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Harm reduction services in female prisons: a scoping review exploring the situation in the MENA region
Isabelle Salameh1, Elie Aaraj2
1Department of Programs and MEAL, Middle East and North Africa Harm Reduction Association (MENAHRA), Sin el Fil, Lebanon, and Department of Public Health American University of Beirut, Beirut, Lebanon.
Purpose:
This study aims to explore and map the existing evidence on HR services, specifically NSP and OST, available to women in prison settings across MENA countries where such services are reported to exist, assessing their availability, accessibility, and gender responsiveness while identifying gaps in research, policy, and practice. Harm reduction (HR) is a public health and human rights approach aimed at reducing drug-related harms through interventions such as Opioid Substitution Therapy (OST) and needle and syringe programs (NSPs). People who use drugs (PWUDs) in prison face elevated risks of HIV, Hepatitis B and C, Tuberculosis and overdose. Women who use drugs (WWUDs) experience additional gender-specific vulnerabilities, yet little is known about its availability and gender responsiveness of prison-based HR in the Middle East and North Africa (MENA) region.
Design/Methodology/Approach:
This scoping review followed the Arksey and O'Malley framework and PRISMA-ScR guidelines. Full-text peer-reviewed and grey literature published, in English, between 2014 and 2024 were retrieved from PubMed, Cochrane Library, JSTOR, Google Scholar and key organizational reports. Studies addressing NSP and/or OST in prison settings within MENA countries were included. Data were synthesized narratively focusing on service availability, accessibility and gender responsiveness.
Findings:
Of 4,238 records identified, 27 studies met inclusion criteria (14 peer-reviewed articles and 13 grey literature sources). Evidence was concentrated in Iran, with limited data from Afghanistan, Morocco and Lebanon, and none from Algeria. OST was reported in several prison settings, while NSP was limited to Iran. Most studies lacked sex-disaggregated data, and where women were included, they were frequently underrepresented and rarely analyzed separately. Evidence on gender-responsive services, post-release care and monitoring and evaluation systems was limited.
Originality/Value:
To the best of the authors' knowledge, this study provides the first regional synthesis of evidence on gender-responsive HR services for WWUD in MENA prisons, identifying substantial gaps in service provision, gender-disaggregated evidence and evaluation.