Introduction

Although the prevalence of HIV/AIDS in prison populations varies greatly in different countries (see Table 17.1), it is significantly higher than in the general population. For example:

• in the USA, the AIDS case rate in prisons is more than five times the rate in the general population (Maruschak, 2004)

• in Canada, the prevalence of HIV in prisons is 10 times the rate in the general population (Canadian HIV/AIDS Legal Network, 2002).

In countries in sub-Saharan Africa, Latin America, Europe, and North America, HIV prevalence among prisoners ranges from 3% based on a cross-sectional seroprevalence study in Senegal to 47% among a subpopulation of injecting drug-using prisoners in Spain (Stubblefield and Wohl, 2000).

The disproportionate burden of HIV disease in prison inmates is largely due to high-risk behaviors that individuals engaged in before being incarcerated. Most inmates with HIV became infected before coming to prison (DeCarlo and Zack, 1996). However, once in prison, inmates engage in high-risk behaviors such as unprotected sex, injecting drugs, and tattooing without sterile instruments, which promote the spread of the disease within correctional institutions (Braithwaite et al., 1996). This means that inmates require effective treatment for HIV as well as access to harm-reduction strategies that could reduce the risk of transmission. According to Braithwaite et al. (1996), prison officials in many European countries, Canada, Australia, and Brazil have begun to endorse harm-reduction strategies, such as condom and bleach distribution, and the provision of syringes, that could potentially reduce the spread of HIV among inmates.