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 issue 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 incarceration 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 officials 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 community ( 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 incarcerated 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 average 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

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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 incarcerated are mistaken. As some experts stated,

prison walls effectively restrain criminals only for short time spans; they neither delimit 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)

It is not surprising that there exists a high rate of HIV infection among correctional populations--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. Approximately 2.5% of those inmates who reported having tested positive for HIV were drug users, 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 counseling and treatment ( Bureau of Justice Statistics, 1998). However, the number of inmates participating in the programs is unknown because attendance data was not collected since 1992. There is probable indication that this rate is low ...