PROBLEMS IN TRANSFERRING RISK REDUCTION MEASURES INTO THE PRISON SETTING

Risk reduction strategies commonly applied outside prison are often regarded as undermining the measures taken inside prison to reduce the supply of drugs. To support, on the one hand, the hygienic use of illegal drugs (by means of bleach and syringe/needle provision) and then, on the other hand, confiscate them when they come to light is a fundamental contradiction. Risk reduction strategies are regarded as a challenge to the prison policy of drug free orientation in general, and may be seen by some as not taking the risks connected with drug use seriously enough.

These risks are the focus of risk reduction strategies which should be seen as an additional strategy to drug free-oriented measures. Drug use itself should be avoided, but when it does occur - which seems to be the case in most prisons - irreversible damage to the user’s health and to that of other inmates, prison personnel and inmates partners and families in the community - should be avoided. Inmates should not leave prison with more damage to health than they had when entering prison. This point of view is clearly supported by the World Health Organisation (WHO 1993).

Additionally, most drug-using prisoners seek to hide their drug use in order to avoid losing privileges (such as home leave, segregation, higher levels of control, frequency of visits, etc.) or being subjected to intensive controls, such as body search (both of themselves
and also their visitors), cell searches, discrimination by non-drug-using prisoners (due to fear of transmission of infectious diseases), etc.

This background makes it difficult for the prison authorities to cope adequately with the health risks of drug users in prison. Due to a lack of anonymity and confidentiality even making contact with the target group on this issue might pose a problem.

Other problems are:
Difficulties talking about sex, drugs and infectious diseases
Lack of confidentiality and anonymity when talking frankly about drug use and sex.
Gender specific taboos (men having sex with men without homosexual identity).
Utilising the knowledge and status of the doctor and personnel of the medical department.
Inside/outside: integrating people from the community
Self-help groups or self-organisations?
Any knowledge acquired is not just for application during the time spent in prison.
Looking at the specific prison conditions: overcrowding, infrastructure, ‘Healthy Prisons’, structures of communication and co-operation?