Treating prisoners with HIV/AIDS: the importance of early identification, effective treatment, and community follow-up.

Abstract

The U.S. currently imprisons a larger proportion of its population than does any other country in the world. Drug-related crimes constitute the largest percentage of arrests, and most of these crimes involve possession rather than sales or manufacture. Given the large number of drug users incarcerated in the U.S., it is not surprising that HIV is more prevalent among prisoners than in the general population. This phenomenon presents both a prison health crisis and a public health challenge. Many inmates either are diagnosed with HIV or first receive medical care for HIV while incarcerated. By screening widely for HIV in prisons, educating and treating HIV-infected inmates, and implementing individualized follow-up care upon release, we can use incarceration as an opportunity for important public health interventions. "War on Addicts" As of June 2001, more than 1.96 million people in the U.S. were incarcerated in state or federal prisons or local jails:1 a 62% increase from 1990 to 2001, during which the proportion of sentenced inmates increased from 292 to 472 inmates per 100,000 residents.2 This rise in incarceration rates can in part be explained by initiatives of the National Drug Control Strategy (NDCS), first announced in 1989. These federal initiatives of the "War on Drugs," which emphasize law enforcement, prosecution, and punishment, are intended to decrease the use of illegal substances.3 In the absence of adequate substance-abuse-treatment programs, however, these policies have increased the number of incarcerated drug abusers without addressing the root of the problem. From 1980 to 1999, drug-abuse arrests increased 3-fold, from 580,000 to more than 1.5 million, with more than 80% of these arrests for drug-possession violations.4 From 1980 to 1995, the number of people incarcerated increased by 239% (from 501,886 to 1,700,661), and drug-law violations accounted for 30%, 60%, and 41% of …