New developments in combating the spread of infectious diseases in prison

In Estonia, the situation regarding the prevention of the spread of HIV improved in 2003. The number of primary HIV tests increased 2.6-fold compared with 2002, although the number of positive tests increased only slightly. Pre- and post-test counselling services also improved in terms of quantity as well as quality. In Romania, programmes aimed at preventing the spread of HIV/AIDS in penitentiaries and among prisoners were developed in cooperation with some international non-governmental organisations (NGOs).

Spain is the only country systematically implementing needle and syringe exchange programmes in prisons. In 2003, these programmes distributed a total of 18 260 syringes. Implementation of similar programmes is not foreseen in other Member States and candidate countries.


Box 12: Alternatives to imprisonment: targeting offending problem drug users in the EU, in EMCDDA Annual report 2005: selected issues

Prison is a particularly detrimental environment for problem drug users and there is a broad political consensus on the principle of treatment as an alternative to prison. The alternatives to prison that may be offered to drug-using offenders cover a range of sanctions that may delay, avoid, replace or complement prison sentences for those drug users who have committed an offence normally sanctioned with imprisonment by national law. The selected issue focuses on those measures that have a drug-related treatment component.

Since the 1960s, UN and EU agreements, strategies and action plans have several times reaffirmed and strengthened the principle of providing treatment, education and rehabilitation as an alternative to conviction and punishment for drug-related offences. This has been translated into national legislation in EU Member States, and the criminal justice systems as well as health and social services systems have been adapted accordingly. Young drug users are especially vulnerable to getting into a vicious circle of drugs and crime, and there is a particular determination to avoid imprisonment for young offenders.

The implementation of alternative measures to imprisonment, however, faces certain difficulties due to the different administrative systems involved and their different underlying principles. Efforts are made to bridge the gap between the judicial and the health and social services systems through coordination structures and initiatives, i.e. between police, courts and prisons and drug treatment services. Often, informal cooperation mechanisms at local level have been forerunners to more stable institutionalised forms.

Recourse to alternatives to prison increased during the last decades in the EU-15 Member States and has recently even stagnated in some, whereas legislation and implementation of alternatives began later in the ‘new’ Member States. Usually, the mainstream treatment system is called on to ensure the treatment of offenders with problematic drug use. In most countries, treatment is usually provided in residential settings, but the possibility also exists to follow outpatient treatment programmes.

European evaluation studies of treatment as an alternative to prison are rare and partly inconclusive. However, consistent with other treatment research, retention in treatment proves to be a key indicator of success and drop-out rates are one of the biggest problems for alternatives to prison. Evidence suggests that it is the quality of treatment provided and not the route of the client into treatment that is important for treatment success. Treatment as an alternative to prison seems to work best if the addicts are motivated for treatment and if care facilities follow good clinical standards and have enough and qualified staff.

This selected issue is available in print and on the internet in English only.