Intended for healthcare professionals

Education And Debate

Provision of syringes: the cutting edge of harm reduction in prison?

BMJ 1998; 317 doi: (Published 25 July 1998) Cite this as: BMJ 1998;317:270
  1. J Nelles, head physiciana,
  2. A Fuhrer, scientific collaboratora,
  3. HP Hirsbrunner, scientific collaboratora,
  4. TW Harding, directorb
  1. aUniversity Psychiatric Services of Bern, Department East, 3000 Bern 60, Switzerland
  2. bInstitute of Legal Medicine, University of Geneva, 1211 Geneva, Switzerland
  1. Correspondence to: Dr Nelles
  • Accepted 5 May 1998

When, in the summer of 1994, a pilot project on prevention of drug use and transmission of HIV was launched in Hindelbank, a Swiss prison for women, not many outsiders paid attention to it. Yet only a few months later, the prison director received repeated calls from television stations, newspapers, and drug experts asking how the project was developing. We describe how this high level of public interest in a small prison (around 85 inmates, 100 entries and releases per year) came about.

Summary points

  • Prisons play a pivotal role in the spread of infectious diseases

  • Distribution of syringes reduces drug-related harm in the community, but its effect in prisons has not been reported

  • Automatic syringe exchange dispensers were installed in a Swiss prison for women in the framework of a pilot project on drug and HIV prevention

  • Ongoing evaluation provided some evidence that syringe distribution in prison did not encourage drug consumption, and syringe sharing among inmates virtually disappeared

  • Other prisons in Switzerland and Germany are conducting prevention projects that include syringe distribution

Provision of syringes—the cutting edge?

The installation of six automatic dispensers for exchange of syringes attracted special attention. The dispensers are freely accessible but hidden from general view in different wings of the prison (fig 1). Clean injection equipment is dispensed only in exchange for another (used) syringe. The first exchange is by means of a dummy syringe that is given to all inmates when they enter the prison.

To distribute equipment for illegal drug use in the framework of a penitentiary—and to provide inmates, many of whom have been sentenced for drug related crimes, with syringes—seemed paradoxical to many people. Fears abounded that inmates could misuse contaminated syringes as weapons against the prison's staff or that improper disposal of injection equipment would provoke injuries and thus cause infections with bloodborne viruses. There …

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