Drug use in prisons: strategies for harm reduction (ANRS-PRIDE Program).

The existence of risky practices related to drug use inside prisons is a reality everywhere and is a major issue for the community as a whole. The level of implementation of harm reduction (HR) measures recommended by the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) is very often poor and reveals inadequate concern about public health issues in the prison environment, without any respect for the principle of equivalence for prevention and health assistance with the general community. In 2009, the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) developed a comprehensive research program focusing on the prevention of infectious risks in prison settings. Different steps were defined and scheduled, and included i) an inventory of harm reduction (HR) measures, ii) a qualitative survey on the reality of risky practices, iii) an assessment of the social acceptability of HR measures, and iv) an intervention trial exploring the feasibility of upgrading existing HR strategies. A progressive implementation of this program has shown it is feasible, but in France, it requires tenacity, simple long-term objectives, support from a scientific authority, pedagogical interventions for all involved, as well as constant discussion with the authorities. The implementation of this program in other countries is equally simple to manage.

Drug use in prisons: strategies for harm reduction (ANRS-PRIDE Program) / Uso de drogas na prisão: estratégias de redução de danos (Programa ANRS PRIDE)

Abstract The existence of risky practices related to drug use inside prisons is a reality everywhere and is a major issue for the community as a whole. The level of implementation of harm reduction (HR) measures recommended by the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) is very often poor and reveals inadequate concern about public health issues in the prison environment, without any respect for the principle of equivalence for prevention and health assistance with the general community. In 2009, the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) developed a comprehensive research program focusing on the prevention of infectious risks in prison settings. Different steps were defined and scheduled, and included i) an inventory of harm reduction (HR) measures, ii) a qualitative survey on the reality of risky practices, iii) an assessment of the social acceptability of HR measures, and iv) an intervention trial exploring the feasibility of upgrading existing HR strategies. A progressive implementation of this program has shown it is feasible, but in France, it requires tenacity, simple long-term objectives, support from a scientific authority, pedagogical interventions for all involved, as well as constant discussion with the authorities. The implementation of this program in other countries is equally simple to manage.

Resumo As práticas de risco relacionadas ao uso de drogas nas prisões são realidades universais e representam grande risco para a comunidade. O nível de implementação de medidas de redução de danos recomendadas pela Organização Mundial da Saúde (OMS) e pelo Escritório das Nações Unidas para Drogas e Crimes (UNODC) é frequentemente baixo e expressa limitado interesse considerando os problemas de saúde pública relacionados ao ambiente prisional, com desrespeito ao princípio da equivalência para prevenção e assistência à saúde em relação à comunidade. Em 2009, a Agencia Nacional de Pesquisa em Aids e Hepatites Virais da França (ANRS) desenvolveu abrangente programa de pesquisa focado na prevenção de risco de infecção na prisão. Foram definidos e planejados diferentes passos, incluindo: i) inventário das medidas de redução de danos (RD), ii) pesquisa qualitativa sobre a realidade das práticas de risco, iii) avaliação da aceitabilidade social das medidas de RD e iv) ensaio de intervenção demonstrando a exequibilidade do aprimoramento das estratégias de RD existentes. A progressiva implementação deste programa mostra sua exequibilidade, mas demandou, na França, tenacidade, objetivos simples em longo prazo, apoio por uma sociedade científica, intervenções pedagógicas para os envolvidos e constante discussão com autoridades. É fácil sua implementação por outros países.