Prisoners & HIV risk: A neglected public health opportunity

Background: The U.S. prison population is disproportionately comprised of drug users and ethnic minorities, who are also grossly overrepresented among individuals infected with HIV/AIDS. Recognizing that prisoners are at an elevated risk of contracting HIV/AIDS, they tend to be medically underserved, and that incarceration worsens health outcomes, the objective of this study was to explore the extent to which prison systems implement comprehensive HIV/AIDS educational programming. Methods: Research studies on U.S. prison-based HIV/AIDS programs and interventions were extracted from literature over a 10 year period, from 2003-2013. The literature was reviewed according to Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Results: Although prevention programs vary greatly by jurisdiction, common characteristics of prison-based HIV prevention programs include educational courses, voluntary HIV testing, and counseling. Despite limited resources, very few prisons offer peer-led programs or integrative programs, which are shown to be cost-effective and demonstrably successful in this environment. Harm reduction strategies are typically not strong components in programming content despite substantial research indicating its effectiveness. Finally, many programs have been adapted from community-based programs without being tailored to address the unique needs of prisoners. Conclusions: By mounting ambitious efforts to confront the spread of HIV/AIDS and administering the appropriate prison-based health promotion programs, correctional officials and health professionals have the opportunity to impact related health disparities among a population that bears a disproportionate share of the burden of HIV infection.