Condoms in Jails Could Combat HIV -- and Perhaps Hepatitis C -- But Remain Rare

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While sex, injection drug use and tattooing are illegal in U.S. correctional facilities, all these activities occur. Without access to prevention measures, such as condoms, those imprisoned are at high risk of acquiring HIV. Yet only two U.S. state prison systems and a handful of jails allow the distribution of condoms, a practice also recommended by the U.S. Centers for Disease Control and Prevention (CDC).

Currently almost every 100th American is in prison or jail. The CDC reports that HIV prevalence among the incarcerated is more than five times that of the general population. Although most seroconverted before entering a correctional facility, a study of prisons in the New York City area found that about 13% of those interviewed reported sexual activity while in custody during the prior six months, according to an article in the Lancet . Such activity spans a spectrum from consensual sex, to bartering sex for protection or services, to outright rape, said Frederick Altice, the director of the HIV in Prisons program at Yale University.

Yet, condoms are rarely available in correctional institutions. Inmates are not legally allowed to consent to sex, and sexual activity is therefore considered a felony in most facilities. A pilot program at the San Francisco County Jail, reported in 2010 in the American Journal of Public Health, installed a free condom-dispensing machine in a public area of the facility. Interviews before and after the machine was installed indicated little increase in sexual activity and greater use of the machine by those who were HIV-positive than those who were HIV-negative. As of 2013, six local jail systems, including those in New York City and Washington, D.C., provided condoms to inmates, Scientific American reports. In 2014, California passed a law expanding condom availability to all state prisons, joining Vermont as the only states distributing condoms throughout their state prison systems.

However, infectious diseases are not only spread during prison sex, but also while sharing needles and other contraband equipment. In a Puerto Rican prison, for example, 60% of inmates reported getting tattoos while incarcerated, according to another Lancet article. Similarly, drug paraphernalia are also often shared in correctional facilities, the article notes. It reports that a number of European countries provide opioid agonist therapy, and in some cases needle and syringe exchanges, in prisons and jails in order to curb the rising incidence of HCV among this population. U.S. prisons do not.

The National Hepatitis Corrections Network reports an estimated 17.4% HCV prevalence among imprisoned people in the Newer medications for this disease have high cure rates, but are very costly. As a result, in many facilities only the sickest prisoners with HCV receive these drugs. The CDC estimates that 25% of people living with HIV are also infected with HCV. While sexual transmission of HCV is very rare, it has been seen in gay men and other men who have sex with men, particularly those who have HIV. The price of HCV treatment will ultimately spur more U.S. authorities to distribute condoms in correctional facilities, attorney Margaret Winter, who retired from the American Civil Liberties Union's National Prison Project, predicts.