ATODA Submission to the ACT Budget Consultation 2011 – 2012 Excerpt
Attachment B:
Needle and Syringe Program Trial in the Alexander Maconochie Centre
B1.
Proposal
To prevent and reduce the transmission of blood-borne viruses (e.g. HIV/AIDS,
hepatitis C and B), improve the safety of staff, and improve the health of prisoners by
conducting a trial, which includes a feasibility study, of a needle and syringe program
(NSP) in the Alexander Maconochie Centre (AMC).
B2.
Background and Rationale
Over 80% of all newly acquired hepatitis C infections in Australia and the vast
majority in most Western countries are associated with injecting (illicit) drug use.i
Sharing injecting equipment is the primary manner in which blood-borne viruses (e.g.
HIV/AIDS, hepatitis C and B) are spread in this population. NSPs are one of the
major components of Australia’s approach to reducing the spread to blood-borne
viral infections among injecting drug users.
Each case of hepatitis C infection, a blood-borne virus, costs the Australian
community and health services between $798 and $18,835 per year.ii NSPs in the
ACT have been cost-effective at preventing the spread of blood-borne viruses,
including hepatitis C.iii However, the substantial savings from NSPs in the
community are being eroded by transmission of hepatitis C among a confined and
identifiable population (i.e. prisoners).
The 2007 Australian prison entrants blood-borne virus survey found that 35% of 740
consecutive prison entrants were HCV antibody positive, compared with 0.2% in the
general Australian population.iv
Prisoners have high rates of hepatitis C upon entry into prison.v For most, this has
resulted from unsafe injecting practices. Injecting drug use occurs in Australian
prisonsvi and continued injecting behaviours and the sharing of injecting equipment
causes the transmission of hepatitis C among prisoners who continue to inject in
prisonvii. NSPs reduce the rate of transmission of hepatitis C and other blood-borne
viruses in this population.viii
Prison staff safety is essential. The risk of punishment for possessing injecting
equipment means that prisoners attempt to hide used syringes which places staff at
risk of needle-stick injuries and contracting blood-borne viruses.ix The prohibition of
injecting equipment also means that prisoners who do inject are at a greatly elevated
risk of negative health outcomes. Syringes are often used many times, increasing the
likelihood of blood-borne virus transmission among prisoners, and making a
substantial contribution to the spread of blood-borne viruses throughout the
ATODA Submission to the ACT Budget Consultation 2011 – 2012
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community. The very fact that substantial numbers of prisoners continue to inject in
prison demonstrates that appropriate treatment and support is not reaching many
prisoners who need it most.x
This population should be targeted for interventions which reduce the risk of bloodborne virus infection. Prisoners who may contract hepatitis C in prison are generally
released into the community within a relatively short period of time; such prisoners
become a substantial contributor to the spread of hepatitis C in the ACT community.
The overwhelming evidence indicates that incorporating NSPs into prisons is safe
and effective in reducing the risk of blood-borne virus transmission among prisoners,
staff and the community.xi
B3.
Aim and Objectives
The primary aim is to reduce and prevent the transmission of blood-borne viruses
and enhance the safety of staff through trialing an NSP that will make sterile injecting
equipment available to prisoners. The objectives include:
1. To reduce blood-borne virus transmissions among prisoners, and as a
consequence, the wider ACT community;
2. To improve the safety of staff by reducing the risk of needle-stick injuries and
the contraction of blood-borne viral infections;
3. To improve prisoners’ engagement with health services to improve the rates
of appropriate alcohol, tobacco and other drug (ATOD) treatment among
substance misusing prisoners;
4. To reduce the social and economic costs of blood-borne viruses on prisoners,
prison health services, community health services, and the general
community;
5. To enhance the AMC’s human rights compliance; and,
6. To reduce the exposure of the ACT Government to litigation for failing to
exercise its duty of care towards prisoners.
The trial will determine the feasibility of introducing and operating an NSP in the AMC
and will evaluate its outcomes.
B4.
