This chapter advocates for the need for HIV prevention programs in the correctional setting; it should be noted that HIV is but one of many health conditions that are disproportionately impacting the incarcerated population. Comprehensive prevention education should include other infectious diseases such as hepatitis, chlamydia, and gonorrhea, all of which are found at greater rates among the incarcerated populations. These interventions should be available at every level targeting every possible audience in order to build a comprehensive, culturally sensitive and feasible HIV prevention program for each institution.

Most HIV prevention programs focus on encouraging the individual to make behavior changes (i.e., the person engaging in high-risk behavior). This is but one strategy for prevention. Other strategies include structural interventions (e.g., condom and clean needle availability), environmental interventions, and policy-level interventions. These efforts would have a synergistic impact on HIV rates in our communities. By providing effective prevention programs to individual prisoners, the results would be felt not only by the individual program participant/client, but also by other prisoners (through diffusion), prison staff (either through observing the program for security reasons or through osmosis), prison visitors, and volunteers. Most importantly, the family members of the prisoners (Grinstead, Zack, Faigeles, et al., 2001) and the free community would be at decreased risk from the effective behavior change of the individual prisoner.

To improve our efforts we need to be mindful of the context of prevention in the correctional setting. The goal for in-prison/jail prevention must include both in-prison and postrelease prevention behaviors. To have the greatest impact on the HIV/STD/hepatitis rates of prisoners, former prisoners, and the communities to which they are released, we should strive to make our prevention programs as comprehensive as possible.

Available data indicate that prevention works. However, we need a commitment by both correctional and medical administrators to increase and improve our prevention efforts. The courts are not looking at the lack of prevention as "deliberate indifference." This commitment must begin with those of us working in the field of correctional health.

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