Barriers to accessing prevention in prison are of particular concern for Aboriginal and Torres Strait Islander peoples. The correctional environment often has impediments to best practice BBV prevention. These impediments are exacerbated by the higher levels of co-infection with HIV and hepatitis C in custodial settings. The prevalence of HIV remains low, but the potential exists for it to increase, particularly as the prison population increases (national surveillance figures reveal that the rates of HIV infection among new prison entrants has increased over the past three to four years 11). Effective HIV and other BBV prevention and health promotion require a whole-of-government approach for juvenile detention centres and adult prisons.

In this context, it is recognised that people in custodial settings are a priority population at risk of HIV, hepatitis B and hepatitis C infections, primarily through unsafe injecting practices, and that there are available and effective evidence based approaches to the prevention of blood borne infections in the context of injecting drug use.

Each state and territory has its own independent systems for police, courts, prisons and juvenile institutions. Health services are provided variously by health or justice jurisdictions and supplied directly, or contracted, by public and private custodial facilities. Australia’s prison systems are relatively small and isolated from each other. This presents challenges for coordinating research and policy development, implementation, evaluation and education. However, these challenges have been overcome within the custodial environment to enable effective responses to a number of key public health issues including BBV and STI initiatives such as provision of condoms, access to bleach, provision of opioid pharmacotherapies, and the National Prison Entrants BBV & Risk Behaviour Survey.

Providing sterile injecting equipment in Australian prisons is controversial in some parts of the community, even though an increasing number of international jurisdictions have implemented this approach, or are actively contemplating doing so. To date there is no evidence of adverse outcomes associated with providing an NSP. A number of positive or beneficial outcomes have emerged from evaluated programs including: no documented increase in illicit or injecting drug use; significant reductions in equipment reusing and sharing; no documented attacks or violence in prisons; no documented seroconversion for HIV or hepatitis; and acceptance by staff and prisoners. In view of the well documented return on investment and the effectiveness of Australian community-based NSPs, it is appropriate throughout the life of this strategy for state and territory governments to identify opportunities for trialling this approach in Australian custodial settings. This is also supported by the international evidence demonstrating the effectiveness of prison NSPs.

In addition, it is essential that the full range of BBV and STI prevention strategies be maintained in Australian custodial settings, including:

  • increasing the provision of, and access to, bleach and disinfectants where no safer alternatives are provided for decontaminating spills, surfaces or equipment
  • easily accessible education and counselling—including peer education and support on HIV and STIs, hepatitis B, hepatitis C and injecting drug use—as a fundamental health promotion technique to support risk reduction practices
  • increasing access to drug treatment programs, including opioid pharmacotherapy programs which have reduced BBV transmission in custodial settings, as well as detoxification and drug rehabilitation programs.
Strategies should also be explored for developing and promoting Australian infection control standards for tattooing and body art to further reduce the risk of BBV transmission in custodial settings.

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11Butler T & Papanastasiou C 2008, National Prisons Entrants’ Bloodborne Virus and Risk Behaviour Survey Report, 2004 and 2007, National Drug Research Institute (Curtin University) and National Centre for HIV Epidemiology and Clinical Research (University of New South Wales).