Priority populations
B4.1
Prisoners who inject drugs
More than half of Australia’s prison entrants have a history of injecting drug usexii and
nearly one-third test positive for the hepatitis C antibody.xiii Many of these prisoners
will continue to inject in prison.xiv Data from NSW has found that 43% of females and
24% of males had injected drugs whilst in prison. Of those, 72% of females and 67%
of males had reused the needle and syringe after someone else.xv
Because the AMC is a relatively new facility, there is limited publicly available data
on rates of blood-borne viral infections, injecting drug use, or the sharing of injecting
equipment among inmates. However, and despite substantial efforts on the part of
AMC staff; drugs and injecting equipment have been found in the AMC. The Chief
Minister has said:
“I would accept, on the information that is available and on the knowledge that we
have, illicit substances are still finding their way into Alexander Maconochie despite
ATODA Submission to the ACT Budget Consultation 2011 – 2012
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our best efforts and there is access through whatever illegal means to contraband
within AMC.”xvi
Injecting drug use occurs in the AMC. Consequently, prisoners are almost certainly
sharing injecting equipment. There has already been one documented case of a
prisoner contracting hepatitis C during their imprisonment at the AMC. The Minister
for Health has confirmed that a detainee contracted hepatitis C while in the AMC,
less than one year after its opening.xvii
The first ACT Inmate Health Survey has been conducted (report yet to be released);
and the Burnet Institute, commissioned by the ACT Government, is currently
reporting on an Evaluation of Drug Policies and Services within the AMC. These
reports will provide further information as to the current situation.
B4.2
Aboriginal and Torres Strait Islander Injecting Drug Users
The over-representation of Aboriginal and Torres Strait Islander people in Australia’s
prisons is partly due to the high rates of alcohol and other drug misuse in these
communities. Consequently, injecting drug use in prison may be major contributor to
growing rates of hepatitis C infection among this population. xviii
Aboriginal and Torres Strait Islander prisoners are more likely to have hepatitis C
before entering prison than other prisoners and are also more likely to inject drugs in
prison than other prisoners.xix Consequently, preventing the transmission of bloodborne viral infections in prisons may have a substantial impact upon improving the
health of Aboriginal and Torres Strait Islander people.
B5.
Evidence of Effectiveness and Safety
The arguments for introducing a NSP into the AMC are many and widely accepted by
international and domestic bodies, health professionals, and the ACT Government.
The overwhelming evidence indicates that incorporating NSPs into prisons is safe
and effective in reducing the risk of blood-borne virus transmission among prisoners,
staff and the community.xx
Prison NSPs are cost-effective, safe, and endorsed by international and domestic
bodies. They have been introduced in 12 countries, where they have been the
subject of extensive evaluation. The results demonstrate that prison NSPs can:



Reduce rates of needle stick injuries among corrections staff and reduce the
likelihood of contracting a blood-borne virus among those who do sustain a
needle-stick injury;
Reduce the rate of blood-borne viral transmission among prisoners who inject
drugs in prisons; and,
Improve the uptake of appropriate treatment among people who inject drugs
in prisons. xxi,xxii,xxiii,xxiv,xxv
The ACT Minister for Health has stated:
“From a health point of view, it is a no-brainer; you have a Needle and Syringe
Program in the jail as soon as you can.”xxvi
Prison staff’s attitudes to NSPs in prisons have been generally positive once they
have been implemented. In a 2004 review of NSPs in European countries, the World
Health Organization found that not a single case of syringes being used as weapons
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by inmates had been reported.xxvii In Australia, there has been only one reported
case, in 1990, in which a prison officer was assaulted with a syringe. However this
occurred when there were no NSP facilities available in the prison.
Evaluations of Needle and Syringe Programs in overseas prisons have shown that
they do not increase drug consumption or injecting and they effectively reduce
needle sharing.xxviii Additionally, there have been no documented cases of adverse
events from NSPs in prisons anywhere in the world, making NSPs in prisons a safe
health intervention.
B6.
