Correctional institutions serve to incarcerate offending individuals; to protect society from them (and them from society); to reform or rehabilitate them; or to exact what is viewed as just punishment. Prisons (for those convicted and sentenced to terms exceeding one year) and jails (for those awaiting trial or sentenced to short terms of a year or less) in the United States are not static: they change in ways that reflect the values, attitudes, and needs of the larger society. They change in response to who is remanded to them, in what numbers, and for which offenses; they change in response to the resources invested in them; and they change in response to their own internal culture. But, perhaps most important in our society, prisons and jails also respond and adapt to the process of judicial review and intervention.

Prisons are confining, not caring, institutions, and adapting to AIDS presents a fundamental dilemma. Their responses lay bare discrepancies between social expectations about the “correctional” function of prisons and the reality. Their efforts to cope with the disease exacerbate existing tensions over the jurisdiction of health care in prisons, and the disease necessarily blurs the boundaries between public health inside and outside the prison walls.

The Prison as an Environment for Infection

Prisons are currently operating at overcapacity, and experts believe that excessive crowding will increase during the next decade — even as prison construction continues at a rapid rate.