HIV Harm Reduction in Prisons
This article, from The New England Journal of Medicine draws attention to an important gap in U.S. HIV prevention efforts: the lack of effective harm reduction practices in our prison systems. This includes making condoms available, providing clean needles or access to bleach for injection drug users, and offering drug treatment and methadone maintenance programs.
Although public health advocates favor harm reduction, U.S. prison officials have rarely adopted it. Some argue that making condoms or clean needles available would send a “mixed message” to inmates condoning sex and drug use. A few even hold the punitive view that HIV and other infections are “just deserts” for breaking prison rules.
Whatever the rationale, policies that block harm reduction in prisons carry a heavy human cost – increased rates of HIV, viral hepatitis, and other infectious diseases both within prisons and in the communities outside.
Here are some sobering facts: The HIV infection rate among the 2 million prison inmates nationwide is more than four times that of the general population. In addition, about one out of every four HIV-infected persons passes through the correctional system in any given year. See this recent report on health disparities for more.
At the end of “Sex, Drug, Prisons, and HIV,” Columbia University’s Robert Fullilove observed:
Any reservoir of infection that is as large as a prison would warrant, by simple public health logic, that we do our best…to reduce the risk of transmission… The issue has never been, Do we understand what has to happen to reduce the risks?… It’s always been, Do we have the political will necessary to put what we know is effective into operation?
For more information, this audio interview with Theodore Hammett discusses HIV in prisons and the barriers to adopting harm reduction measures there.