Safety guarding the community from blood-borne virus infection
The National Drug and Alcohol Research Centre’s technical report 112 reviewing
international research and program development for prison-based syringe exchange
programs concludes the following:xxix
“The rationale for establishing syringe exchange programs in prisons is even stronger
than in communities. This rationale is accepted by an impressive number of
prestigious bodies… Because of the rapid turnover of inmate populations, spread of
blood borne viral infections among prisoners cannot be considered to remain for long
within the confines of correctional facilities. There is increasing evidence that
experience of incarceration is a strong predictor of HIV and hepatitis C infection.”
The authors elaborate:
“The failure to reduce the risk of hepatitis C and other blood borne viral infection
transmission in prisons severely undermines the work being conducted in the
community with injecting drug users.”
B7.
Improve the uptake of ATOD health services by prisoners
Prison drug treatments are effective in reducing substance misuse and their
associate risk behaviours.xxx However, for these treatments to be effective, prisoners
in need must first access these services. Alcohol, tobacco and other drug (ATOD)
assessments of prisoners cannot guarantee that prisoners with ATOD issues are
identified and appropriately treated.xxxi Additionally, the risk of punishment for
engaging in drug use in prison, or possessing injecting equipment, ensures that
some prisoners will intentionally avoid contact with needed AOD treatment services.
Consequently, there is a need to promote engagement with health services among
prisoners with problematic AOD issues. NSPs in the community are a primary point
of contact between injecting drug users and AOD treatment services. This can also
be the case in custodial settings,xxxii so long as this effort does not act as a barrier to
prisoners accessing the NSP.
B8.
Enhancing the Human Rights Compliance of the AMC
Developing a human rights culture in the ACT is a progressive process which builds
upon the Territory’s previous success. The AMC is a unique opportunity to develop a
truly human rights compliant prison. Currently, prisoners are not afforded the same
standard of healthcare made available to them in the general community. Dr Helen
Watchirs, ACT Human Rights Commissioner, suggests: “To deny protection against
disease transmission in such a high-prevalence and closed population in prison may
be viewed as inhumane.” xxxiii
The ACT Human Rights Commission conducted two audits of the operation of the
ACT’s corrections facilities in 2006 and 2007. One of the Commission’s
recommendations was for a trial of an NSP, which was based on a prisoner's right to
ATODA Submission to the ACT Budget Consultation 2011 – 2012
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life, which includes protection from infectious diseases, as well as the right to the
highest attainable standard of health.xxxivxxxv
B9.
Support for a NSP in the AMC
A range of international bodies with responsibility for developing an international
response to drugs and blood-borne virus transmission have indicated strong support
for prison NSPs as one of many methods to reduce the spread of hepatitis and
HIV/AIDS in prisons. These include the United National Office on Drugs and
Crime,xxxvi the World Health Organization, and the Joint United Nations Programme
on HIV/AIDS.xxxvii
The Australian National Council on Drugs (ANCD), the primary advisory council to
the Australian Government, appointed by the Prime Minister, has recommended:
“That each jurisdictional department responsible for the management of prisons and
juvenile detention centres, in consultation with staff, health authorities and relevant
community-based organisations, develop occupationally safe and culturally
appropriate policies, protocols and procedures regarding the introduction of trial
needle and syringe programs within at least one of its prisons and juvenile detention
centres.”xxxviii
The National Hepatitis C Strategy 2010-2013 states:
“In view of the well documented return on investment and effectiveness of Australian
community-based needle and syringe program, combined with the international
evidence demonstrating the effectiveness of prison needle and syringe programs it is
appropriate throughout the life of this strategy for State and Territory governments to
identify opportunities for trialing the intervention in Australian custodial settings.” xxxix
The ACT Human Rights Commission has recommended that:
"[a] pilot program for a needle and syringe exchange with provision for safe disposal
of needles should be developed for the Alexander Maconochie Centre…" xl
The ACT Chief Minister’s and the ACT Minister for Health’s comments, quoted
above, further strengthen this support. Adding to that, the Attorney General has
stated, "What we want to do is stop the spread of disease that comes from sharing
needles.”xli
The ACT Greens have called for the establishment of an NSP, developed a
discussion paper and a consultation summary.xlii Anex, an national leader in public
health, has also recently released a paper supporting NSPs in prisons.xliii
B10.
