Abstract
We aimed to identify how strategies to reduce the risk of hepatitis C virus (HCV) in prisons could be implemented in a way that is acceptable to those with the responsibility for implementing them. Prison officer and nurse perceptions of HCV and attitudes toward a range of harm reduction interventions, including clean needle and bleach provision, were explored. In the context of highly prevalent feelings of resentment, most of the proposed strategies were perceived by all staff as a threat for officers and a privilege for prisoners. Addressing the underlying concerns of prison staff is essential in achieving a fully collaborative harm reduction effort. Ongoing resistance to proposed harm reduction strategies underscores the relevance of these findings for prison settings in Australia and elsewhere.
Highlights
With an estimated prevalence of up to 1.5% (Alter, 2007; Hellard, Horyniak, & Aitken, 2009), hepatitis C virus (HCV) infection is one of the most commonly notified communicable diseases in Australia
While the risk is greatest in people with a history of injection drug use (National Centre for HIV Epidemiological and Clinical Research, 2010), history of imprisonment has long been independently associated with HCV (Crofts et al, 1996; Dolan, 2000a; Stark et al, 1997)
Transmission risk was a major theme in nurse discussions and, for both groups, all discussion was located within the discourse of personal risk rather than that of susceptible prisoners or other prison staff
Summary
With an estimated prevalence of up to 1.5% (Alter, 2007; Hellard, Horyniak, & Aitken, 2009), hepatitis C virus (HCV) infection is one of the most commonly notified communicable diseases in Australia. Evaluations of the extent to which the international guidelines have been adopted over the ensuing two decades, have yielded disappointing results— with respect to the provision of syringes and bleach (Bollini, Laporte, & Harding, 2002). This is despite strong evidence from around the world for the effectiveness of needle and syringe programs in the community (Commonwealth Department of Health and Ageing, 2002) and their successful implementation in a growing number of prisons in Switzerland, Germany, Romania, Belgium, Scotland, and elsewhere (Chu & Elliott, 2009). Efforts to understand the attitudes and beliefs of prison staff could promote a more collaborative approach to introducing effective strategies in the future (Gollop et al, 2004; Grol & Wensing, 2004; Mogg & Levy, 2009)
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