The prevalence of human immunodeficiency virus among incarcerated persons in the United States is four times greater than the prevalence in the general population. Given this, the reentry of formally incarcerated people into their communities presents a danger of spreading HIV and other infectious diseases. It is a public health concern.
A policy brief entitled “HIV Testing in State Prisons,” written by Jemel Aguilar at the University of Texas in Austin, proposed the idea of mandatory testing in prisons. The report makes a convincing case for prisons to conduct HIV/AIDS mandatory testing/screening of inmates.
Aguilar asks us to consider, “How state prisons can join community efforts to reduce the number of new infections and identify individuals unaware of their HIV status?”
The correctional system in the United States consists of state and federal prisons, jails, and juvenile facilities. Each facility serves a different purpose, plays a different role and has different policies. As a result, HIV/AIDS screening policies differ from one jurisdiction to another.
In many correctional facilities, policies may require that inmates be tested upon entry, upon release, or both. In addition, testing may be mandatory, routine, voluntary, or only on demand. However, more than 50 percent of state prison systems do not require HIV testing at any point.
In high-risk settings such as prisons and jails testing should be mandatory. In addition, inmates should be offered educational interventions prior to testing and after testing if they are given a positive status. Because incarcerated people may lack accurate information about HIV, it is important to provide education.
They should also receive care and treatment if they test positive. Currently, only 16 states and the federal prison system make it mandatory for inmates to be tested.
The World Health Organization and the American Public Health Association (APHA) Standards of Health Care in Correctional facilities are strongly opposed to the idea of mandatory testing.
One of their reasons is that confidentiality is difficult to protect in prisons. Establishing mandatory HIV testing for inmates may result in prisoners being discriminated against. Many conclude that HIV/AIDS in prisons should be treated the same as it is in communities.
But, how effective are the strategies in communities? We can either allow inmates to be left untreated, undiagnosed, and continuously spread HIV to others or we can deal with discrimination due to an HIV positive status. Which is the lesser of two evils?
The number of people infected with HIV/AIDS in the United States today is skyrocketing. According to the CDC, there are about 50,000 new HIV infections per year. More than one million people are living with HIV/AIDS in the U.S today, and one in five living with HIV is unaware of their infection.
Maybe it is time we take a different approach. Identifying HIV positive inmates during incarceration may be the route to take. Research shows that the lifestyles of many inmates prior to incarceration include unprotected sexual intercourse, drug and alcohol abuse, poverty, homelessness, under education, and unemployment—all of which are associated risks of HIV/AIDS.
Correctional facilities provide us with the opportunity to test individuals who might not get tested otherwise. Implementing a mandatory policy of testing inmates will reveal many undiagnosed cases.
The majority of incarcerated people will eventually return to their communities. Some return in a few months or a few years. In the event that the inmates return home and do not know their status, they may infect someone unknowingly.
Many people are often unaware of their HIV status because they are asymptomatic. Research also tells us that persons who are unaware of their HIV status are approximately three times more likely to transmit HIV than persons who are aware.
Knowing one’s status can provide a person with the information needed to make better decisions about their health. Early detection poses a great benefit to the health of the individual and leads to early medical attention.
Ultimately, health issues in prisons eventually become issues for society as a whole. On a bigger scale, early detection of infected inmates can reduce the spread of HIV/AIDS in our society.