Drug Use and Prisons: An International Perspective Edited By D. Shewan & J. B. Davies. Amsterdam: Harwood Academic. 2000. 256 pp. £19.00 (pb), £38.00 (hb). ISBN 90 5823 004 X (pb), 90 5823 003 1 (hb)

Despite its title, the central theme of this multi-author book is not drug use in prisons. It is the impact on prisons across the world of the emerging epidemic of AIDS in the 1980s, and the associated risk of the transmission of HIV by needle-sharing. That risk was recognised early on, and the tragic episode at Glenochil prison in 1993, in which at least eight prisoners were shown to have become infected with HIV while incarcerated, proved that it was not merely theoretical. This presented prison doctors, prison governors and governments with a novel and unwelcome dilemma. To minimise the spread of a lethal illness, not only within prisons but ultimately in the wider community, they had to envisage condoning the provision either of disinfectant or of clean needles and syringes to prisoners, and possibly of methadone and condoms as well. But if they were to do so they would immediately be accused of condoning and encouraging drug taking and sodomy in their prisons.

It is fascinating to see how different countries reacted to this challenge. In the aftermath of Glenochil, Scotland, England and several other jurisdictions ensured that disinfectant was readily available to prisoners and that they knew how to use it, and in some prisons doctors started prescribing methadone to known addicts. Several countries made condoms available and a few, led by Switzerland, started to provide both sterile needles and syringes and methadone, and even to allow prisoners to self-inject with heroin under supervision. Others, like Germany and the normally pragmatic Netherlands, refused to condone disinfectants, clean syringes or methadone, or played for time by setting up small pilot studies which never progressed beyond the pilot stage. Only the USA, and even there only a few states, introduced comprehensive treatment and rehabilitation programmes for heroin addicts. It is equally instructive to see what stimulated these innovations. In most countries it was not the results of research, or even the 1993 World Health Organization declaration that “prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community”. It was litigation, or the threat of it, by prisoners themselves.

I learnt many interesting things from the 11 essays in this book, for example, that twelve-step programmes are forbidden in American prisons because of their religious content; that in Brazil syphilis is a greater threat than HIV, and that the prison authorities try to minimise the risk of infection by allowing visita intima by wives and girlfriends rather than by issuing condoms; and that in most prisons in sub-Saharan Africa conditions are so terrible that the risk to life and health from HIV and hepatitis hardly registers on the scale. There is, however, a good deal of repetition, and Gore & Bird's description of their innovative methodology for anonymous salivary HIV surveillance is spoilt by a tedious, self-justifying description of their war with the Home Office over its mandatory drugs testing policy. All in all, this is a book for prison doctors and governors, and for civil rights lawyers, rather than for psychiatrists.