevention in European prisons, to

set up common tools for studies on HIV sero-prevalence and the prevalence

of risk behaviours in prisons, to implement international epidemiological

multi-center studies, to evaluate the priorities and the conditions of harm

reduction strategies in prison which could have major impact on the AIDS

epidemic, and to implement and/or evaluate innovative prevention

programmes.

She presented how the network had set up co-ordination structures in

each EU member State, and collected data on HIV and Hepatitis among

prisoners. Large scale multicenter studies were carried out in seven

Western European countries, which confirmed the high prevalence of HIV and

Hepatitis in prison - compared to the outside - with alarming rates among

intravenous drug users (average 12,9% of which were HIV positive; 49,8%

Hepatitis C positive). These studies also indicate that a considerable

number of prisoners started intravenous drug use while in prison, and that

an average of 45% (35% in France and Belgium vs 67% in Sweden and Spain) of

IDUs do not stop injecting drug use while imprisoned.

The network disseminated its information also by organising

international Conferences on HIV/Hepatitis Prevention in prisons. The next

Conference is planned for May 1999 in Milan.

Steve Rossell: Working towards a Co-ordinated Response - presented a

brief description of the Network, its background and development, aims and

structure. Cranstoun Drug Services provide services to drug users in

residential and community based treatment and rehabilitation programmes and

through a number of low-threshold community outreach and access services.

In 15 prisons they have teams using a variety of models, ranging from brief

interventions and diversion from custody, to structured programmes, using

HR approaches as well as abstinence.

The aim of the network is twofold and theoretically relatively simple

in nature to provide a means to investigate, collate and disseminate

information concerning good practice in the field and to act as forum for

debate for members and participants.