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AIDS in prisons: a spreading problem

Education is the best way to fight the virus everywhere, including prisons

by Cesar Chelala

NEW YORK — Several investigations worldwide have shown that the human immunodeficiency virus responsible for AIDS is spreading rapidly in prisons, where the rate of infection has been found to be several times higher than in the general population. Prisons have become one of the most potentially dangerous incubators of the epidemic. If new and more effective measures are not put into effect, it is not only prisoners who will be at risk. Prison staff and members of the communities to which the prisoners belong will also be affected.

In the United States in 1994, the incidence of AIDS in places of detention was nearly six times higher than that occurring in the general population. In French prisons, the incidence of HIV-infected prisoners is roughly 10 times that of the general population. In Canada, the number of federal inmates known to be living with HIV or AIDS increased 100 percent between 1994 and 1999. In Brazil and Argentina, the rates of HIV infection of prisoners are also several times higher than in the general population.

Women inmates pose a particularly serious problem, since in many countries incarceration rates are rising faster for women than for men, and women in prisons are more likely to be drug users than are male prisoners. Economic dependence, unsafe sexual practices (such as exchanging sex for drugs or money), and intravenous drug use place women at serious risk for HIV/AIDS.

Prisons are a perfect breeding ground for transmission of the virus. High-risk behaviors, such as intravenous drug use, sex without condoms, coerced sex and tattooing are occurring in prisons regardless of prohibitions. Consensual homosexual relations are frequent among prisoners, and so is forcible sex. A study by the U.S. Federal Bureau of Investigations found that between 9 percent and 20 percent of inmates in federal prisons had been raped. In most correctional systems, condoms are not available to inmates, use of contaminated needles is frequent, and tattooing without sterile needles (often done with guitar strings or other materials) is common practice.

Instead of providing prisoners with prevention materials (such as condoms for safe sex and liquid bleach for sterilizing needles and syringes), prison administrators often prohibit the entry of these items. Even HIV/AIDS education, which is a crucial means of effectively combating the spread of the infection, is rarely found in penal institutions anywhere in the world. In addition, because HIV infection severely weakens the immune system, infected people are at a much higher risk for developing active tuberculosis, which can rapidly spread to other prisoners.

In California, the Correction and Health Services departments are following strict detection and contact-tracing procedures for TB, after an investigation of two outbreaks in HIV units of state prisons that then spread to the community. In that investigation, 32 cases of TB were found; the victims included HIV-positive inmates, parolees and a visitor.

Education is still the best way to combat the spread of HIV/AIDS. Prisoners constitute a captive audience; medical care and AIDS-prevention education will be of use to them not only while they are in prison, but once they are released into their communities. Moreover, prisoners have a right to be cared for by doctors and nurses adequately trained to deal with AIDS. Prisoners, too, have the basic human right to be healthy.