HIV and AIDS have often been seen as the stimulus for a reconsideration of the treatment of heroin addiction in the late 1980s and 1990s. Many analyses of drug treatment in the UK, for example, agree that widespread acceptance of the view that HIV and AIDS presented a greater public health threat than the use of illicit drugs meant that the reduction of high risk behaviours such as needle sharing could be prioritised over the promotion of abstinence. In the Republic of Ireland, however, this publically-stated shift in priorities was notably absent. This paper therefore aims to assess the extent to which HIV and AIDS affected the treatment of heroin addiction in Ireland.
Taking the provision of treatment for heroin addiction in Dublin’s Mountjoy prison as a case study, this uses archival material, published reports and studies, and interviews with some of those involved in designing and delivering treatment. Analysis of these sources indicate how, when, and on what grounds the treatment available to prisoners changed.
Mountjoy was slow to adopt any form of treatment other than rapid detoxification. Although HIV and AIDS did have some influence over eventual changes to policy and practice, they were not the primary driver. Perhaps more significant were concerns about hepatitis C infection, about drug-related crime, and most importantly, a revival of interest and investment in the prison system more generally.
Treatment for heroin addiction was affected only indirectly by HIV and AIDS. As this case study suggests, approaches to treatment that pre-dated HIV and AIDS, coupled with nationally specific political and cultural concerns, affect which treatments for addiction can be proposed and implemented.