Emily Cooper has seen first-hand the impact of a lack of harm minimisation programs in Australia’s prisons.

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During her time in prison in Queensland, she saw people reusing the same needles, with many contracting serious infectious diseases and bacterial infections, including someone who is now permanently wheelchair-bound.

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Cooper is now the support and advocacy lead at QuIVVA, an organisation providing advocacy, support and harm reduction education to people who have used substances, including in prisons.

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The organisation is one of many advocacy and medical groups calling for the introduction of needle and syringe programs and other harm minimisation schemes in Australia’s prisons.

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While prisons are acknowledged as very high risk environments for the transmission of infectious diseases including HIV and hepatitis C, no prison in Australia provides clean needle and syringe exchange programs.

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This is despite these programs being widely accessible in the outside community, and prisons being meant to provide equivalent healthcare.

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“It’s hugely important to have the access that you have out in the community to clean equipment,” Cooper told About Time.

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The campaign for harm minimisation in prisons has picked up steam recently after it was revealed that hundreds of people incarcerated in Queensland may have been exposed to HIV and hep C after they shared needles in prison.

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Queensland Health has confirmed that nearly 300 people in prison in the first half of last year that have since been released have been contacted and told to be tested after a man infected with the diseases shared injected equipment inside.

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Those who may have been exposed and are still in prison are being followed up with by prisoner health services to assess their risk and offer testing.

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A separate study recently revealed many of the highly risky injecting techniques being used in Queensland prisons due to a lack of available clean equipment, including 86 people using the same needle in one day.

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Needle and syringe programs provide free clean needles and syringes, sharps disposal containers and sterile swabs, and also allow for the returning of used equipment.

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There are more than 4000 sites providing this in the Australian community, with more than 50 million needles and syringes distributed annually.

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But there are none in Australian prisons.

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Dr Wendell Rosevear worked as a doctor in Queensland prisons for several decades. He said news of the potential infections was “sadly expected and predictable”, due to the lack of harm minimisation.

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“Unless people can take action to achieve personal safety, then the risks are quite real,” Rosevear told About Time.

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“Needle exchanges are available in our community so they shouldn’t be banned in prison.”

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It’s important to give people in prison the chance to make safe choices, he said.

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“When you treat people as valuable then they make good choices and make choices to be safe,” Rosevear said.

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“Let’s move to a respect culture rather than a revenge culture by allowing people to feel valuable and make good choices to protect themselves.”

An academic paper analysing available studies has estimated that one in nine people in prison around the world have injected drugs, a rate that is 50 times higher than among the general public.

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But a study into the use of drugs in Queensland prisons found that harm minimisation services are “severely limited”, and that this is a “serious issue of healthcare inequity”.

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For the study, the researchers interviewed 30 people who have experienced incarceration in Queensland and have overdosed in the last three years.

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Nearly all of the participants said they had seen needles and syringes being shared in prison, and two-thirds had contracted hep C during their time being incarcerated.

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They said that a lack of available clean equipment led to the sharing of needles and syringes.

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“If you don’t have your own drug utensil, you’ve got to share,” one participant said.

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“That’s the only way you’re going to get [on] is through sharing.”

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One man told the study that he had shared a cell with someone who got an infection on his spine and was put in an induced coma and nearly died after sharing a syringe.

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The study also found that existing syringe needle tips were sometimes sharpened on concrete floors, and nail files were being used to “resurrect” them for continued use.

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While these programs have been blocked in Australian prisons due to concerns they would lead to increased drug use and for safety reasons, they have been in place in prisons around the world for decades, with great success.

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Switzerland was the first country to implement a needle and syringe program, and the sharing of equipment was virtually eliminated in that facility.

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Spain introduced its first program in the late 90s and reported positive results, including no increase in drug use or accidental needle injuries or violence.

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The Australasian Society for Infectious Diseases has urged state governments to introduce these programs in prisons.

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“There is a wealth of evidence that injecting-related prison harm reduction programs including needle and syringe programs can reduce the transmission of blood-borne viruses,” the organisation said.

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“The efficacy and safety of needle and syringe programs in prisons is well-established in the literature, with precedence available in the international experience.”

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Cooper said that many people with lived experience of incarceration are now standing up for the rights of people still in prison.

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“We’re not hiding away in shame anymore, we’re calling this out publicly and drawing attention to human rights abuses,” she said.