Tuesday, June 3, 2003

MJA - BBCD Outbreaks in NSW prisons

Seems some of our friends in & around Corrections Health Service (CHS) were able to take advantage of a couple of recognised cases of needle sharing by HIV positive prisoners to gather data for a study.

They use the post exposure administration of anti-retrovirals as a hook for the media but can't really draw any conclusions about that from their dataset. Mostly the study focuses on Hep C seroconversion of the prisoners they followed up in the study.

If the paper has anything to say it is that IV drug using NSW prisoners are at very high risk of contracting serious bloodborne infections and that health officials know it.

Hardly news. However the fact that CHS are using large scale interventions and follow ups in some cases they detect, albeit with treatments of unknown effectiveness, is presumably meant to reassure us that they are taking great care to prevent major outbreaks.

The article does not mention proven cost effective methods of infection control such as peer drug education or needle-syringe programs.

Oh well, as long as DCS continue to pursue policies which facilitate the spread of bloodborne infection in NSW prisons I guess there will be a conveniently organised pool of guineapigs for studies such as these. And there's nothing like putting the fear of AIDS into a prisoner when you are seeking 'volunteers' for 'treatments which might reduce risk of infection' and subsequent follow up studies.

Correction:

"We have documented hepatitis C transmission in the prison setting, probably related to sharing of injecting equipment. Possible prevention measures that might be implemented include needle and syringe exchange programs, which are the community standard."

I guess the point it doesn't make strongly enough is that given these two *detected* cases of potential HIV (and actual HCV) transmission in the NSW prison system in a single month, how many potential BBCD transmissions are undetected (and therefore, untreated with post exposure prophylaxis or anything else)?

The revelation that "Inmates were initially provided with a four-week course of PEP, but it became evident that some were trading the PEP for other commodities" seems to strongly suggest that there are prisoners who believe they may have been exposed to HIV but are unable to access CHS preventative therapies.

Seems to underline the argument that effective BBCD control measures need to emphasise participation by prisoners themselves, as DCS and CHS will only ever have access to a small part of the story.

By Michael Strutt Posted 3 Jun 2003

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