Policy Context
Trialing a NSP in the AMC is:



Consistent with the principles of the ACT Adult Corrections Health Services
Plan 2007 – 2010;
Consistent with initiatives being undertaken through the Alexander
Maconochie Centre including the evaluation of drug polices and services;
A recommendation from the ACT Human Rights Commission’s Human Rights
Audit on the Operation of Correctional Facilities under Corrections
Legislation; and the ACT Legislative Assembly’s Standing Committee on
Health report 2003;
ATODA Submission to the ACT Budget Consultation 2011 – 2012
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


B11.
Consistent with and progresses Actions 19, 20, 29, 30, 57 from the ACT
Alcohol, Tobacco and Other Drug Strategy 2010 – 2014;
Consistent with and progresses Action 26 from the A New Way: The ACT
Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006
– 2011; and the recommendations from the Winnunga Nimmityjah Aboriginal
Health Service report You do the Crime, You do the Time; xliv
Part of a broader NSP program which is supported by the National Drugs
Strategy, the National HIV/AIDS Strategy and the National Hepatitis C
Strategy as part of a harm minimisation framework that is based on the three
pillars of supply reduction, demand reduction and harm reduction.
Issues for Consideration
B11.1 Addressing the concerns of some staff
Corrections Officers, their representatives, and ACT Corrective Services have
concerns over the introduction of a trial NSP into the AMC. Their concerns to date
have focused on issues of occupational health and safety (OH&S) for staff - the risk
of needle-stick injuries and injecting equipment being used as weapons. The
evidence states that:
“International experience has shown that regulated prison NSPs do contribute to
institutional safety, and that they do not result in syringes being used as weapons.
The introduction of prison-regulated and controlled NSPs would be consistent with
efforts to comply with OHS principles, as well as the approved standards for
corrections in Australia.”xlv
The ACT Minister for Health has said:
“From a corrections staff point of view—I have said this in these forums a number of
times—it is more complex than that. Corrections staff have mixed and strongly held
views around the commencement of a Needle and Syringe Program. It would be a
brave new step. We would be the first jail in the country to head this way—not the
first jail in the world but the first jail in the country.”xlvi
Appropriate education and training to staff complemented by appropriate amendment
to OH&S policies and practices will need to form part of a trial NSP. However, to
maximise the potential benefits of a trial NSP, it will be necessary to have the support
of staff.
ATODA believes that engagement by staff with the issues, evidence, and
experiences of colleagues from prisons in which NSPs have been introduced will
help to facilitate a change in mindset from one of opposition to one of engagement.
Opportunities for key staff and representatives to investigate, first hand, the
experiences of overseas prisons in which NSPs have been introduced should be
considered. Additionally, all staff at the AMC would benefit from hearing the
experiences of colleagues from overseas about the introduction of a NSP in their
prison.
Extensive consultation with staff will need to be undertaken before, during, and after
the introduction of a NSP. Incorporating staff into the implementation and evaluation
process may help to develop a sense among staff of ownership over the trial.
B11.2 Legislative Issuesxlvii
ATODA Submission to the ACT Budget Consultation 2011 – 2012
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New legislation would need to be enacted by the ACT Legislative Assembly to allow
a trial of the NSP to be implemented. There is nothing unusual about this. For
example the ACT Public Health Act 1997 includes Part 3A: ‘Supply of Syringes’,
authorising the Chief Health Officer to approve designated people to supply syringes
for purposes of ‘preventing the spread of disease’ (s. 66C) (McDonald 1989) and this
approval could be extended to people working in correctional centres.
