HIV PREVENTION IN PRISONS AND JAILS - OBSTACLES AND OPPORTUNITIES

High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of inject ion drug use, and other high-risk behaviors among inmates create a pri me opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the o pportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have diff ering approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or se gregated by HIV serostatus, and whether condoms, bleach, or clean need les should be made available to the prisoners, are questions hotly deb ated by public health and correctional officials. Even accurate assess ment of risk-taking within the institutions leads to controversy, as a sking questions could imply acceptance of the very behaviors correctio nal officials are trying to prevent. Education and risk-reduction coun seling are the least controversial and most widely employed modes of p revention, but the effectiveness of current prevention efforts in redu cing HIV transmission in this high-risk population is largely underter mined.