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Experience has shown that drugs, needles, and syringes will find their way through the thickest and most secure of prison walls. While continuing and often stepping up drug interdiction efforts, prison systems around the world have therefore taken steps to reduce the risk of the spread of HIV and other diseases through injection drug use. These include provision of bleach to sterilize needles and syringes, making sterile needles available (info sheet 6), and methadone maintenance treatment (info sheet 7).

Providing Bleach
According to the World Health Organization’s network on HIV/AIDS in prison, 16 of 52 prison systems surveyed made bleach available to prisoners as early as 1991. Bleach was available in some prison systems in Germany, France, and Australia, in prisons in Spain, Switzerland, Belgium, Luxembourg, and the Netherlands, and in some African and at least one Central American prison system.

Significantly, no system that has adopted a policy of making bleach available in prisons has ever reversed the policy, and the number of systems that make bleach available continues to grow. For example, in a number of surveys undertaken in Europe, the proportion of prison systems that declared having made bleach available rose from 28 percent in 1992 to 50 percent in 1997. In the most recent survey, bleach was available in 11 of 23 systems. Of the respondents who did not make it available, three said that it should be made available and five said that both needles and bleach should be made available.

Canadian Federal Prisons
In its 1994 Report, the Expert Committee on AIDS and Prisons (ECAP) recommended that bleach be made available to prisoners. The Committee emphasized that this “in no way condones drug use, but rather emphasizes that in correctional facilities as elsewhere, the overriding concern in any effort to deal with drug use needs to be the health of the persons involved and of the community as a whole.”

Initially, the Correctional Service of Canada (CSC) rejected ECAP’s recommendation, agreeing only to pilot-test a bleach-distribution program in one institution. However, in the spring of 1995 the Commissioner of CSC instructed CSC to initiate the implementation of bleach distribution in all institutions. As a result, bleach became available in all institutions in the fall of 1996.

Provincial Prisons
In a small number of provincial prison systems bleach has also become available or has continued to be informally available.

A model to follow
In 1992, the BC provincial system issued a policy directing that bleach be made available to prisoners. Adoption of the policy did not lead to any “incidents of misuse ... or any evidence to indicate an increase in needle use.” In April 1995 a revised policy was approved, requiring that bleach be freely available, readily accessible, and distributed in a way that ensures anonymity and minimizes risk of injury.

Not making bleach available runs counter to all Canadian and international recommendations, which agree that full-strength liquid bleach, together with instructions on how to sterilize needles and syringes, should be provided to prisoners.

Recommendation
Full-strength liquid bleach, together with instructions on how to sterilize needles and syringes, needs to be made easily and discreetly accessible to prisoners in all institutions.
 

Limitations
Making bleach available is important, but not enough :

Based on research, bleach disinfection should be considered as a method to reduce the risk of HIV infection from the re-use or sharing of needles and syringes only when no other safer options are available. Sterile, never-used needles and syringes are safer than bleach-disinfected, previously used needles and syringes. With regard to HCV infection, a new study suggests that bleach may reduce its spread. However, the authors emphasized that bleach “is not a substitute for clean needles each and every time.”

Research has shown that even outside of prison many injection drug users - as many as half or more in some studies - do not know, or do not practice, the proper method of using bleach for disinfecting needles. The probability of effective decontamination is decreased further in prison. Injecting is an illicit activity. Because prisoners can be accosted at any moment by prison staff, injecting and cleaning is a hurried affair. Studies have shown that bleach disinfection takes more time than most prisoners can take.

Additional Reading
Correctional Service Canada. Evaluation of HIV/AIDS Harm Reduction Measures in the Correctional Service of Canada. Ottawa : CSC, 1999. The report on the 1998 evaluation of CSC’s harm reduction activities.

K Dolan et al. Bleach Availability and Risk Behaviours in New South Wales. Technical Report No 22. Sydney : NDARC, 1994 ; and K Dolan et al.

Bleach Easier to Obtain But Inmates Still at Risk of Infection in New South Wales Prisons. Technical

Report. Sydney : NDARC, 1996. The first studies to allow the independent monitoring of a prison bleach distribution program.

PM Ford et al. HIV and hep C seroprevalence and associated risk behaviours in a Canadian prison. Canadian HIV/AIDS Policy & Law Newsletter 1999 ; 4(2/3) : 52-54. Concludes that we must “stop pretending that weak bleach solutions are the answer to anything.” Available at www.aidslaw.ca/Maincontent/otherdocs/Newsletter/spring99/prisons.htm.

Third, revised and updated version, 2004. Copies of this info sheet are available on the Network website at http://www.aidslaw.ca/Maincontent/issues/prisons.htm and through the Canadian HIV/AIDS Information Centre (email : aidssida@cpha.ca). Reproduction of the info sheet is encouraged, but copies may not be sold, and the Canadian HIV/AIDS Legal Network must be cited as the source of this information. For further information, contact the Network (tel : 514 397-6828 ; fax : 514 397-8570 ; email : info@aidslaw.ca). Ce feuillet d’information est également disponible en français.

Funded by Health Canada under the Canadian Strategy on HIV/AIDS. The findings, interpretations, and views expressed in this publication are entirely those of the author and do not necessarily reflect the official policy or position of Health Canada.

© Canadian HIV/AIDS Legal Network, 2004