HIV/AIDS, STDs, and TB in Correctional Facilities Update of Issues and Practices - a Summary

By Hammond, Theodore M.; Harmon, Patricia et al. | Corrections Forum, Fall 1999 | Go to article overview

HIV/AIDS, STDs, and TB in Correctional Facilities Update of Issues and Practices - a Summary


Hammond, Theodore M., Harmon, Patricia, Maruschak, Laura M., Corrections Forum


At midyear 1998, more than 1.8 million people were in prisons and jails in the United States, and 6 million were under some form of criminal justice supervision. Inmates have disproportionately high rates of infectious disease, substance abuse, high-risk sexual activity, and other health problems. Thousands of former correctional inmates return to the community each month. Because prisoners are part of the community and because correctional health and public health are increasingly intertwined, health care and disease prevention in correctional facilities should be based on the collaborative efforts of correctional, public health, and community-based health care and social service organizations.

This Update reports on the extent of HIV/AIDS, STDs, and TB among correctional inmates and on the policies and practices being implemented to prevent and control these diseases in correctional settings. In this report, statistics on the prevalence of HIV infection and AIDS in correctional populations are derived primarily from surveys conducted by the Bureau of Justice Statistics (BJS) in 1996 and 1997. Findings regarding policies and practices and legal and legislative issues are based primarily on the ninth national survey of HIV/AIDS, STDs, and TB in correctional facilities, sponsored by the National Institute of Justice (NIJ) and the Centers for Disease Control and Prevention (CDC) and conducted between December 1996 and August 1997.

HIV/AIDS: Burden of Disease Among Inmates

The overall prevalence of HIV infection and AIDS among inmates has been quite stable since 1991, but some systems have experienced declines in HIV seroprevalence.

There have been some declines in AIDS deaths among inmates since 1995.

Nevertheless, HIV infection and AIDS continue to be far. more prevalent among inmates than in the total U.S. population.

The Northeast region has the largest number and percentage of inmates with HIV infection and AIDS.

The prevalence of HIV and AIDS is higher among Hispanic and black inmates than among white inmates.

The prevalence of HIV and AIDS is higher among female inmates than among male ones.

Sexually Transmitted Diseases and Hepatitis: Burden of Disease Among Inmates

Available data on STDs and hepatitis B and C among inmates are very incomplete, reflecting the relative rarity of routine screening for these conditions in correctional facilities. However, behavioral profiles and anecdotal evidence suggest that inmates are disproportionately affected by STDs and hepatitis.

HIV and STD Education and Behavioral Interventions

HIV and STD education programs are becoming more widespread in correctional facilities. However, few correctional systems have implemented comprehensive and intensive HIV prevention programs in all of their facilities.

Peer-based education and prevention programs offer important advantages, such as cost-effectiveness, credibility, flexibility, and benefits to peers themselves.

Although few HIV/STD prevention programs in correctional settings have been rigorously evaluated, anecdotal evidence suggests that programs can be successful in reaching this extremely high-risk population with practical risk-reduction messages.

HIV Transmission and Risk Factors, Precautionary and Preventive Measures

High-risk behaviors for HIV transmission - sex, drug use, sharing of injection materials, and tattooing occur in correctional facilities.

HIV transmission among correctional inmates has been shown to occur.

Comprehensive and intensive education and prevention programs represent the best response to these facts, although the precise content of such programs is controversial.

Rape and coerced sexual activity also occur in correctional facilities but require a different response, one based on inmate classification, housing, and supervision.

The implementation of "universal precautions" represents the heart of a correctional infection-control program and the first line of defense against the occupational transmission of HIV. …

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