"A never-ending cycle": The structural, economic and social (re)production of blood-borne virus transmission and bacterial infection amongst people who inject drugs in Queensland prisons.

INTRODUCTION

Illicit drug-related harms remain a significant public health issue globally and in Australia, particularly among people who inject drugs (PWIDs) in prison settings where access to harm reduction (HR) is severely limited. This study aimed to explore the experiences of PWIDs incarcerated in Queensland prisons, focusing on how the prison environment shaped their risk of blood-borne viruses (BBVs) and injection-related bacterial infections (IRBIs), and to identify ways current HR interventions could be improved.

METHODS

The study recruited 30 PWIDs aged 29-52 who had experienced incarceration in Queensland and overdosed within the past three years. Participants were recruited via social media and lived-experience organisations providing culturally safe support. Semi-structured interviews were audio-recorded, transcribed, and analysed using a critical realism framework and reflexive thematic analysis to identify and develop common themes.

RESULTS

Participants described how structural, economic, and social factors within Queensland prisons foster risky injecting practices and elevate BBV and IRBI risks. Limited access to HR resources, punitive policies, and inadequate healthcare led to reliance on informal economies and unsafe behaviours such as equipment sharing and syringe cutting. Stigma and fear further hindered healthcare access. Participants emphasised the need for expanded HR measures, including needle and syringe programs, delivered within enabling environments that reduce barriers and promote peer support.

DISCUSSION: These findings suggest more consideration regarding policy changes to enhance the accessibility of HR interventions, including needle and syringe programs in Queensland prisons.