HIV/AIDS Crisis in US Prisons

It's official - the United States is the prison capital of the world. The United States has less than 5 percent of the world’s population. But it has almost a quarter of the world’s prisoners.

With this high rate, prison activists see this as an opportunity to revisit the issue of HIV prevalence and treatment in the prison system. According to new information from the American Foundation for AIDS Research, prisoners are three times more likely to be HIV-positive than the general population. The reasons that HIV rates are higher in prisons include needle sharing for tattoos or drugs among inmates, as well as unprotected sex with multiple partners at high-risk of HIV before and during incarceration. Most states don't require their prisoners to get test during or immediately after release from prison.

Barry Zack, a correctional health programs consultant, said recently on a panel discussion on this issue that prisons should provide condoms to inmates -- a practice advocated by the World Health Organization and UNAIDS but implemented in only a few states. In addition he said that not only should clean needle exchange programs should be established, but prisoners preparing for release should be provided with copies of their prison medical records and information about how to access HIV/AIDS treatment, as well as mental health, housing and job programs.

However, given that HIV/AIDS prevalence among prison inmates in North Carolina is "several-fold higher than that of the general population," mandatory HIV testing "of inmates on face value seems attractive," said University of North Carolina medical professors David Wohl and David Rosen in the Raleigh News & Observer, but "forced testing is unlikely to stem the transmission of HIV, just as mandating syphilis testing of prisoners has not led to a decline in that sexually transmitted disease."

The doctors said that forced testing creates further stigma as well as ethical questions.

A reasonable approach can be found in the CDC's general HIV testing recommendations. This roadmap for identifying those unknowingly living with HIV calls for testing to be routinely offered to most everyone participating in medical care, just like screening tests for abnormal cholesterol or prostate cancer. Those at high risk are offered testing regularly.

The CDC testing strategy respects the magnitude of the threat of undiagnosed HIV infection but also the right of an individual to make an informed decision regarding whether to be tested.