HIV Infection in U.S. Correctional Systems: Its Effect on the Community

Journal article by Sandra K. Leh; Journal of Community Health Nursing, Vol. 16, 1999

Journal Article Excerpt

HIV Infection in U.S. Correctional Systems:
Its Effect on the Community

Sandra K. Leh, RN, MSN

Visiting Nurse Association of Pottstown and Vicinity
Montgomery County Community College

Increased rates of HIV infection and risk-taking behaviors among incarcerated men and
women make the fight against HIV within the prison and jail systems an especially critical is-
sue in community health. Overcrowded conditions impact on the rotation of inmates in and
out of the correctional system. This revolving door phenomenon has implications for disease
prevention and control within the community into which the inmates are released. As more
people pass in and out of jails and prisons, more problems and diseases associated with incar-
ceration pass into the community. The special needs of the prison population must be taken
into consideration not only by nurses but also by all health care workers and correctional of-
ficials when planning and implementing control and prevention strategies.

Over 1.6 million men and women are currently in the nation's jails and prisons. The
United States incarcerates its population at the highest known rate in the world. Over 22
million people are released each year from correctional facilities into the outside commu-
nity ( Kantor, 1998). Explosive increases in prison and jail populations over the past two
decades have been attributed to the mandatory sentencing for drug-related crimes.

From 1980 to 1990, the population of state and federal prisons had more than doubled,
and the jail population had increased by 75%. Between year end 1990 and 1997, the in-
carcerated population has grown on the average of 6.5% annually. During this period, the
federal and state prison population and the local jail populations have grown at an aver-
age annual rate of 8.4%, 7.0%, and 5.3%, respectively. By the end of 1997, state prisons
were operating between 15% and 24% above capacity, federal prisons were operating at
19% above capacity, and 97% of the local jail capacity was occupied. Fifteen percent of
the state facilities had been cited for overcrowded conditions, 10% for conditions related
to medical care, and 9% related to staffing ( Bureau of Justice Statistics, 1998). Morbidity
and mortality data strongly suggest that residents of correctional institutions experience a
higher rate of disease and disability than the general population. Infectious diseases such

____________________

Requests for reprints should be sent to Sandra K. Leh, Visiting Nurse Association of Pottstown and Vicin-
ity, 1963 East High Street, Pottstown, PA 19464.

-53-

as upper and lower respiratory conditions, influenza, gonorrhea, tuberculosis, hepatitis,
and HIV are thought to occur at higher rates in jail populations ( Glaser & Greifinger, 1993; Weiner & Anno, 1992).

Those who assume that HIV infection in prisons does not affect those who are not in
carcerated are mistaken. As some experts stated,

prison walls effectively restrain criminals only for short time spans; they neither de
limit nor contain the public health dilemmas of HIV infection. How we care for the
incarcerated will in the future have a direct effect on needed clinical and public
health services in the community. (Polonsky et al., 1994, p. 621)

HIV RISK FACTORS RELATED
TO INCARCERATED POPULATIONS

It is not surprising that there exists a high rate of HIV infection among correctional popu
lations--a population characterized by heavy illicit drug use. Although the sharing of
needles is a well-documented mode of HIV transmission, the use of other illicit drugs is
also an associated risk for the disease. This is due in part to the fact that many drug users
exchange sex for drugs or money to support their habits, and they do so without the use of
condoms ( Polonsky et al., 1994). The Bureau of Justice Statistics ( 1993 ) reported that, in
1991, 79% of prison inmates indicated they had at some time used illicit drugs. Approxi
mately 2.5% of those inmates who reported having tested positive for HIV were drug us
ers, compared to 0.8% of those who had never used drugs. Twelve percent of all inmates
and 20% of those who used drugs in the month before their offense reported that they had
shared a needle. Needles are available through the black market at exorbitant costs and
with no guarantee of safety. As a result, shared needles are often the only ones available to
prisoners.

In 1995, 97% of the large jail jurisdictions were providing some type of drug counsel
ing and treatment ( Bureau of Justice Statistics, 1998). However, the number of inmates
participating in the programs is unknown because attendance data was ...

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HIV Infection in U.S. Correctional Systems: Its Effect on the Community

Journal article by Sandra K. Leh; Journal of Community Health Nursing, Vol. 16, 1999

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