The best magazine
The highest concentration of individuals at risk for HIV infection is found in correctional institutions. For these individuals, their risk of acquiring HIV infection is greatest not while behind bars but rather when they return to their communities and resume high-risk behaviors. Effective prevention programs are needed for this high-risk population during and after release from incarceration. Institutional, political, and cultural obstacles must be overcome before the various stakeholders can work together to develop and install effective HIV prevention and treatment programs within correctional facilities.
The concept of "harm reduction," while still controversial in the corrections community, is becoming increasingly necessary as a tool to prevent the spread of HIV infection both inside and outside prisons. Harm reduction strategies in HIV prevention aim to reduce the harm or risk associated with behaviors that potentially may lead to infections rather than to eliminate these behaviors altogether. Such strategies include distributing bleach kits, condoms, sterile needles, or sterile injection equipment and even conducting methadone maintenance programs within prisons and jails. Also, an important part of a harm reduction strategy is diligent follow-up, consisting of HIV education and comprehensive treatment, once inmates return to the community at large.
There is a perception in the corrections community that harm reduction strategies and certain types of prevention measures send the wrong message to an incarcerated population. Many working in the correctional system feel that by acknowledging that high-risk activity occurs in corrections facilities, harm reduction programs condone behavior that is prohibited within the institution. Implementing a harm reduction model in a corrections setting will thus require a strong and strategic advocacy effort to change this perception.
How does the HIV/AIDS caregiving and advocacy community meet and respond to the expected obstacles that the corrections community will put forward, particularly in the United States? First, it is essential to emphasize that preventing the spread of HIV in correctional facilities will also protect the unincarcerated population, since most inmates are in jail or prison for relatively short periods, after which they are released into the community. Second, prisoners may have lost their liberty, but they retain basic civil rights, including the right to the same quality of health care as the general population.
At a recent conference on HIV in correctional institutions, moderated by Nan Feyler, JD, of the AIDS Law Project, four different speakers presented four different interlocking facets of HIV prevention and treatment. Summaries of these presentations follow.
Source: ...