Scaling up harm reduction in prisons: a role for prison monitors and new tools

Harm Reduction International has published a new tool for use by prison monitoring mechanisms (national, regional and international) to monitor the management of communicable diseases and harm reduction in prisons and prevent human rights violations in this context. Gen Sander, Human Rights Analyst at Harm Reduction International, introduces the tool here.

Last October, I wrote a blog for PRI in which I discussed the necessity of tackling communicable diseases such as HIV, hepatitis C (HCV) and tuberculosis (TB) in prisons. I explained that prisoners are significantly more likely to be living with these diseases than the general population for several reasons, including the fact that people who use or inject drugs comprise a large portion of the world’s prison population as a result of punitive drug laws, combined with an absence of harm reduction services, such as needle and syringe programmes (NSP) and opioid substitution therapy (OST), which are proven to prevent HIV and HCV transmission and strongly recommended by WHO, UNAIDS and UNODC.

Despite the exponential growth of support for harm reduction globally in the last decade, progress in prisons has been shamefully slow. In the case of NSP provision, it has actually regressed. I will repeat the numbers because they are so revealing: 90 countries now provide NSPs in the broader community, but only seven provide the service in at least one prison (down from 10 in 2012); and 80 countries provide OST in the broader community, but only 44 currently provide the service in at least one prison. This, I explained, is nothing short of a public health emergency.

Denying harm reduction services to prisoners is also a clear violation of their right to the highest attainable standard of health, and is increasingly being found to meet the threshold of inhuman or degrading treatment. Furthermore, it flies in the face of widely accepted minimum standards on the treatment of prisoners, including the Mandela Rules, and countless public health guidelines. But, as we know too well, there is a cavernous gap between public health and human rights standards on the one hand, and effective implementation in prison settings on the other. So how can we close, or even narrow, this gap?

I concluded my last post by suggesting that human rights-based prison monitoring mechanisms, including National Preventive Mechanisms (NPMs), the European Committee for the Prevention of Torture and Inhuman and Degrading Treatment or Punishment (CPT) and the United Nations Subcommittee for the Prevention of Torture (SPT), are in an incredibly unique and critical position to help do this. Today I will elaborate on this idea.

It is the role of these bodies to work to prevent torture and ill treatment by examining whether conditions of detention are in conformity with minimum standards and making suitable recommendations to authorities on where and how improvements could be made. They are granted unrestricted access to detainees, facilities and information, and are explicitly mandated to look into health-related issues. Their approach is based on dialogue and cooperation, and their access to, and relationship with, prison authorities are like none other.

Research conducted by Harm Reduction International (HRI) on the extent to which issues relating to harm reduction and communicable diseases are being examined by these mechanisms reveals that much more could be done, particularly at the international (SPT) and national levels (NPM). In an effort to help these mechanisms examine these important issues in a more comprehensive and systematic way, HRI has developed a user-friendly monitoring tool.

The monitoring tool is presented as a questionnaire, made up of indicators derived from widely accepted public health and human rights standards. Its main focus is on the most pressing and currently overlooked issues concerning the prevention of ill treatment in the context of harm reduction, HIV, HCV and TB in prisons. This is its unique contribution to the monitoring process. Taken as a whole – including complementary questionnaires on national context, the prison health system and accountability – the tool is meant to be comprehensive and examines the main elements of a human rights-based approach to harm reduction in prisons. It also identifies the main elements of a strong and equitable health system that is conducive to realising rights in prison settings.

While the tool is principally targeting human rights-based prison monitoring mechanisms whose mandates include the prevention of ill treatment, it can certainly also be used by monitors that are not explicitly working within a human rights framework. This includes, for example, Health Care Inspectorates, non-governmental organisations, and prison boards. It could also function as an instrument of self-assessment for states and prison authorities already implementing harm reduction and who wish to evaluate and improve their services.

The bottom line is this: ensuring quality harm reduction services are available in prisons is not optional, it is a legally binding human rights obligation and a public health necessity. The evidence is out and it shows harm reduction works – it saves lives, improves health, respects dignity and human rights, is cost-effective and can be safely and successfully implemented in prison settings. Now given their mandate and unique positioning, human rights-based prison monitoring mechanisms have a critical role to play in ensuring that harm reduction is urgently scaled up in prisons.

About the author

Gen Sander joined Harm Reduction International as a human rights analyst in 2014. Prior to that, she was a senior researcher at the University of Essex Human Rights Centre, where she taught a module on human rights and worked with Prof. Paul Hunt, former UN Special Rapporteur on the right to health, on issues relating to health and human rights. She has also been a consultant for the WHO and the Independent Expert Review Group (iERG) on right to health issues, and has worked with various human rights NGOs in Canada, Europe and the Middle East.