Access to harm reduction and HIV-related treatment services inside Indian prisons: experiences of formerly incarcerated injecting drug users.

PURPOSE: The authors aimed to examine the incarceration experiences of injecting drug users in accessing harm reduction, and HIV-related services inside prisons in India. DESIGN/METHODOLOGY/APPROACH: The authors conducted three focus groups with a purposive sample of 23 formerly incarcerated male IDUs and four key informant interviews with a former police official, a drug dealer and service providers. Data were analyzed using a constant comparative method.
FINDINGS: Participants reported availability of alcohol and injectable or oral drugs such as heroin, dextropropoxyphene, and marijuana inside prisons. Inmates obtained drugs and clean syringes (one syringe bought for 2.5-4 USD) through prison staff, and collected used syringes and needles from the dustbins in prison sickrooms. Needles and syringes were reused and shared. Prisons did not have needle and syringe programmes, detoxification, overdose management or opioid substitution treatment. Drug-using prison inmates faced several challenges in accessing antiretroviral treatment and HIV testing. PRACTICAL IMPLICATIONS: The authors' findings emphasize the need to protect the health of injection drug-using inmates by introducing harm reduction programmes and removing barriers to HIV testing and antiretroviral treatment. ORIGINALITY/VALUE: This study illustrates, for the first time, the contexts behind high risk injecting drug use behaviours among prison inmates in India. It also highlights the lack of availability of harm reduction services such as needle and syringe programmes, drug detoxification and opioid substitution treatment inside prisons. Further, it demonstrates the difficulties faced by HIV-positive prison inmates in getting timely and uninterrupted antiretroviral treatment.