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New England Journal of Medicine Examines HIV/AIDS in U.S. Prison Systems

January 12, 2007

"Sex, Drugs, Prisons and HIV," New England Journal of Medicine: All U.S. prison systems "fall short" of international guidelines for reducing HIV transmission risk in prisons, according to an article in the Jan. 11 issue of NEJM. The World Health Organization and UNAIDS recognize that "sex occurs in prisons despite prohibitions," and the groups have recommended for more than 10 years that prisoners be provided with access to condoms, NEJM reports. UNAIDS and WHO also recommend that prisoners have access to "bleach for cleaning injecting equipment, that drug-dependence treatment and methadone maintenance programs be offered in prisons if they are provided in the community and that needle-exchange programs be considered," according to NEJM. Although reports from programs providing prisoners with access to clean needles -- which have been established in about 50 prisons in eight countries -- have been positive, no prison in the U.S. has established a needle-exchange program. In addition, access to condoms is provided "on a limited basis" in only two state prison systems -- Vermont and Mississippi -- and five county jail systems -- New York; Philadelphia; San Francisco; Los Angeles; and Washington, D.C. -- according to NEJM. In 2004, HIV prevalence among U.S. prison inmates was recorded at 1.8% -- more than four times the prevalence in the general population -- and the number of AIDS cases among prisoners also was "substantially higher" than in the general population, according to NEJM. The debate over providing prisoners with access to HIV prevention methods like condoms and needle-exchange programs "reflects philosophical differences, as well as uncertainty about the frequency of HIV transmission inside prisons," NEJM reports. Recommendations from WHO and UNAIDS "assume that sexual activity and injection of drugs by inmates cannot be entirely eliminated and aim to protect both prisoners and the public" from HIV and other diseases, according to NEJM. However, many U.S. prison officials say that providing prisoners with access to clean needles or condoms would "send a mixed message," NEJM reports. State policies on HIV testing among inmates also vary. Twenty states reportedly conduct HIV tests among all inmates, and the remaining states offer tests for high-risk groups, at inmates' requests or in specific circumstances. In addition, critics of U.S. prison policies say that incarceration has intensified the HIV epidemic among blacks in the country, who comprise 40% of the prison population (Okie, New England Journal of Medicine, 1/11)

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