Living and working behind bars.

Abstract

As we approach the year 2000, we are faced with a crisis in our prisons and jails. This crisis has been fueled by changes in criminal law and sentencing, resulting in an exploding number of persons being incarcerated. These overcrowded prisons are environments that are conducive to violence and disease transmission. Correctional facilities nationally house nearly 2 million men and women with an increasing number of these individuals incarcerated with chronic disease, mental illness, chemical dependency, and histories of physical and emotional abuse. Due to mandatory lengthy sentences, correctional facilities are faced with a growing geriatric population. Unfortunately, prisons and jails are often serving as our psychiatric institutions due to the increased criminalization of the mentally ill. Incarcerated persons with HIV disease, due to treatment advances, are confronted with hope for the future contingent upon having access to the emerging HIV treatment. Amid the increased need for quality clinical care, adequately trained correctional health care providers, and serious public health challenges confronting these providers, funding for correctional health care services is often inadequate thereby limiting access to hopeful new treatment for HIV disease. The number of inmates with HIV disease continues to grow, placing increased clinical demands and ethical obligations for correctional facilities to provide HIV clinical care, HIV prevention education, and support services. With fewer opportunities for the incarcerated to participate in treatment programs, jobs, and education within correctional facilities, nurses have an important role in humanizing this often chaotic and hostile environment by providing care and comfort to this often forgotten population. Nurses are key in providing HIV prevention education and risk reduction to incarcerated men and women as well as providing specialized clinical care and support services. New challenges for nursing include assuming a leadership and advocacy role in developing correctional policies that support HIV treatment adherence, peer education, and address the existing and emerging health care issues for the incarcerated, including substance abuse, violence, sexually transmitted disease, and hepatitis. This issue, “HIV Behind Bars: Implications for Prevention, Treatment, and Policy,” is aimed at providing a forum to discuss the complicated issues for persons living with HIV disease behind bars, the nurses who care for them, and correctional policy implications. After nearly 10 years of conducting HIV education and training for health care providers within correctional facilities and in designing and conducting HIV peer education programs, it has become quite obvious to me that nurses are the cornerstone of care, treatment, and compassion within the correctional system. Without them, many persons with HIV disease would not have access to care and support. With limited opportunities for recognition and reinforcement within the correctional system, the work of nurses in prisons and jails has often gone unnoticed and unappreciated. This lack of recognition occurs not only from the correctional system itself, but from the nursing community outside of the system. Despite this, nurses working in prisons and jails continue to provide compassionate care and hope to inmates in environments that are often less than optimal due to limited resources, inadequate clinical staffing, and regimentation with the context of containment and punishment. Just as inmates with HIV are required to live with HIV disease behind bars, nurses working in corrections must provide HIV care behind bars. This is not an easy task, but a most important and critical role for nursing in the HIV epidemic. Editorial