What Works for Women and Girls

needles and razors, with almost 100% of needles distributed returned. Shared razorscan transmit Hepatitis C and distribution of razors gives an incentive for all prisonersto visit peer distributors. All prison staff are trained to act as though all prisoners areHIV-positive and therefore to use rubber gloves when handling blood or other bodilyfluids, thus reducing HIV stigma. Estimates are that the number of HIV-positive prisonershas decreased from 200 in 2002 to 145 in 2008, with more prisoners requestingHIV tests. Prisoners report never sharing injecting drug equipment. Used syringes areincinerated on prison grounds. Prison officials would like to conduct a scientificallyrigorous evaluation to show that the reduction in HIV cases is due to the program;however, a randomized controlled trial would be unethical. (Hoover and Jurgens, 2009).(Gray III) (harm reduction, prisoners, needles, razors, Moldova)Needle exchange programs have been introduced to 12 countries in Western andEastern Europe and Central Asia. A comprehensive review of the published literatureon harm reduction programs in prisons found that “there is evidence that needleand syringe programmes are feasible in a wide range of prison settings, including inmen’s and women’s prisons….There is evidence that providing clean needles [is] effectivein reducing ….HIV infections. At the same time, there is no evidence to suggestthat prison-based needle exchange programs have serious, unintended negative consequences.In particular, they do not appear to lead to increased drug use or injecting, norare they used as weapons” (Jurgens, 2007b: 5; Jurgens et al., 2009b). In addition, “sincemost prisoners leave prison at some point to return to their community, implementingneedle and syringe programs in prisons benefits not only prisoners and prison staff, butalso the people in the sexual and drug injecting networks in which prisoners participateafter their release” (Jurgens et al., 2009b: 61). (Gray V) (harm reduction, needles, prisoners,Western Europe, Eastern Europe, Central Asia)2. Making opioid substitution treatment available in prisons can be effective in reducing HIVtransmission.“Given that many prisoners have severe problems with illegal drugs, it would be unethicalnot to use the opportunity that imprisonment provides for treatment” (Jurgens etal., 2009: 62). A 2009 review of international implementation of opiod substitution,along with a 2004 Cochrane review, found that opiod substitution treatment is themost effective treatment available for heroin dependence, resulting in reduced heroinuse, HIV transmission and mortality. Opiod substitution treatment is currently availablein community and prison settings in: Albania, Azerbaijan, Belarus, Bosnia andHerzegovina, Bulgaria, China, Croatia, Czech Republic, Estonia, Georgia, Hong Kong,Hungary, India, Iran, Kyrgyzstan, Latvia, Lebanon, Lithuania, Macedonia, Malaysia,Mauritius, Mexico, Moldova, Myanmar, Nepal, Poland, Romania, Serbia, Slovakia,Slovenia, South Africa, Taiwan, Thailand, Ukraine, Uzbekistan and Vietnam. However,China and Russia, countries with large prison populations, do not provide any of theseservices in prison (Larney and Dolan, 2009). (Gray III) (opiods, prisoners)102 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS