The Presence of HIV/AIDS in Prison Populations

Welcome to The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I'm Ali Cundari.

U.S. prison populations are at a record high today, with barely enough room to house incarcerated individuals. Due to the close proximity and high-risk behaviors of inmates, as well as a lack of intervention from authorities, the transmission of HIV in prisons is a major problem today. A combination of both pre-existing and new infections plague prison populations, making them one of UNAIDS’ four major at-risk groups for HIV/AIDS.

In 2005, 1.8% of all state inmates and 1.0% of all federal prison inmates in the U.S. were believed to be HIV positive, leading to a total of 22,480 infected individuals behind bars. These percentages are disproportionate to the rest of the general population, making HIV/AIDS about four times as common among inmates than the population at large. Around 25% of all HIV infected people have spent time in a correctional facility, and these HIV infections are often accompanied and exacerbated by high rates of hepatitis and tuberculosis.

There are several means of transmission regarding the spread of HIV/AIDS in prisons, both primary and secondary. Injection drug use is one major cause of transmission, as sharing of dirty needles and syringes (estimated to be greater than 70%) is a common practice. Sharing items such as razors and toothbrushes contributes to the spread of other germs. Along with injection drug use there is tattooing and body piercing, a widespread activity among many inmates. Typically, it is performed through multiple skin-punctures and without sterile instruments, causing the inmates to resort to recycled, make-shift tools such as staples, paper clips, and plastic ink tubes from ballpoint pens. Finally, various sexual activities and rape directly contribute towards the problem. It is difficult to obtain accurate statistics regarding this area, due to fear and embarrassment, but consensual and non-consensual sex are both quite prevalent among prisoners. Boredom, identity issues, and the desire to assert dominance all contribute towards sexual activity. Types of sexual activities include consensual same-sex activity, sex between prisoners and staff, conjugal visits, and rape or other forms of sexual violence. Rape is a particularly complex problem, often brutal and gang related, and the violent nature of it makes recipients more prone to vaginal or anal tears, and thus increases the chances of HIV transmission.

Also contributing to the spread of HIV/AIDS, and co-infection with other STI’s, is the absence of condoms or clean needles. Additionally, a lack of information is a major problem, with many inmates being forced to live in a state of silence and fear, and a third major confounding factor is the lack of people getting tested. Currently, very few inmates get tested due to the large stigma surrounding it and fear of ridicule or violence if their test results confidentiality were to be violated. Additionally, the prison lifestyle and rapid turnover of inmates makes consistently adhering to ARV therapy difficult. Thus, the major hesitations to reform in U.S. prisons come from a lack of political will, security concerns, and false assumptions that such programs will encourage injection drug use and sexually risky behavior. Also, many opponents believe there is a lack of resources and technology to meet the overwhelming need in prisons.

In recognizing these problems, many ideas have been proposed for prevention and change. The main goal would be to develop a multi-pronged approach to enhance detection, prevention, and the reduction of sexual violence. Next, condoms, clean needles and syringes, and bleach kits must be distributed. Many advocates of reform also believe post-exposure prophylaxis (PEP) should be made available to victims of sexual encounters. Additionally, health education and support programs, and the strong encouragement to get tested would both serve to be useful. Finally, once diagnosed, HIV positive individuals must be able to receive consistent drug treatment.

Many model prisons show promising results in their quest to enact some of these changes, including the Hampden Country, MA, Correctional Center and Brown University’s Rhode Island Prison. Further lessons can be learned from countries like England who successfully prevented problems by targeting injection drug users early on in the epidemic, and Cuba, who was able to keep HIV under control through superb penitentiary health and clean conditions.

Overall, change is a daunting challenge due to the rapid turnover of inmates and the large sense of stigma and secrecy within prison walls. In order for change to be effective, it must occur on multiple levels. Officials can no longer turn a blind eye to this problem. Prisoners are ethically entitled to the same safety, health care, treatment, and support as the rest of society. Reforming the current state of correctional facilities would not only help these facilities run smoother, but according to the UNAIDS and WHO Framework, good prison health would equate to good public health. The vast majority of all incarcerated individuals will eventually return to society, bringing with them any known and unknown diseases they may have acquired in prison. If officials can bridge these barriers, they can indeed have a lasting impact on the spread of HIV/AIDS in the U.S. as a whole.

Thanks for listening. Until next time, this is Ali Cundari.


For more information:
• Jürgens, Ralf. “Interventions to Address HIV in Prisons – Prevention of Sexual Transmission.” World Health Organization. . 2007.
• Kanter, Elizabeth. “HIV Transmission and Prevention in Prisons.” HIV InSite Knowledge Base Chapter. . April, 2006.
• Lines, Rick, et al. “HIV/AIDS Prevention, Care, Treatment, and Support in Prison Settings.” WHO & UNAIDS Framework for an Effective National Response. . 2006.
• Maruschak, Laura. “HIV in Prisons, 2005.” Bureau of Justice Statistics Bulletin. . September, 2007.
• Polonsky, S., et al. “HIV Prevention in Prisons and Jails: Obstacles and Opportunities.” Public Health Rep. 109(5): 615–625. . September-October, 1994.
• “Prisons.” Joint United Nations Programme on HIV/AIDS. .

Social Components of HIV/AIDS Transmission in Mwandi, Zambia

I'm Dominique Maietta.

Mwandi is a relatively rural village in the South-Western corner of Zambia. The town is home to the Mwandi Christian Hospital, which has a catchment area of approximately 25,000 individuals. During the summer of 2006, I traveled to Mwandi in order to study the psychological and social components associated with HIV/AIDS there. Here I will talk about some of my findings.

The incidence of HIV in the village is around 30-40% and the percentage of HIV positive people is larger within the Mission Hospital patient population according to interviews with medical officers on the hospital staff. The majority of the interviewees expressed their feelings that economic hardship is a major social component of the spread of HIV in Mwandi, just as it is in the rest of Sub-Saharan Africa. Despite the influx of education and knowledge regarding HIV and it’s spread, including mandatory classes in the schools and public service campaigns around the country, the low financial status of the Mwandi community is the root cause for many of the risky behaviors associated with HIV transmission, such as multiple partners and non-use of condoms. This need to engage in risky behaviors appeared to be a particular problem for women and girls who have no other way of making an income other than through sex. Sex for them is not about emotion, but instead about survival.

The problem of poverty affecting HIV rates in Mwandi has further been exacerbated by the construction of a new paved road linking this relatively rural village to other towns and countries. The relatively recent accessibility of Mwandi to the outside world has introduced truckers and migrant workers as passer-bys to the village, and thus created a uniquely new set of problems for HIV transmission in Mwandi. These migrant individuals provide both a source of income for the impoverished village, but also a ready supply of HIV positive individuals to transmit the disease to villagers. As one social worker explained to me, when people come, they come looking for women. Thus the presence of the road, and the truckers from neighboring countries provide a source of income for destitute women and girls with no other means of providing income for their families. Interestingly, the use of sex for money in Mwandi is not so much acceptable, but merely a behavior that occurs, and according to one nurse I spoke with, “this is one of the poorer parts of Zambia, and if a woman has to keep her family, especially if her husband is not around, she will do it somehow”.



Gender disparity issues, then, apart from womanizing on the part of men, is also seen as a major social component of HIV transmission in Mwandi. While men have the power and social standing to hold jobs and make money, women and children have no similar means of providing for their families. Furthermore, although some male orphaned heads of household are given governmental support such as fishing nets which can be used to make a living, young females in similar situations are given minimal support. Thus when husbands die or children are left orphans due to the death of their parents, (generally as a result of AIDS), there is little those children or women can do to raise money other than to fall back to prostitution.

The lack of finances for much of the Mwandi community was also linked by many of the people I spoke with to excessive alcohol consumption, which contributes to promiscuous sexual behavior among Mwandi townspeople. A majority of village leaders perceived that the paucity of jobs and alternative activities in Mwandi village led to the abuse of alcohol followed by unscrupulous sexual activity, (especially by men), which in turn exacerbated the already present problem of HIV transmission. The custom of casual sex and multiple partners was prevalent among men before the HIV pandemic, and is viewed in Mwandi as the “normal mode of boy existence”. This acceptance of male promiscuity also appears to be a key contributor to the continuance of HIV transmission in Mwandi. Lack of sexual control exerted by women, (especially wives), combined with a lax view of expected fidelity in men has resulted in a growth of HIV transmission as husbands will sleep with several partners, become infected, and then infect their wives.

Although it was generally recognized that women lacked the social dominance and power necessary to prevent their husbands from suffering the results of their risky behavior, there were conflicting views as to whose behavior was “responsible” for the spread of HIV. Many of the male interviewees implicated the social behaviors of young people and prostitutes in the spread of HIV. In Mwandi many traditional family cultural values are being challenged with the introduction of the “modern life. As a result, many perceive that young people and their rampant and unprotected sexual behavior is a major social problem contributing to the spread of HIV. This behavior is most often the result of children behaving in a manner mimicking their adult counterparts.

Thus, in Mwandi, extreme poverty combined with alcohol abuse, accessibility to outsiders, and a lack of role models attempting to change behavior are the main factors contributing to the spread of HIV. As the village and the rest of the world becomes more aware of these social factors, changes can be gradually made to stop those underlying social behaviors that support transmission of HIV. Already in Mwandi village leaders have begun to address the issues of poverty and gender disparity by supporting religious and governmental run support groups and clubs to promote sustainable income by women there. Furthermore, use of traditional drama has been incorporated in order to increase public knowledge about the connection between underlying social factors and the spread of HIV in order to stop the cycle of transmission. Although there is much work to be done, the residents of Mwandi are moving in the right direction to combat the social facets contributing to HIV transmission in Mwandi.