Less risky use Information and education on the risks of HIV and hepatitis B and C virus transmission by sharing contaminated injection equipment are prerequisites for harm reduction of drug use. In trying to achieve the greatest efect with the least drug dose, most opiate‑addicted prisoners go for the intravenous route, behaviour that can be efectively reduced by sufciently dosed oral opioid‑substitution treatment. Hence, oral opioid substitution is a measure for reducing demand for consumption of illegal opiates and is a safer use of an opiate. In those prisons where sterile injection paraphernalia are not available (see below, Needle/syringe‑exchange programmes), prisoners should at least have access to disinfectants together with information how to rinse and disinfect contaminated injection equipment in order to lessen the risk of transmission. However, it must be made very clear that disinfecting is anything but safe use and that the only way to avoid transmission is not to use contaminated instruments at all. When household bleach (5.25% sodium hypochlorite) is used as disinfectant, it must be fresh and undiluted in order to have any efect at all.19 Needle/syringe‑exchange programmes There is compelling evidence that needle/syringe‑exchange programmes in the community are efective in reducing HIV infection among injecting drug users; they are cost‑efective and have no negative unintended consequences.20 The philosophy of needle‑exchange programmes is not only to provide sterile injection equipment to injection drug users, but also to safely dispose of con‑ taminated injection instruments, which is equally important. As mentioned above, in accordance with the principle of equivalence of care, which applies for reasons of both preventive health care21 and serious epidemiological Recommendation R (1998) 7; The CPT Standards 2002 (rev. 2011); UNAIDS/UNODC/ WHO: HIV/AIDS Prevention, care, treatment and support in prison settings: a framework for an effective national response; WHO Europe: WHO guidelines on HIV infection and AIDS in prisons (Geneva 1993); Møller L. et al: Health in prisons: a WHO guide to the essentials in prison health (Geneva 2007); World Medical Association: Declaration of Edinburgh on prison conditions and the spread of tuberculosis and other communicable diseases; UNODC: HIV prevention and care in prisons and other closed settings: a comprehensive package of interventions, Policy Brief (Vienna 2012). 19. CDC: Syringe disinfection for injection drug users (Atlanta GA 2004). 20. WHO Europe: Efectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users, Evidence for Action Technical Paper (Geneva 2004). 21. The CPT Standards 2002 (rev. 2011). Prison health care and medical ethics Page 58