Inmates receive health care, but lack means to prevent transmission

You’re in: AIDS at 25 Coverage / Mixed Record for Prisons in Fight Against HIV/AIDS

Credit: Adam Tinney

As told to Lindsay Borthwick

BOSTON—There’s a persistent perception that jails and prisons are “breeding grounds” for HIV and other infectious diseases. But in a recent commentary in the American Journal of Public Health, I argue that there actually isn’t strong evidence for HIV transmission among correctional inmates. There certainly is evidence of transmission within the prison population, but not evidence that it’s widespread, which suggests that the vast majority of inmates with HIV/AIDS probably acquired their infections on the outside.

Still, I agree from many standpoints with UNAIDS’ recent characterization of prisoners as one of four “major at-risk and neglected populations” in the HIV/AIDS pandemic. There’s little doubt that in the US, the highest-risk populations for HIV infection are in these facilities. This presents a unique opportunity for those of us in public health to design and implement good interventions for prevention and care, as well a services to assist prisoners with the transition back into society upon their release.

Correctional facilities should be primary settings for HIV prevention and treatment, but government has been slow to adopt this point of view—and results have been mixed.

For instance, if like most public health professionals, you think that making condoms available to prisoners is an important component of preventing HIV transmission, then nothing has changed. There are still just seven prisons and major jail systems in the US that distribute condoms. But from a human rights perspective, there’s been a lot of improvement in medical treatment in prisons in the last 20 to 30 years, particularly since the advent of HIV. (Ironically, for this population, the best care they get for HIV/AIDS may be when they’re in prison.)

Another very positive trend is the dramatic decline in the extent to which HIV-positive prisoners are segregated within jail and prison facilities. In the early years, and even into the mid-to-late 1980s, a fair number of correctional facilities had policies that required all people with HIV to be separately housed. That was really discriminatory. Particularly now, with the emergence of effective treatment, there’s no reason why people with HIV/AIDS can’t live within the general prisoner population and do all the same kinds of work and activities as everybody else.

—Hammett is vice president of Abt Associates Inc., a public health consultancy in Boston, Mass. He has been working on AIDS in the prison population for more than 20 years and completed 10 national surveys of policies and practices in correctional systems regarding HIV/AIDS.

Originally published August 17, 2006


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