HIV infection is a major public health problem in prisons and jails, and AIDS has become the leading cause of death in several correctional systems.
Seroprevalence estimates for different correctional systems in the United States and Europe range from 0 to 18 percent among inmates entering prison, indicating geographic variation. Reported HIV rates are higher among females compared to males, among inmates over 25 years of age, and among racial/ethnic minorities. The major risk factor for HIV-1 infection and AIDS in the correctional setting is intravenous drug use prior to incarceration. In addition, given that homosexual activity and intravenous drug use occur in prison and that the median length of incarceration is usually 2 to 3 years, concern exists over the potential for correctional facilities to serve as amplifying reservoirs of HIV-1 infection into surrounding communities. Prisons and jails provide an opportunity to educate, counsel, test, and treat individuals at risk of HIV infection who otherwise might have limited access to care, but services to this population must be voluntary and confidential. Specific responses to HIV-1 in the correctional setting should focus on the education of inmates about risk, the serological screening of inmates, and drug abuse treatment. Rational policies about HIV-1 and AIDS in correctional facilities need to balance information from multiple data sources. Using epidemiological data to identify institutions or individuals at high risk can assist in balancing the need to assume increased responsibility for the care and safety of inmates and political, ethical, and economic consequences of meeting that responsibility. 40 references and 1 table (Author abstract modified)