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HIV Prevention: The Current Need for Intervention in Prisons

According to the Centers for Disease Control(CDC), prison inmates have a disproportionately high rate of health problems. Although most of the people passing through the prison system acquired HIV while living in their communities, the high rate of HIV still puts inmates at risk of infection. That problem is compounded by presence of high-risk individuals, including drug users and commercial sex workers.

This risk makes it important for prisons to create effective intervention programs. After all, this problem doesn’t remain exclusive to inmates. Once they reenter their communities, they could contribute to HIV’s spread among the free population. To curb the disease’s effect, people with criminal justice master’s degrees should consider the most prominent issues and the interventions that offer the most promise.

Issue #1: Spread of HIV Through Drug-Use

Image via Flickr by Elfboy

Inmates have a lot of time on their hands, so it’s not surprising that a lot of them use drugs to stave off boredom. All drug use poses a health problem within the prison system. Injected drugs, however, stand out as a common way that HIV gets spread throughout the population. While gangs have learned how to smuggle heroin into prison, needles aren’t always so easy. That could mean that a lot of prisoners resort to sharing needles.

Some experts believe that needle and syringe exchange programs could reduce HIV in prison. To some, this sounds like a terrible idea. Won’t giving prisoners easier access to needles cause an increase in drug-use? Not according to research by Harm Reduction Coalition. The organization finds that needle exchange programs in prison actually:

  • reduce HIV transmission
  • increase inmate referrals to substance abuse treatment
  • do not increase drug use, violence, or security risks

Issue #2: Tattoos and Piercing Can Spread HIV

Needles of all types can spread HIV when used by more than one person. That includes needles that inmates use for piercings and tattoos.

Unfortunately, prison systems don’t seem to take this very seriously. The Correctional Service of Canada started a pilot program that could have reduced the spread of blood-borne diseases such as HIV and hepatitis C through tattooing. The Public Safety Minister cut the program, which cost about $820,000. Some taxpayers saw this as a smart move that cut unnecessary expenses. Others believe that cutting the program actually ended up costing Canada more by forcing the prison system to treat more HIV positive inmates.

Considering that HIV prevalence is about 10 times higher in prison than the general population, any program that reduces the unintentional exchange of body fluids is worth considering.

Issue #3: Sexually Transmitted HIV

Inmates can also transmit HIV and other STDs while imprisoned. The CDC recommends that detention centers make HIV testing a routine part of inmate medical care. Unfortunately, some prisons only perform tests when processing criminals into the system. That provides an excellent opportunity for prisons to catch and treat HIV, but it only solves a portion of the problem since HIV-positive inmates mix with the rest of the prison population.

Other detention centers avoid testing because it adds to medical costs.

Solving this issue requires at least three things:

  • HIV education
  • continued HIV testing throughout a prisoner’s incarceration
  • condom programs

HIV education is particularly necessary. Current programs do not have the desired effect. Both adult and juvenile offenders participate in unsafe sexual practices after HIV training. Research shows that as much as one-third of juvenile offenders have unprotected sex that puts them at a higher risk of contracting HIV.

Condom programs are also important. They could lower risk while also reducing the amount of money states spend treating HIV positive inmates. California’s legislative analyst estimates that the state spends about $41,000 per year treating each inmate with HIV. If a condom program only prevented 10 HIV cases per year, it would more than pay for itself.

Issue #4: HIV Spread Through Sexual Assault

Even after the Prison Rape Elimination Act of 2003, about 10 percent of U.S. prisoners become victims of sexual assault. Guards and staff aren’t effective at preventing rape because they commit about half of prison sex assaults. That puts everyone at risk of contracting HIV.

Clearly, serious changes need to occur at the administrative level. Some experts recommend separating vulnerable individuals from the general prison population. Implementing stricter, more thoughtful policies that take sexual assault seriously could significantly reduce infection rates.

What issues concern you about HIV prevention in prisons? Do you think it’s a solvable problem?