Incarcerated individuals bear a disproportionate burden of infectious diseases, including Hepatitis B virus (HBV), Hepatitis C virus (HCV), and HIV/AIDS. The HIV prevalence in state and federal prisons is more than 3 times higher than in the general population. The prevalence of HCV among prisoners approaches 40 percent. Co-infection is also a concern: although data is scarce, a significant number of HIV-positive prisoners are also infected with HCV.
Although the majority of prisoners infected with HBV, HCV and HIV acquired the infection outside of prison, the transmission of infectious disease in prison is increasingly well documented. Despite overwhelming evidence that condom use prevents the transmission of HIV, US prison officials continue to limit the availability of condoms to incarcerated persons. These policies stand in stark contrast to the public health approach taken by prison officials in Canada, Western Europe, Australia, Ukraine, Romania, and Brazil, where condoms have been available to prisoners for years. Moreover, several large, urban jails in the US as well as Vermont (Mississippi provides condoms only for conjugal visits) have provided condoms to prisoners, either through medical staff or more general distribution.
Moreover, leading correctional health experts in the US endorse condom distribution in prisons and jails. The National Commission on Correctional Health Care (NCCHC) and the American Public Health Association recommend that harm reduction measures, including condoms, be considered for prisoners in order to prevent the transmission of infection.
Some prison and jail officials have been concerned that condom distribution would negatively affect institutional security. Several recent evaluations of condom distribution programs in correctional settings provide evidence that security concerns are not well founded. For example:
? In the Washington DC jail, a study found that the condom distribution program has proceeded without serious incident since 1993 and is generally accepted by both prisoners and staff;
? In the Canadian system, their internal evaluation found that condoms have been available since 1997 without significant security incidents;
? In New South Wales, Australia, condoms have been distributed since 1996. A study found that security concerns expressed before the program began have not materialized.
? Condom distribution has proceeded for years without incident in Los Angeles and San Francisco County jails. Sheriff Michael Hennessey of San Francisco supported state legislation in California for condom distribution, and it passed the legislature in 2005 but was vetoed by Governor Schwarzenegger.
The treatment of prisoners in the United States is governed by international human rights law. The United States is a party to the International Covenant on Civil and Political Rights (ICCPR), which guarantees to all persons the right to life, and to be free from cruel, inhuman or degrading treatment; and if deprived of their liberty to be treated with humanity and with respect for the inherent dignity of the human person. The United States is also a party to the Convention Against Torture (CAT), which protects all persons from torture and ill treatment; and a signatory of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which guarantees the right to the highest attainable standard of health.
The World Health Organization Guidelines on HIV Infection and AIDS in Prisons specifically addresses the issue of condom distribution in a prison environment:
Preventative measures for HIV/AIDS in prison should be complementary to and compatible with those in the community. Preventative measures should also be based on risk behaviors actually occurring in prisons, notably needle sharing among injection drug users and unprotected sexual intercourse? Since penetrative sexual intercourse occurs in prison, even when prohibited, condoms should be made available to prisoners throughout their period of detention.
Despite increasing documentation of high rates of infectious disease, the occurrence of high-risk behaviors, and transmission of disease among inmates, the distribution of condoms in US jails and prisons continues to be limited. Opposition to these programs on the basis of security concerns is not supported by the evidence. Human Rights Watch urges prison officials and policymakers to comply with best practice based upon international human rights standards, US constitutional law, and the recommendations of national correctional health experts to ensure that condoms are available to prisoners.
Megan McLemore directs the HIV/AIDS and Human Rights Program of Human Rights Watch.
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