Most, if not all Australian States and Territories, have removed the offence of
possession of syringes for the purpose of self-administration of an illegal drug as a
public health measure (Norberry 1997). In 2004, the Legislative Assembly passed
the Drugs of Dependence (Syringe Vending Machines) Amendment Act to authorise
a trial of syringe vending machines in Canberra. These are all examples of legislative
changes made to facilitate access to sterile injecting equipment as a public health
measure.
Acts and/or regulations covering the operation of the Alexander Maconochie Centre
(such as the Corrections Management Act) could also be amended to remove any
barriers to the NSP, such as current offences relating to the possession and use of
syringes. Other existing offences related to drugs would remain in force, including
possession, cultivation, manufacture and supply. This mirrors the position in the
Canberra community, where all these behaviours are criminal offences that coincide
with an extensive community-based NSP without substantial conflict.
B12.
Design and Evaluation
While it is premature to draw attention to any preferred model, the particular
approach used in implementing a prison NSP should be sensitive to context, taking
into account the local needs and opportunities of the AMC – including allowing
sufficient time for program development and for trust building amongst stakeholders.
The approach taken will depend, in part, on the objectives of the program and how
health staff interact with the drug-using inmates. Overall, however, across the more
than 50 prison NSPs currently operating, some for over a decade, five broad models
have been described (Stöver & Nelles 2003). They are:
1.
2.
3.
4.
5.
Syringe dispensing machines;
Hand-to-hand provision of injecting equipment by corrections health staff;
Hand-to-hand provision by the staff of external drug sector agencies;
Distribution by peer leaders/educators; and,
Various combinations of these.xlviii
The trial would include a feasibility study, which would determine the strengths and
limitations to the models available and determine the best way forward given the
complex context of the AMC. The program will include a comprehensive evaluation,
which will contribute to the evidence base both within the ACT, nationally and
internationally.
B13.
Funding Estimates
Preliminary estimates are that the implementation of the trial would cost $200,000.
This would include:
1. Feasibility research including detailed consultation with all the key
stakeholders;
2. Trial implementation; and,
3. Trial evaluation.
ATODA Submission to the ACT Budget Consultation 2011 – 2012
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The recurrent costs of an NSP in the AMC would be significantly less. Due to the
national interest of the initiative, additional funding may be able to be identified to
contribute to the costs of the trial.
i
Awofeso N. (2009) Updating the hepatitis C infection risk reduction hierarchy in prison settings.
Australasian Journal of Correctional Staff Development. Volume 4, No 1-4
ii Return on Investment 2: DoHA (2009) available online at:
http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/Reports/$file/RO-2ReportLQ.pdf
iii National Centre in HIV Epidemiology and Clinical Research (2009) Return on investment 2: evaluating
the cost-effectiveness of needle and syringe programs in Australia, National Centre in HIV Epidemiology
and Clinical Research, The University of New South Wales, Sydney.
iv Butler T, Papanastisiou C. (2008) National prison entrants’ blood borne virus and risk behaviour
survey report 2004 & 2007. NDRI, Curtin University and NCHECR, University of New South Wales.
v Butler T, Milner L (2003) The 2001 New South Wales Inmate Health Survey, Corrections Health
Service, Sydney.
vi Butler T, Milner L (2003) The 2001 New South Wales Inmate Health Survey, Corrections Health
Service, Sydney.
vii Dolan K, Teutsch S, Scheuer N, Levy M, Rawlinson W, Kaldor J, Lloyd A, Haber P. (2010) Incidence
and risk for acute hepatitis C infection during imprisonment in Australia. European Journal of
Epidemiology 25(2): pp. 143-148.
viii Dolan K, Larney S, Jacka B, Rawlinson W. (2009) Presence of hepatitis C virus in syringes
confiscated in prisons in Australia. Journal of Gastroenterology and Hepatology 24(10); pp. 1655-1657.
ix
Ryan J, Voon D, Kirwan A, Levy M, Sutton. (2010) Prisons, needles and OHS. Journal of Health
Safety and Environment. 2010;26(1): pp. 63-72.
x Butler T, Milner, L (2003) The 2001 New South Wales Inmate Health Survey, Corrections Health
Service, Sydney.
xi Lines R, Jürgens R, Betteridge G, Stöver H, Laticevschi D, Nelles, J (2006) Prison needle exchange:
lessons from a comprehensive review of international evidence and experience, 2nd edn, Canadian
HIV/AIDS Legal Network, Montréal, Québec.
xii Australian Institute of Health & Welfare (2010) The health of Australia's prisoners 2009, AIHW cat. no.
