This New England Journal of Medicine article examines many of the facts, perceptions, and proposed solutions to the HIV epidemic--and the behaviors and policies that drive it--occurring behind bars. The prohibition of condom availability, absence of needle exchange programs, and inadequacy of HIV diagnosis, treatment, and programs for reducing high-risk behavior before and after release have resulted in continued rising rates of HIV infection in the U.S. prison system. As this article discusses, both the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) have recommended for more than a decade that condoms be made available to prisoners and that measures for clean needles be implemented. Several Western European countries, as well as Canada, Australia, Indonesia, and Iran, have adopted some or all of these harm reduction approaches and have seen no increase in drug use or new cases of HIV infection. Moreover, critics of U.S. penal policies contend that incarceration has exacerbated the HIV epidemic among African Americans, who are disproportionately represented in the prison population, accounting for 40% of inmates.
The Center for HIV Law and Policy challenges barriers to the rights and health of people affected by HIV through legal advocacy, high-impact policy initiatives, and creation of cross-issue partnerships, networks, and resources. We support movement building that amplifies the power of individuals and communities to mobilize for change that is rooted in racial, gender, and economic justice.