HIV and TB in Prison
Braithwaite, Ronald L., Braithwaite, Kisha, Poulson, Ronald, Corrections Today
Increasing Incidence of Infectious Diseases Calls for Aggressive Plan of Action
In addition to the already daunting problems posed by crowding and fiscal stringency, today's correctional administrators and health care professionals must deal, with an increasingly ill, troubled and "graying" inmate population. HIV/AIDS, sexually transmitted diseases (STDs) and tuberculosis (TB) represent complex and major communicable diseases for this population. These health and psychosocial problems, including substance abuse and mental illness, are becoming increasingly common among inmates.
Traditionally associated with high-risk sexual activity, drug use, poverty, disenfranchised status, population density, homelessness and poor access to preventive and primary health care, the health problems of the inmate population pose difficult programmatic and fiscal challenges for correctional policy-makers and personnel. Ironically, these concerns also create opportunities and challenges for public health agencies, community-based organizations and correctional systems to address and improve the health of a particularly underserved and vulnerable segment of society.
Better HIV/AIDS, TB and STD prevention programs, as well as regular medical care, also can benefit society at-large, since the majority of inmates return to the community. It would be prudent for inmates to return to their homes armed with prevention knowledge, healthy attitudes and concepts of appropriate behavior to reduce their risk of infecting others or encountering these communicable diseases.
The past and current behaviors of inmates increase the risk of HIV infection among incarcerated populations. The rate of HW infection and AIDS is significantly higher among inmates than in the general population. In fact, correctional populations have the highest rates of HIV infection of any public institution. Moreover, previously incarcerated inmates may pose a greater threat of HIV transmission upon release than do other population groups.
Efforts to reduce the incidence of HIV infection among offenders are complex, and pose numerous policy and program implementation issues for the criminal justice and public health systems. Prison officials acknowledge that sexual intercourse occurs within their facilities. But while condom use is the most effective method of preventing HIV transmission, the distribution of condoms (considered contraband) as a strategy to promote safer sex presents a serious dilemma for prison officials.
Likewise, injection drug use also occurs in prison, but prison officials may be reluctant to provide information on the avoidance of HIV transmission through sterilization of hypodermic needles. Tattooing also may increase the risk of HIV transmission in prisons (see "Tatooing and Body Piercing," page 120).
In addition to the appropriateness of intervention, prison officials also grapple with the time of intervention. is the optimal time for program implementation prior to incarceration for those indicted and awaiting due process from the court system; after persons are sentenced and serving time; upon release from prison during probation or parole; or at the completion of the sentence?
According to data compiled by the Bureau of Justice Statistics, 23,404 inmates in state prisons were HIV-positive in 1995 (2.4 percent of the total population); in federal prisons, the number totaled 822 (.9 percent of the population). Of all inmates in U.S. prisons, 5,099 inmates (.5 percent) had confirmed AIDS, and 18,165 inmates were HIV-positive. In 1995, 1,010 state inmates died of AIDS-related causes, up from 955 in 1994. For every 100,000 state inmates in 1995, 100 died of AIDS-related causes. According to the Centers [TABULAR DATA FOR TABLE 1 OMITTED] for Disease Control, at least 4,588 adult inmates in U.S. prisons and jails had died as a result of AIDS by the end of 1994; and during 1994, at least 5,279 adult inmates with AIDS were incarcerated in prisons and jails. …