Monday, April 24, 2006

HIV transmission in prisons

Not a happy topic. Also not a topic that gets any intelligent discussion in policy making communities (yes, I refer to your elected representatives!). A new article in the journal Emerging Infectious Diseases presents a single case study in graphic detail (docs can talk about the darnedest things, no?) and uses it as a springboard to make a number of policy recommendations--all of 'em very sound and worth mentioning in policy making communities (yes, I'm still referring to your elected representatives!).

Among the recommendations:
  • Condom distribution in correctional facilities;
  • Annual continuing education on HIV for correctional health care workers;
  • Access to HIV counseling and testing for all inmates.

None of this is particularly new, but this time physicians are making the recommendations, and the recommendations are published in a journal that is produced by the CDC. Both factors should carry some weight with policy makers, although [sigh] there's no guarantee that they will get the point. Unless, of course, their constituents (that would be you) help them.

In Texas, we have access to HIV counseling and testing for inmates. It is, however, optional upon admission to a facility. Testing (without recognition of the statutory requirement for counseling) is now mandatory prior to release. The purpose of this policy (which was passed into statute during the last regular legislative session via HB 43) is to protect the civilian community, not inmates, from HIV transmission.

The health care professions in Texas, via their professional associations, has been resistant to content-specific continuing education requirements, including education about HIV (or Hepatitis C). The argument is that these professionals are already overburdened with CE requirements and people who need to know more about HIV will seek that information out.

Condom distribution in correctional facilities was introduced in the last regular legislative session (HB 2057), perhaps in response to HB 43, but failed.

The good news is that these issues have been discussed in Texas. The bad news is that people don't quite get it.

Prisoners have at least the right to a healthy environment in their place of incarceration. If sexual contact occurs, no matter whether it is prohibited, the risk for transmission of infectious diseases is present. A more coherent policy regarding counseling and testing is needed as well as effective tools for prevention, including condoms and protection from coerced sex. Health care workers, especially in an environment where turnover is high, need to be properly educated regarding the risks and effects of HIV transmission so that they can assist inmates in making decisions regarding thier health.

The opportunity to continue this discussion exists in the next legislative session. If this is an issue that concerns you, I'd recommend starting the discussion with your elected representatives well in advance of the session. The EID article will be helpful when you do.
Citation: Macher A, Kibble D, Wheeler D. HIV transmission in correctional facility. Emerg Infect Dis [serial on the Internet]. 2006 Apr [date cited]. Available from

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