In the correctional environment, there are often impediments to best practice BBV prevention. These problems are exacerbated by higher levels of co-infection with HIV and hepatitis C in this population. Effective HIV and other BBV prevention and health promotion requires a whole-of-government approach enlisting those concerned with juvenile detention centres as well as adult prisons.
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.
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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.