PHE 123, Australian Institute of Health & Welfare, Canberra.
xiii NPEBBV_RBS 2007
xiv Loxley W, Carruthers S, Bevan J. (1995) In the same vein: First report of the Australian study of HIV
and injecting drug use. Perth: Curtin University of Technology. Cited in Mogg D, Levy, M (2007) Moving
beyond non-engagement on regulated needle-syringe exchange programs in Australian prisons. Harm
Reduction Journal. 2009; 6: p. 7.
xv Butler T, Milner L. (2003) The 2001 New South Wales Inmate Health Survey. Sydney. Cited in Mogg
D, Levy, M (2007) Moving beyond non-engagement on regulated needle-syringe exchange programs in
Australian prisons. Harm Reduction Journal. 2009; 6: p. 7.
xvi The Canberra Times (16 September 2010) p. 1
xvii Legislative Assembly for the ACT (18 May 2010) Select Committee on Estimates 2010 – 2011,
Canberra. Available online at: http://www.hansard.act.gov.au/hansard/2009/comms/estimates16.pdf
xviii National Indigenous Drug and Alcohol Committee (2009) Bridges and Barriers: Addressing
Indigenous Incarceration and Health. Canberra: Australian National Council on Drugs.
xix Australian Institute of Health & Welfare (2010) The health of Australia's prisoners 2009, AIHW cat. no.
PHE 123, Australian Institute of Health & Welfare, Canberra.
xx Lines R et al. (2005) Taking action to reduce injecting drug-related harms in prisons: The evidence of
effectiveness of prison needle exchange in six countries. International Journal of Prisoner Health 1(1):
pp. 49-64.
xxi Dolan K, Rutter S, Wodak, A.D. (2003) Prison-based syringe exchange programmes: a review of
international research and development, Addiction, vol. 98, no. 2, pp. 153-8.
xxii Lines R, Jürgens R, Betteridge G, Stöver H, Laticevschi D, Nelles, J (2004) Prison needle exchange:
lessons from a comprehensive review of international evidence and experience, Canadian HIV/AIDS
Legal Network, Montréal, Québec.
xxiii Niveau, G (2005) Prevention of infectious disease transmission in correctional settings: A review,
Public Health.
xxiv Stöver H, Nelles J (2003) Ten years of experience with needle and syringe exchange programmes in
European prisons, International Journal of Drug Policy, vol. 14, no. 5-6, pp. 437-44.
xxv Rutter S, Dolan K, Wodak A, Heilpern H (2001) Prison-based syringe exchange programs: a review
of international research and program development, NDARC technical report no. 112, National Drug &
Alcohol Research Centre, Sydney, NSW.
xxvi Legislative Assembly for the ACT (18 May 2010) Select Committee on Estimates 2010 – 2011,
Canberra. Available online at: http://www.hansard.act.gov.au/hansard/2009/comms/estimates16.pdf
ATODA Submission to the ACT Budget Consultation 2011 – 2012
December 2010
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xxvii
Lines R, Jürgens R, Betteridge G, Stöver H, Laticevschi D, Nelles, J (2004) Prison needle exchange:
lessons from a comprehensive review of international evidence and experience, Canadian HIV/AIDS
Legal Network, Montréal, Québec.
xxviii I. van Beek (2004) In the Eye of the Needle: Diary of a Medically Supervised Injecting Centre.
xxix Rutter S, Dolan K, Wodak A, Heilpern, H (2001) Prison-based syringe exchange programs: a review
of international research and program development, NDARC technical report no. 112, National Drug &
Alcohol Research Centre, Sydney, NSW.
