Prisons and AIDS book outlines public health challenges

Prison walls effectively restrain criminals, but not the AIDS virus," said Ronald L. Braithwaite of the Rollins School of Public Health, in his new book Prisons and AIDS (Jossey-Bass Inc. Publishers, 1996).

Along with co-authors Theodore M. Hammett and Robert M. Mayberry, Braithwaite quantifies and comments on the pervasiveness of HIV infection and AIDS among inmates in U.S. correctional facilities. The book is based largely on research funded by the U.S. Centers for Disease Control and Prevention and the National Institute of Justice, U.S. Department of Justice.

The picture the authors paint is at first glance bleak; AIDS incidence is much higher in the prison population than in the U.S. population as a whole. But as public health practitioners, the authors see the advantages in targeting prevention and education messages to this high-risk group.

"Administrators, health and mental health workers in prisons and jails have a unique opportunity to assist inmates--who are literally a `captive audience' and thus, at least logistically, are easier to reach than similar at-risk populations in the community--with health care, prevention, education and substance abuse treatment," the authors wrote. "Better HIV/AIDS, TB (tuberculosis) and STD (sexually transmitted disease) prevention programs and medical care in prisons and jails will also benefit the larger society, since the vast majority of inmates return to the community."

Braithwaite is associate professor of Behavioral Sciences and Health Education in the School of Public Health. The excerpts below illustrate some of the complicated realities and avenues of possible relief outlined by the authors in Prisons and AIDS:

*AIDS Incidence: "AIDS incidence rates are significantly higher among correctional inmates than in the total population. The annual AIDS incidence rate in the total U.S. population in 1994 was 31 cases per 100,000 population... in state/federal systems in 1994, the aggregate AIDS incidence rate... was 518 cases per 100,000.... The aggregate incidence rate for reporting city/county jail systems was 706 cases per 100,000 inmates in 1994..."

*Characteristics of inmates with HIV/AIDS: "...racial/ethnic breakdowns of AIDS cases in responding state/federal systems as 43 percent black, 38 percent white and 13 percent Hispanic. This compares with the distribution among total cumulative AIDS cases in the U.S. population of 50 percent white, 32 percent black and 17 percent Hispanic... data from other sources indicate that injection drug use is probably the most common exposure category in inmate AIDS cases."

*Minority inmates: "The picture of AIDS in correctional facilities is even grimmer for ethnic minorities... African Americans have been described as the `second wave' of the AIDS epidemic. They make up 12 percent of the nation's population, but 28 percent of the nation's AIDS patients.... The institutionalized racism that contributes to the increase of the AIDS epidemic among ethnic minorities in correctional facilities is most clearly reflected when the criminal justice system's view of illicit drugs is considered. The national control strategy stresses incarceration as a method to control the supply of illicit drugs and treat drug abuse. The strategy is failing."

*Women inmates: "...incarceration rates are rising faster among women than men, and women in prisons and jails are more likely to be drug users than are male inmates. Economic dependency, injection drug use, crack use and associated increases in unsafe sexual practices (for example, exchanging sex for drugs and/or money) have placed many women at elevated risk for HIV/AIDS.

*Current AIDS Education and Prevention Efforts: "AIDS prevention training geared toward parolees with histories of injection drug use; training included learning skills, self-help, community therapeutics and job training... prison-based drug abuse treatment... in-jail voluntary AIDS education curriculum among inner-city adolescents... promotion of abstinence as a means of AIDS prevention in youth... peer drug and alcohol prevention programs for youth offenders... condom and dental dam distribution... bleach availability... HIV post-test counseling... pregnancy testing for juveniles... post-release methadone maintenance treatment..."

*"...The public at large will be protected to the highest degree possible in a system where public health and corrections coordinate their activities toward reducing HIV infection.... Historically, the public health profession has been based on social justice. Today, public health professionals must rise to the challenge of advocating for improving inmates' health for the sake of the inmates and all of society. From a public health perspective, the availability of clean needles, condoms and bleach within correctional institutions would reduce the risk of HIV transmission in those settings. From the correctional point of view, items usable to prevent the spread of AIDS are potential weapons for inmates or could be used to smuggle contraband..."

*"Building more prisons is certainly not the answer to combating AIDS within correctional facilities. On the contrary, less money invested in prisons would allow for society to invest in combating social factors... that contribute to high-risk behavior in relation to HIV/AIDS. As a society, we need to confront the issues... that are plaguing the disproportionate number of ethnic minorities in correctional facilities. When we meet this challenge as a society, we will see a decline in AIDS cases in and out of correctional facilities."

--Lorri Preston

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