On 17 March 2023, at a side event during the 66th UN Commission on Narcotic Drugs, a coalition of prisoners’ rights defenders, community activists and other stakeholders, called on States to ensure equivalence of care for people who use drugs in prison and reinforce the independence of health professionals providing harm reduction and health services in prison.
The side event was organised by PromoLEX Association and the Prison Health and Rights Consortium (bringing together the European Prison Litigation Network, Harm Reduction International, UnMode – Community Movement for Access to Justice and Health without Barriers – the European Federation for Prison Health) and discussed the structural factors hindering public health and harm reduction policies in detention, especially the impact of the lack of independence of prison doctors on access and quality of care for prisoners, including imprisoned people who use drugs.
Yanina Stemkovska (UnMode), Julia Krikorian (EPLN) and Vadim Vieru (Promo-LEX Association), reminded that prisons remain mostly outside the scope of public health policies and stressed that the insufficient integration of public health and human rights policies at the international and domestic levels creates structural conditions for unequal care and ill-treatment of vulnerable and ill people in prison. The statutory independence of prison medical staff from the prison administration is essential to ensure access to quality harm reduction and healthcare services to people who use drugs in prison. Prisoners are in a particularly vulnerable situation, as their access to health care depends in most cases on the intervention of prison staff.
Dr. Tlaleng Mofokeng (UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health) urged States to make harm reduction services, including opioid agonist therapy, available to people in prison without discrimination. She underlined the negative impact of the war on drugs, including within places of deprivation of liberty, when harm reduction and healthcare services are implemented without a harm reduction approach. She also emphasised that in order to ensure that harm reduction and health services are tailored to the specific needs of people in prison and that medical considerations prevail over security and punitive aspects, medical practitioners in prison should be independent from the prison staff.
See her full intervention here >>
Jane Batte (Civil Society and Networking Adviser at UNAIDS) recalled that people who use drugs and people in prisons are key populations for HIV response and their access to HIV and health services are among the priority targets set by the Global AIDS Strategy 2021-2026. In this regard, she reminded that it is the responsibility of the State to ensure access to quality HIV and harm reduction services for people in prison, under conditions equivalent to those enjoyed by people in the community. She also emphasised that State efforts to provide harm reduction services should be combined with the reduction of the number of people in prison who need such services. In this regard, the COVID-19 pandemic has shown that it is possible to implement decarceration policies, including the release of prisoners found guilty of non-violent offences, such as drug possession for personal use
The panel discussion was closed by Fadi Meroueh (Health without Barriers). Based on his experience of more than 25 years as a health practitioner in French prisons, he analysed the structural problems of the country’s prison healthcare system, which has been under the authority of the Ministry of Health since 1994. In particular, he stressed that despite evidence that the prevalence of HIV, HVC and TB is decreasing in prisons where harm reduction, HIV, TB and HVC services are implemented , medical staff remain under the pressure from the prison administration not to provide harm reduction services. He recalled that in order to ensure access to and quality of care in prisons, States should create the conditions for a patient-centered care rather than a care system driven by punitive and security rationales.