A study by Arizona State University's Center for Prevention and Community Safety has shown a high rate of infection with sexually-transmitted infections (STIs) among prisoners in the Maricopa County jails in Phoenix, Arizona. 130,000 people are booked into the jails each year with an average incarceration period of a month.

The first anomaly was noticed when the Center conducted a federally-funded study which tested women under 35 for diseases that could affect fertility. That study noted elevated infection rates among incarcerated women for chlamydia and gonorrhea. Believing that incarcerated men must also have a higher rate of infection, the researchers were able to expand the study to include all prisoners, regardless of age or gender. The expanded study showed a infection rates of 5 to 10% among various prisoner groups, about 50 to 80% higher than the national average in the general population.

Public health care officials hope the study will be a springboard for additional studies of STI rates in other county jails. According to them, the main thing holding back such studies is the high cost of STI testing. The federal grant-funded testing in the study cost about $18 per prisoner while tests without a grant run about $95. Maricopa County health officials are working with the Centers for Disease Control in Atlanta, Georgia to determine the real value of testing by developing a cost-benefit analysis.

Of course, the cost-benefit analysis must take into account the fact that releasing infected prisoners back into the general population without testing and treatment will result in the spread of STIs among the non-prisoner population which would also cost money to combat. Often that money will come from government health services since many former prisoners and their families are dependent upon public health care services. Therefore, treating prisoners with chlamydia or gonorrhea at the jail, where their compliance with taking the antibiotics necessary to cure STIs can be closely monitored, is more cost effective than waiting until after they are released to treat them.

"Whether they're outside or in here, if you look at it from a public-money standpoint, it's still tax dollars," said Dr. Jeff Alvarez, medical director of the county agency that provides medical services to jail prisoners. "It's hard to help taxpayers understand we are paying for this. Even if you don't think of the good that we're doing for people, it's still cheaper for you to take care of this now."

The argument that you shouldn't screen prisoners for diseases so that you don't have to pay to provide them medical care also runs into another problem. The U.S. Constitution requires that prisoners be given necessary medical treatment. It is unlikely that the courts would view allowing a disease to be undiagnosed and untreated as a constitutionally-adequate level of medical care.

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