Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey.

Introduction

Willing anonymous salivary HIV (WASH) surveillance in Scottish prisons provided consistent estimates in 1991-5 of the prevalence of risk behaviours inside and outside prisons, of their geographic and sentencing correlates, and of the prevalence of HIV among injector inmates.[1-4] Two studies in 1996 were important for different reasons[5]: the study in Lowmoss prison, Glasgow, monitored changes since willing anonymous salivary HIV surveillance in 1994 at Barlinnie prison, also in Glasgow; the study in Aberdeen prison gave the first insight to injector and HIV prevalence in north east Scotland at a time of concern about the availability of cheap heroin.[6]

Questions were added in 1996 to evaluate prisoners' access to harm reduction measures, including hepatitis B vaccination. Sterilising tablets have been available to all Scottish prisoners since December 1993 for purposes including the cleaning of needles and works. But are they being used for the intended harm reduction purpose? Random mandatory drugs testing has been challenged as "a means of gathering information."[7 8] We used volunteered information on the frequency of injecting inside prison in the previous four weeks to estimate the likely efficiency of random mandatory drugs testing at detecting inmates who inject class A drugs such as heroin inside prison. So far as we know this is the first such study.

Methods

Willing anonymous salivary HIV surveillance was conducted with ethical approval and as described[1-3 9] by external teams of volunteers at Lowmoss prison on 11 October and at Aberdeen prison on 30 October 1996. Saliva samples were tested for HIV antibodies at the regional virus laboratories in Glasgow and Edinburgh respectively. On the surveillance days AGB briefed prisoners about why the survey was being performed, and explained the linkage of questionnaire and saliva sample by sealed number pair (chosen at random by the prisoners)[2] and that the survey and research team were unconnected with random mandatory drugs testing (due to be introduced to both prisons in 1997).

Results

The participation rate was 94% (293 of 312 prisoners) at Lowmoss and 93% (146/157) at Aberdeen (table 1). Two Lowmoss prisoners (both injectors) tested positive for HIV antibody. HIV prevalence was 0.7% overall and 1.7% (2/116) for injector inmates. At Aberdeen one saliva sample was insufficient and two prisoners (both non-injectors and heterosexual, one known to the …