HIV/AIDS in state and federal prisoners was more than 2.5 times higher than that in the U.S. population. Approximately 46 per 10,000 prison inmates were estimated to have confirmed AIDS compared with 17 per 10,000 persons in the general population.[19] At the end of 2006, approximately 22,000 state and federal prisoners were HIV-positive or had confirmed AIDS; 1.6 percent of male inmates and 2.4 percent of female inmates in state and federal prisons were known to be HIV positive or have confirmed AIDS. New York, Florida, and Texas housed nearly half of the inmates known to be infected.[19] Twenty-one states reported testing all inmates for HIV at admission or at some time while in custody. Forty-seven states and the federal system reported testing inmates if they have HIV-related symptoms or if they requested an HIV test.

Trend data indicate that the overall number of HIV-positive state and federal inmates has decreased from 22,676 to 21,980. Whereas 16 states reported a decrease in the number of HIV-infected prisoners,  25 states reported an increase. Texas reported the largest increase and New York posted the largest decline in HIV-positive cases.[19] HIV/AIDS statistics from other countries also show that HIV/AIDS in prisoners is much higher than in the general population.[20]

HIV and AIDS in places of detention
In many countries, the groups most vulnerable to HIV are also groups at increased risk for criminalization and incarceration, as many of the same social and economic conditions that increase vulnerability to HIV also increase vulnerability to imprisonment. As a result, in some countries the populations with the highest rates of HIV infection are also disproportionately represented within the prisons.  In countries where the injection of drugs is present, the prevalence of injecting drug users in prison will be high.

In prison, there is a high risk of transmission of HIV and other infections. Prisons are frequently overcrowded and characterized by an atmosphere of violence and fear. Even though sexual activity is forbidden, it nevertheless occurs in prisons. As within the general community, despite the control measures implemented, illicit drugs are circulating.

Tensions abound. Release from these tensions, and difficulties of prison life, is often found in the consumption of drugs or in sex. Often condoms are not available. When drugs are injected,  needles and syringes-being scarce,  illegal and difficult to hide-are almost always shared,  carrying with them a high risk of transmission of infectious   diseases.

Tattooing is also common in prison, part of the subculture, but in the absence of clean equipment can also be a factor of transmission.  Health,  dental and gynaecological services are often poorer and not always safe as it relates to the risk of transmission of infections.

Prisoners are most at risk, but prison staff shares this high-risk environment with the prisoners.  Because HIV is transmitted only through contact with blood or other body fluids, prison staff can adopt simple and routine practices to greatly reduce the likelihood that they will become infected with HIV as a result of an occupational exposure, practices that are called “universal precautions”.¹ However, other infections that can spread more easily than HIV-in particular tuberculosis-pose a real threat to prison staff.

In addition, prison health is public health. Prisoners and prison staff are in continuous contact with the community. Prisoners come from the community and most go back to the community, often after serving short sentences. Prison staff, visitors, and suppliers also go in and out of prisons. This means that whatever is done-or not done-to promote health in prisons and protect prisoners and staff from contracting infections will ultimately have an impact on the health of the public outside prisons. Prison health issues necessarily are community health issues.

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¹Universal precautions are simple infection control measures that reduce the risk of transmission of blood borne diseases through exposure to blood or body fluids among patients,  health care workers and other staff.  Under the “universal precaution”  principle,  blood and body fluids from all persons should be considered as infected with HIV,  regardless of the known or supposed status of the person.  Improving the safety of injections is an important component of universal precautions.

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Madelon L. Finkel, PhD
Madelon L. Finkel, PhD, is professor of clinical public health and director of the Office of Global Health Education at the Weill Cornell Medical College in New York City, NY. Dr Finkel is an epidemiologist whose work focuses on women’s health issues. Her interests also include global public health issues with ongoing research projects in rural India and Peru. Dr. Finkel has published extensively, including Praeger’s Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening and Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide.

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REFERENCES

1. Walmsley R. World prison population list. 7th ed.
2. Wikipedia. Prisoner population rate 2007-2008.
3. Mauer M. Comparative international rates of incarceration: an examination of causes and trends: Presented to the US Commission on Civil Rights; June 20, 2003; Washington, DC.
4. US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Correction statistics.
5. Ibid.
6. Federal Bureau of Investigation. FBI uniform crime report.
7. Maruschak LM for US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Medical problems of prisoners.
8. Griefinger RB, Heywood NJ, Glaser JB. Tuberculosis in prison: balancing justice and public health. J Law Med Ethics. 1993;21:332-341.
9. World Health Organization. Tuberculosis in prisons.
10. Shalit M, Lewin MR. Medical care of prisoners in the USA. Lancet. 2004;364:34-35.

Full References  »