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Drug Use, HIV, and the Criminal Justice System

August 2001

About 80 percent of prison and jail inmates have serious substance abuse problems. Many also have or are at high risk of having HIV or hepatitis. Substance abuse treatment and HIV services can help inmates and others under correctional control. They also can help inmates' families, corrections staff, and the community at large.

Drugs and Criminal Justice Are Important Issues for the Nation

The United States has the largest number of people under criminal justice control of any nation in the western world.

At the end of 1999, 6.3 million people, or more than 3 percent of all U.S. adult residents, were under the control of the criminal justice system. More than 1.3 million were in federal or state correctional facilities. About 600,000 were in county or city jails. The remainder -- more than 4 million -- were on parole or probation or under some other form of court-ordered community supervision. Nearly 126,000 juveniles were in correctional facilities.

Many inmates are drug users who are in prison or jail because of drug-related offenses.

More than one-fourth of all inmates are in prison or jail because of arrests related to using, possessing, or trafficking drugs.

Between 1980 and 1996, the prison population tripled, in large part because of convictions associated with drugs.

A substantial majority of inmates -- men and women -- have serious drug problems. Many have problems with alcohol as well:

HIV, hepatitis, and sexually transmitted diseases (STDs) are big problems for inmates.

Many inmates are at high risk of becoming infected with HIV, hepatitis, or STDs. Many others are already infected. This is because of past and continuing risky drug use (sharing syringes and other injection drug equipment) and sexual behaviors (multiple sex partners, unprotected sex, and untreated STDs). Data from 1999 show that HIV and AIDS rates among inmates are very high:

Data from 1996 show that STD and hepatitis infections are also common among inmates:

Many inmates have other conditions as well, such as tuberculosis, mental illness, or other chronic health problems. Many women inmates have reproductive health needs and histories of physical, emotional, and sexual abuse.

The Criminal Justice System Is a Key Setting for Prevention, Treatment, and Care Efforts

The large numbers of drug users in the criminal justice system and their high risk of getting and transmitting HIV, STDs, and hepatitis, create an urgent need for:

For many inmates, the criminal justice system provides a first chance for basic health care, substance abuse treatment, prevention education, and counseling and testing. This can help them break the cycles of addiction, incarceration, and disease transmission. These services also can benefit inmates' families and the larger community through reduced disease transmission, reduced medical and social welfare costs, and reduced drug-associated crime.

Corrections and the community are closely linked.

Conventional wisdom holds that prisons and jails are walled off and separate from the community. More and more, however, people are recognizing that this is not true. Many ties connect the community with prisons or jails. For one thing, inmates are constantly moving back and forth between corrections and the community:

This means that the problems and high-risk behaviors inmates had in the community come with them to prison or jail. Problems or risky behaviors begun in prison or jail return with inmates to the community after release.

Other links between corrections and communities:

It is critically important for prisons and jails to provide high quality prevention, treatment, and care services. It's also crucial that inmates receive these services after they are released. Without the support of these services, inmates going back to their home communities often return to the behaviors that led them to prison. This increases the chances they will use drugs, commit crimes, spread or acquire disease, and return to prison or jail.

Meeting the Need for Treatment and Prevention Services Is Challenging

Many federal and state facilities provide HIV/AIDS education and treatment programs, case management, and substance abuse treatment programs. However, significant gaps in coverage remain. For example, a recent study by the National Center on Addiction and Substance Abuse at Columbia University (CASA) found that although 800,000 inmates in correctional settings would benefit from substance abuse treatment, fewer than 150,000 receive it. Few prison and jail systems have instituted comprehensive programs, and most prevention programs focus on education rather than on behavior change. Several factors contribute to this gap in coverage:

Priorities and orientations of corrections and public health are different. Corrections' primary mission and responsibility to society is maintaining security and control over inmates. Losing control over a facility and its inmates can cause major problems for the facility. Public health activities, such as HIV counseling and testing, risk reduction education, or access to medications, may be viewed as conflicting with these objectives. Each group must recognize and respect the priorities and activities of the other.

