A Comprehensive Approach:
Preventing Blood-Borne Infections Among Injection Drug Users

Chapter 3, Section 2: Key Strategies

INTERVENTIONS IN THE CRIMINAL JUSTICE SYSTEM

Because injection drugs are illegal and drug users often resort to crime to support their drug addiction, IDUs are frequently arrested and imprisoned. A recent study on substance abuse and prisoners found that 81 percent of state inmates, 80 percent of federal inmates, and 77 percent of local jail inmates had some type of drug abuse problem (Belenko, 1998). In 1996, an estimated 250,000 state prison inmates had injected drugs, including 120,000 who had shared needles. Some 14,000 federal prison inmates had injected drugs, including 6,000 who shared needles (Belenko, 1998).

At the same time, inmates in prisons and jails have disproportionately high rates of HIV infection and other STDs, hepatitis, and other health problems. At the end of 1996, 2.3 percent of male and 3.5 percent of female state and federal prison inmates were known to be infected with the HIV virus (Hammett et al., 1999). AIDS was diagnosed in 0.5 percent of all inmates, a rate six times higher than that of the U.S. population. The high-risk behaviors responsible for the transmission of HIV and other blood-borne illnesses among inmates include high-risk sexual activity, sharing of needles and other drug injection equipment, and tattooing with improvised tools and materials (Calzavara et al., 1997; Dolan et al., 1996; Mahon, 1996; Struckman-Johnson et al., 1996).

In light of the many IDUs who are in the criminal justice system and the large numbers of at-risk and infected individuals, this setting is a crucial venue for HIV- and hepatitis-related interventions and services. Providing a range of health and prevention education interventions to inmates not only benefits them and their overall health but can also improve the health of the communities to which the vast majority of inmates return (Hammett et al., 1999).

One of the most important types of interventions in prisons and jails is education and prevention efforts led by inmates themselves. These programs can be cost-effective and they have a credibility that programs led by outsiders cannot match. Peer-led programs also provide significant benefits to the peer educators themselves. Through participating in the programs, peer leaders can develop a positive focus in their lives, regain a sense of purpose and empowerment, and realize that they are able to influence others in ways they never believed possible (Hammett et al., 1999).

Prevention services currently offered to inmates vary widely across state, county, and city jails and prisons. They include instructor-led and/or peer-led HIV education, pre- and post-test counseling, multi-session prevention counseling, the use of audiovisual materials, and the distribution of written materials. Most correctional systems provide HIV antibody testing, although testing policies differ widely. Few systems routinely screen inmates for STDs and only limited viral hepatitis prevention and treatment services are available. A very few systems make condoms available to inmates.

New antiviral and combination therapies are widely available in correctional facilities (Hammett et al., 1999). However, a number of factors, including the high cost of the regimens, inmate reluctance to seek testing and treatment, uneven clinical quality of services, and a lack of uniform treatment standards means that the availability of comprehensive care for infected inmates that involves case management, psychosocial treatment in conjunction with medical services, hospice care, substance abuse treatment, and continuity of services between prison and the community, may be limited (Hammett et al., 1999)

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