A report released in late 2003 by Portugal's Justice Ombudsman (Provedor de Justiça) recommends that Portugal set up needle exchange programs or safe injection sites in prisons. 
According to the Ombudsman's report, widespread drug use is leading to rising HIV rates among Portugal's 14,000 prisoners. Fourteen percent of prisoners are living with HIV and 396 prisoners have AIDS. As well, 11 percent of prisoners who participated in a study admitted to having injected drugs while in prison,  with more than three-quarters of them sharing their needles - creating an ideal environment for the spread of HIV.
The report recommends that the government establish pilot needle exchange programs or safe injection sites in prisons to slow the spread of HIV,  and makes reference to Spain's positive experience with the introduction of prison needle exchange programs.
As reported by Agence France Press,  the recommendation was immediately backed by Portugal's lawyers association and by former UN General Assembly President Diogo Freitas do Amaral, who currently chairs a commission on prison reform in Portugal. Justice Minister Celeste Cardona, however, has rejected the proposal. Instead, government policy will continue to focus on addiction treatment programs, including methadone maintenance treatment, she said. Fernando Negrao, head of Portugal's Drugs Institute, a branch of the health ministry, argued that injection rooms could be effective but only after prisons become less crowded.
This is not the first time that the establishment of safe injection sites in prisons has been recommended. As previously reported in the Review, at the time the Spanish government ordered the distribution of clean needles in all prisons, a Spanish labour union stated that it would have preferred the creation of safe injection rooms instead of needle exchange programs. Ralf Jürgens in Canadian HIV/AIDS Policy & Law Review (April 2004). Quarterly journal of the Canadian HIV/AIDS Legal Network
 O Provedor de Justiça. As nossas prisoes. Apresentaçao do Relatorio sobre a Sistema Prisional/2003. 13 November 2003. Available at www.provedor-jus.pt/publicacoes/Rel2003Prisoes/welcome.html.
 Ibid at 14.
 Ibid at 15.
 Levi Fernandes, Agence France Presse, 24 December 2003.
 Spain: Government orders distribution of clean needles in prisons. In: R Jürgens. HIV/AIDS in prisons: new developments. Canadian HIV/AIDS Policy & Law Review 2002; 6(3): 13-19 at 16-17.