Correctional testing and treatment policies and data collection systems vary widely. The criminal justice system has many different facilities and programs, from federal and state prisons and city and county jails to juvenile facilities, facilities operated by other U.S. government agencies, and community-based corrections programs. Policies, practices, organizational structures, accreditation, and resources vary widely. As a result, the quality and coverage of programs differ and data collection and sharing are uneven.

Inmate populations, especially in jails, are ethnically diverse and are constantly changing. The number of inmates with substance abuse problems, HIV/AIDS or hepatitis infection, or high risk of infection continues to grow. In addition, populations change constantly as inmates enter and leave the system or are moved from facility to facility. These factors make it difficult for staff to plan and carry out interventions. Service providers also face challenges in working with inmates who have educational and literacy problems as well as differing cultures and languages.

To Learn More About This Topic

Visit these Web sites of the Centers for Disease Control and Prevention ( and the Academy for Educational Development ( for these and related materials:

Visit these Web sites for information and materials on substance abuse, HIV, and the criminal justice system:

See the June 2001 issue of the Journal of Urban Health. In a special feature entitled "Continuity of Care from Corrections to Community," this issue of the Journal includes 11 papers covering a range of issues related to the health needs of correctional inmates, the impact of the correctional system on community health, the need for continuity of health care from corrections to community, and HIV/AIDS and injection drug use among inmates. Journal of Urban Health 2001;78(2).

Check out these sources of data:

Belenko S. Behind bars: substance abuse and America's prison population. New York: National Center on Addiction and Substance Abuse at Columbia University (CASA); January, 1998.

Centers for Disease Control and Prevention (CDC). Hepatitis B outbreak in a state correctional facility, 2000. Morbidity and Mortality Weekly Review. 2001;50(25):529-532.

Gallagher C.A. Juvenile offenders in residential placement, 1997. Washington (DC): U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs; March 1999. #96.

Hammett T.M. Public health/corrections collaborations: prevention and treatment of HIV/AIDS, STDs, and TB. Research in Brief. Washington (DC): U.S. Department of Justice, Office of Justice Programs, National Institute of Justice; July 1998. NCJ 169590.

Hammett T.M., Harmon P., Maruschak L.M. 1996-1997 update: HIV/AIDS, STDs, and TB in correctional facilities. Issues and Practices in Criminal Justice. Washington (DC): U.S. Department of Justice, National Institute of Justice; July, 1999. NCJ 176344.

Maruschak L.M. HIV in Prisons and Jails, 1999. Washington (DC): U.S. Department of Justice, National Institute of Justice, Bureau of Justice Statistics; July 2001. NCJ 187456.

Petersilia J. When prisoners return to the community: political, economic, and social consequences. Sentencing and Corrections: Issues for the 21st Century. Washington (DC): USDOJ, National Institute of Justice, Office of Justice Programs; November 2000. NCJ 184253.

Spaulding A., Greene C., Davidson K., Schneidermann M., Rich J. Hepatitis C in state correctional facilities. Preventive Medicine 1999;28:92-100.

The Robert Wood Johnson Foundation. Substance abuse: the nation's number one health problem. Princeton (NJ): RWJ; February 2001.

U.S. Department of Justice, Bureau of Justice Statistics. Prisoners in 1999. Washington (DC): USDOJ/BJS; August 2000. NCJ 183476.

U.S. Department of Justice, Bureau of Justice Statistics. Drug use, testing, and treatment in jails. Washington (DC): USDOJ/BJS; May 2000. NCJ 179999.

U.S. Department of Justice, Bureau of Justice Statistics. Substance abuse and treatment, state and federal prisoners, 1997. Washington (DC): USDOJ/BJS; January 1999. NCJ 172871.

U.S. Department of Justice, National Institute of Justice, Arrestee Drug Abuse Monitoring Program. 1999 annual report on drug use among adult and juvenile arrestees. Washington (DC): USDOJ/NIJ/ADAM; June 2000.

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