|HIV in Correctional Settings
Inmates in jails1 and prisons2 across the United States (US) are disproportionately affected by multiple health problems, including HIV, other sexually transmitted infections (STIs), tuberculosis (TB), and viral hepatitis. Each year, an estimated 1 in 7 persons living with HIV pass through a correctional facility. Most of them acquired HIV in the community, not while they were incarcerated. Compared with those who have not been incarcerated, incarcerated populations have more risk factors that are associated with acquiring and transmitting HIV, including injection drug and other drug use, commercial sex work, untreated mental illness, and lower socioeconomic status.
The NumbersMore than 2 million people are incarcerated in the US. At the end of 2010, 1,612,395 persons were in state and federal prisons. At midyear 2010, 748,728 persons were in local jails.
Men and women of color—particularly black men and women—are disproportionately represented in the US correctional system.
In 2007 (the most recent year for which this information is available), the rate of confirmed AIDS cases among state and federal prisoners was about 2.4 times the rate in the general US population. At year-end 2008, an estimated 5,733 inmates in state and federal prisons had confirmed AIDS. Of the 120 AIDS-related deaths in state prisons in 2007, nearly two-thirds, or 65%, were among black inmates, compared with 23% among white inmates and 12% among Hispanic/Latino inmates.
HIV TestingThe correctional setting is often the first place incarcerated men and women are diagnosed with HIV and provided treatment. These settings are ideal for reaching persons who have HIV, other STIs, TB, and viral hepatitis, as well as for providing at least initial treatment and care for persons with these infections. They also offer an opportunity to provide risk-reduction interventions that help prevent infection among those at highest risk. Yet, correctional staff and health care providers in jails and prisons frequently confront challenges related to
Other HIV Prevention InterventionsIn addition to HIV testing, CDC recommends that HIV education and prevention counseling be made available to inmates in correctional facilities. These programs should address risk inside and outside of the correctional setting. Prevention education programs delivered by peer educators are particularly effective in establishing the trust and rapport needed to discuss sensitive topics related to sexual practices, substance use, and HIV. Providing condoms and clean syringes to sexually active persons is an integral part of HIV prevention interventions outside prisons, but most US prisons and jails specifically prohibit the distribution and possession of these items. Although sex and substance use are forbidden in jails and prisons, the reality is that some incarcerated men and women have consensual or forced sex and that some use illicit drugs.
All inmates with HIV should have access to appropriate HIV medical care and treatment in addition to prevention counseling and, before release, should receive discharge planning and linkages to medical care in the community to ensure the continuity of HIV care and treatment. Such planning is crucial to sustain effective local HIV control efforts within the communities inmates return to.
People who are incarcerated are at increased risk for acquiring and transmitting HIV and other infections. Correctional health, public health, and community-based organizations need to improve HIV prevention and care for incarcerated populations through 1) routine HIV screening and voluntary HIV testing within prisons and jails and 2) other effective prevention strategies, including those that address inmates' transition back into the community. Correctional institutions can be important partners in preventing and treating HIV to protect and improve inmate and community health.
What CDC Is Doing
1Jails are short-term facilities that are usually run by a local law enforcement agency. Jail inmates usually have a sentence of less than 1 year.
2Compared with jail facilities, prisons are longer-term facilities owned by a state or by the federal government. Prisons typically hold felons and persons with sentences of more than a year.
Last Reviewed: July 24, 2012
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention