Australian Prisons Have a Hepatitis C Problem, and Drug Criminalisation is to Blame

Australian prisons have a problem with blood-borne viruses. They have the highest concentrations of hepatitis C in the country. 

Rates of hepatitis C infection have been on a downward trajectory for years, and today about 120,000 people in Australia live with the virus – or 0.5 per cent of the population. 

But 10 to 15 per cent of Australia’s current prison population is infected with hepatitis C, because almost 50 per cent has a history of injecting drug use, according to research published in March by the University of New South Wales and the Burnet Institute’s justice health and HIV/STI prevention research group.

“The prevalence of hepatitis C in the community is relatively low because it's concentrated amongst people who inject drugs,” the head of public health at the Burnet Institute, Mark Stoove, told VICE. 

“But in prisons, because of the ongoing criminalisation of drugs and the frequent incarceration of people with injecting drug histories, the concentration of hepatitis C, in Australian prisons and in prisons all over the world, is exceedingly high.”

Australia has a strategy to eliminate hepatitis A, B and C as a public health concern by 2030, parallel with the World Health Organisation’s targets. 

And it is possible. Tests are easily carried out, and the disease can be cured with pills.

But advocates say drug-use criminalisation and a total absence of harm-reduction measures for inmates – like needle and syringe programs that provide people with clean and safe injecting equipment – means prisons not only breach the human rights of those in their care, but keep the wheel of infection and reinfection spinning and needlessly sustain Australia’s hepatitis C epidemic.

“I think people would be quite amazed at the extent to which drug use, and injecting drug use in particular, drives or is associated with incarceration in Australia,” Stoove said. 

“If we are incarcerating these people who are dependent upon injectable drugs … they've created a market for drugs in prison. And whenever there's a market and a lot of money to be made from drugs, well there's not a prison system in the world that has kept drugs out of it.”

In every prison, there’s constant movement of goods in and out – laundry, medicine and food – as well as people, including staff and visitors. It’s not hard to get drugs in, but the substances and the injecting equipment are in shorter supply than in the community. 

“Almost every injection is done with a shared, old, banged-up needle and syringe that's been hidden in someone's cell for God knows how long,” Stoove said. 

Reducing harm to people with drug dependencies in prisons was a key topic at this year’s Harm Reduction International Conference held in Melbourne in April.

One panel speaker, Michael, who has lived experience with drug dependency and incarceration, said the syringes in prisons “disgusted” him, but the lack of needle and syringe programs in prisons (that do exist in the wider community) meant they were the only option.

“I’ve seen so many syringes blunt, they tear through your skin,” he said. 

Michael explained that prison authorities knew about drug use and would mark inmates as users. Prison policy then subjected anyone suspected of using drugs to regular, random strip searches, drug tests and cell raids.

“There’s an actual pride in the system for how to catch someone using drugs and if they catch with a syringe, that's a prize,” he said.

“What are the consequences of finding a syringe? [Losing your] $10 spend, not being able to see your kids, not having visitors, in the slot, all that kind of stuff.” 

Advocate for marginalised and criminalised people, Sara-Michelle Stilianos, was dependent on substances from age 12 to 27 and has been incarcerated. She told the Harm Reduction International Conference panel that the lack of harm reduction measures in prisons can aggravate drug dependencies, as well as cause people to actually become drug-dependent. 

“The problem lies within prison policies adopting a war on drugs approach,” she said. 

“Sanctions do not deter a person from using because people with a drug dependency will find a way to get and to use.” 

Illicit drugs are expensive in prison, so Stilianos said it’s common for people with trauma, depression or plain boredom to turn to replacement therapies like methadone – which can also be addictive in their own way – even if they’d never tried heroin before. 

“Most people resort to methadone programs even if they have not had an opioid dependency – predominantly because a person who is drug-dependent is dependent on escaping themselves and numbing the emotional pain that comes with life,” she said. 

“This is exacerbated by the re-traumatisation and grief experienced when incarcerated. I know people who developed an opioid and opioid replacement dependency in prison when initially their drug of choice was methamphetamine. But there are no existing replacement therapies for methamphetamine users.” 

The Commonwealth has invested millions of dollars in hepatitis medicines, including $8.6 million in last year’s Federal Budget to put them on the Pharmaceutical Benefits Scheme.

But we know the strategy is flawed because 40 per cent of all hepatitis C treatment in Australia is now being done in prisons, Stoove told VICE.

“It costs taxpayers money to treat people, but people are being treated again and again and again and being reinfected because of inadequate harm reduction coverage in the community – particularly in prisons,” he said. 

“It fundamentally undermines our aim to eliminate hepatitis C as a public health threat.”

Stoove said needle and syringe programs are, in part, to thank for Australia’s relatively low rates of HIV in the 80s and still today. But, to date, such a program has never got off the ground in an Australian prison, which puts us in breach of the United Nations Standard Minimum Rules for the Treatment of Prisoners that stipulates people in prison must have access to the same healthcare they would otherwise get in the community. 

“A trial needle and syringe program has been in national hepatitis C strategies as a priority for the last decade or so. These are strategies that every jurisdictional Health Minister has signed up to,” Stoove said.

“Yet, no one has even trialled a prison needle and syringe program in a country that has a strong history of community harm reduction.

“It’s a fundamental breach of human rights.”

Aleksandra Bliszczyk is a Senior Reporter for VICE Australia. Follow her on Instagram, or on Twitter.