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Clarion Call for Condoms in Corrections (Prisons and Jails)
Infectious Diseases in Corrections Report (IDCR)
PROVIDENCE, RI. April 15, 2006
Dr. Annie De Groot
Co-Chief Editor
Associate Professor of Medicine (Adjunct)
Brown Medical School
Portable (401) 952-4227
Office (401) 453 6028
David Alain Wohl, MD
Co-Chief Editor
Associate Professor of Medicine
AIDS Clinical Research and Treatment Unit
The University of North Carolina at Chapel Hill
Tel (919) 843-2723
Fax (919) 966-8928
Pager (919 216 0629
The recent report from MMWR on detection of intramural spread of HIV in Georgia prisons during an all-too-brief period of routine, voluntary HIV screening of inmates simultaneously demonstrates that HIV is being transmitted within prisons and that screening programs can be effective in detecting these infections.
We co-chief editors IDCR (2005-2007) feel that this MMWR report is a clear call to bring HIV prevention in prisons and jails into the 21st century.
To get their perspectives on the MMWR report Infectious Diseases in Corrections Report asked the former medical director of the Georgia Department of Corrections (who is also an IDCR board member) and Madeleine LaMarre, author of the MMWR report, to provide their views on the implications of the results.
Readers can assess the data and the views of these individuals for themselves.
The issue of IDCR that discusses the MMWR report can be found at
Readers are also referred to the April issue of IDCR at,
which focused on HIV testing in correctional systems nationwide.
Individuals with potentially contagious infections, such as HIV and hepatitis B and C, are concentrated within correctional facilities in the U.S. It is, therefore, hardly surprising that transmission of these infections--via sex, needle sharing and tattooing--occurs in prison. What is surprising and perplexing is the inability of officials responsible for decision making in most correctional facilities to take action toward reducing the spread of these infections by and among their inmates. All too often, attempts to implement common-sense prevention measures are stymied by rules, regulations, and laws. Correctional administrators are too often caught in the middle between lawmakers and the reality of correctional medicine, and lack support from legislators to support changes that could lead to improved diagnosis, prevention, and education in the correctional setting. Nonetheless, state and local officials are eventually likely to be held accountable for their lack of action, which will have long ranging impact on the communities to which inmates return following release. We urge state legislators and correctional decision-makers to take steps to stop HIV transmission now.
Evidence that consensual and non-consensual sex occurs among inmates has been available for many years, both in the United States and in other prison settings. Despite this evidence, one of the most rudimentary and effective interventions to reduce HIV transmission--condoms--are not legally available in almost every U.S. jail and prison. Likewise, despite the high prevalence of HIV among those incarcerated, in-prison prevention counseling is often not available and jail-based HIV counseling programs are practically non-existent, save for a handful of notable exceptions.
The most worrisome failing of our correctional approach to HIV is our lack of consistency regarding screening for HIV infection. Effective HIV prevention starts with identification, counseling and treatment of those infected, and HIV testing is currently the major focus of the CDC's prevention efforts. Yet, as described in detail last month in IDCR (April 2006, available at,
a patchwork of HIV testing policies are in place across the country and do not necessarily reflect the prevalence of the virus in each state. Further, while some prisons offer testing at entry on either a voluntary, quasi-voluntary or mandatory basis, rarer are testing programs designed to detect infection during incarceration. Few states have data on HIV seroconversion among inmates, and those that do have neither published nor shared those results.
As a first step, we recommend that the CDC, the American Medical Association, the Infectious Diseases Society of America, the National Commission on Correctional Health Care and the American Academy of HIV Medicine should recommend, based on sound scientific evidence supporting the role of condoms in the prevention of HIV transmission, that condoms be made available in correctional facilities. Arguments regarding condoms as promoting sexual activity ignore the accumulation of evidence of the effectiveness of condoms in reducing HIV and sexually transmitted disease transmission in practically every setting where condoms have been studied. Although most correctional facilities have policies against inmate sex, sex clearly continues (both forced and consensual) and inmates must have access to this life-saving intervention. Second, the national disregard for HIV prevention in corrections is as tragic as it is ethically wrong. Evidence-based HIV prevention programs need to be instituted by every prison and the major jails.
Next, HIV testing must become routine and offered regularly to inmates in a way that protects their safety and confidentiality. Culturally appropriate counseling about prevention of transmission should go hand in hand with routine testing. Last, sexual contact between staff and inmates, as described in the MMWR report, must be investigated, and if confirmed, recognized as sexual abuse and punished accordingly.
Correctional administrators and front-line providers of medical care will not and cannot accomplish all that has to be done alone, even if they desire to improve HIV testing and prevent HIV transmission. For example, in many jurisdictions' laws will need to be changed to enable implementation of the recommendations accompanying the MMWR report. County, state and federal health agencies need to become actively engaged and help fund and support efforts to meet these goals. We must do a better job of demonstrating to taxpayers why resources allocated to the incarcerated are a good public health investment. The lessons from Georgia are clear and should not be ignored.
Due to the controversial nature of its content, we would like to clarify that this press release only reflects the opinions of present, former and future co-chief editors (2006-2007) of IDCR, Dr. Annie De Groot (RI) Dr. David Wohl (NC), Dr. David Thomas (FLA) and Dr. Joseph Bick (CA) and does not reflect all of the opinions of the IDCR advisory board. See the editorial by David Wohl in the May IDCR issue ( for more information.
Dr. Annie De Groot
Executive Editor IDCR
Associate Professor of Medicine (Adjunct)
Brown Medical School
Portable (401) 952-4227
Office (401) 453 6028
Dr. David Alain Wohl, MD
Co-Chief Editor IDCR 2006
Associate Professor of Medicine
AIDS Clinical Research and Treatment Unit
The University of North Carolina at Chapel Hill
Campus Box 7215
Chapel Hill, NC 27599
Tel (919) 843-2723
Dr. Joseph Bick, MD
Co-Chief Editor IDCR 2004-2007
Chief Medical Officer,
California Medical Facility,
California Department of Corrections
Dr. David L. Thomas, MD JD
Co-Chief Editor IDCR 2005
Professor & Chairman
Department of Surgery
3200 So. University Drive
4th Floor Terrry Bldg
Ft. Lauderdale, FL 33328-2018
Asst's Office - 954-262-1418
Phone 954-262-1554
Annie De Groot, M.D.
TB/HIV Research Lab
Brown University
cell 401 952 4227
office 401 863 6083
fax 401 863 6087
EpiVax, Inc.
cell 401 952 4227
office 401 272 2123
fax 401 272 7562
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