xxx Hall W, Lucke, J (2010) Legally coerced treatment for drug using offenders: ethical and policy issues,
Crime and Justice Bulletin no. 144, NSW Bureau of Crime Statistics and Research, Sydney.
xxxi Butler T, Milner L (2003) The 2001 New South Wales Inmate Health Survey, Corrections Health
Service, Sydney.
xxxii Lines R, Jürgens R, Betteridge G, Stöver H (2005) Taking action to reduce injecting drug-related
harms in prisons: the evidence of effectiveness of prison needle exchange in six countries, International
Journal of Prisoner Health, vol. 1, no. 1, pp. 49-64.
xxxiii Speech by Dr Helen Watchirs (5 September 2009) Human Rights for Prisoners – the ACT
Experience, ACT Human Rights & Discrimination Commissioner. NSW State Library, Sydney. Available
online at: http://www.hrc.act.gov.au/content.php/content.view/id/194.
xxxiv ACT Human Rights Commission (2007) Human Rights Audit on the Operation of Correctional
Facilities under Corrections Legislation. Canberra.
xxxv Mogg D, Levy, M (2007) Moving beyond non-engagement on regulated needle-syringe exchange
programs in Australian prisons. Harm Reduction Journal. 2009; 6: p. 7.
xxxvi United Nations Office on Drugs and Crime (2008) HIV and AIDS in places of detention: a toolkit for
policymakers, programme managers, prison officers and health care providers in prison settings, United
Nations Office on Drugs and Crime, Vienna.
xxxvii World Health Organization, United Nations Office on Drugs and Crime & Joint United Nations
Programme on HIV/AIDS (2007) Interventions to address HIV in prisons: needle and syringe
programmes and decontamination strategies, World Health Organization, Geneva.
xxxviii Australian National Council on Drugs (2002) Needle and syringe programs. ANCD Position Paper.
ANCD, Canberra. Available online at:
http://www.ancd.org.au/images/PDF/Positionpapers/pp_needle_syringe.pdf
xxxix Department of Health & Ageing (2010) Third National Hepatitis C Strategy: 2010-2013, Australian
Government Department of Health & Ageing, Canberra.
xl ACT Human Rights Commission (2007) Human Rights Audit on the Operation of Correctional
Facilities under Corrections Legislation. Canberra.
xli Mogg D, Levy M (2007) Moving beyond non-engagement on regulated needle-syringe exchange
programs in Australian prisons. Harm Reduction Journal. 2009; 6: p. 7.
xlii For further details see: http://act.greens.org.au/issues-2
xliii Anex (2010) With conviction: the case for controlled needle and syringe programs in Australian
prisons. Available online at:
http://www.anex.org.au/downloads/HMPC%20Paper%20on%20NSP%20in%20Prison%20%20October%202010.pdf
xliv Poroch N (2007) You do the crime, you do the time: Best practice model of holistic health services
delivery for Aboriginal and Torres Strait Islander inmates in the ACT prison. Winnunga Nimmityjah
Aboriginal Health Service, Narrabundah, ACT.
xlv Ryan J, Voon D, Kirwan A, Levy M, Sutton. (2010) Prisons, needles and OHS. Journal of Health
Safety and Environment. 2010;26(1): pp. 63-72.
xlvi Legislative Assembly for the ACT (18 May 2010) Select Committee on Estimates 2010 – 2011,
Canberra. Available online at: http://www.hansard.act.gov.au/hansard/2009/comms/estimates16.pdf
xlvii
This section is an excerpt from McDonald, D. (2005) The Proposed Needle and Syringe Program at
the Alexander Maconochie Centre, Canberra’s New Prison – An information paper on the evidence
underlying the proposal. Canberra.
xlviii This section is an excerpt from McDonald, D. (2005) The Proposed Needle and Syringe Program at
the Alexander Maconochie Centre, Canberra’s New Prison – An information paper on the evidence
underlying the proposal. Canberra.
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