NYT Editorial: Fighting AIDS Behind Bars

The New York Times Editorial
Fighting AIDS Behind Bars
Published: July 22, 2005

The United States has done relatively little to curtail the AIDS epidemic that rages within the prison system, where the H.I.V. infection rates are many times as high as in the world outside. Strategies for fighting disease behind bars are better developed in Europe, where the World Health Organization is 10 years into a public discussion project aimed at slowing the spread of H.I.V. and other deadly infections in the prison population. The Europeans seem to have grasped the idea that infections contracted behind bars end up back in the broader society when infected inmates get out.

The World Health Organization's most recent update consolidates what the Europeans have learned over the last 10 years and should be required reading for public health and prison officials in this country. The emerging consensus is that prison has become the perfect environment for the transmission of dangerous diseases like tuberculosis, hepatitis C and AIDS because of crowding, unprotected sex among inmates and widespread needle-sharing for intravenous drug use.

The rising infection rates among addicts in general show clearly that merely declaring sex and drug use illegal has not worked. The prison systems that have managed to slow the spread of AIDS have employed drug treatment and "harm reduction" strategies - like offering methadone maintenance and distributing condoms.

Many nations, including the United States, are hampered in the fight against AIDS by a pervasive denial of drug use and sex behind bars. Politicians often argue that harm-reduction strategies can seem to promote illicit behavior.

It's understandable that some prison systems may reject the idea of providing needles to people who use drugs behind bars, even though needle exchanges have proved to be a cheap and effective way to slow the spread of disease in the outside world. But it seems inexcusable that prisons don't pursue other strategies - like testing inmates and educating them about disease - while making condoms readily available to those who want them.

It's not necessary to condone behavior that spreads AIDS. But it is critical to acknowledge that such behavior persists in prisons. The aim must be to slow the spread of disease so as few people as possible get out with infections that endanger society.