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Prison's hidden threat

Male inmates and their partners are at high risk of HIV infection. A tough testing program is needed.

January 31, 2007

EVERYONE KNOWS THAT male prisoners are one of the highest-risk populations for HIV/AIDS, spreading the virus not just behind bars but out in the community upon release. Yet few public officials have done anything about it. Until now.

Rep. Maxine Waters (D-Los Angeles) is about to introduce legislation to make HIV testing automatic for inmates as they enter and exit federal prisons, unless the prisoners opt out. It's a strong step in the right direction, even if we'd rather see that loophole closed.

Research shows that male prisoners are three to five times more likely to be infected with HIV than are members of the general population, yet many prisons test only when an inmate shows HIV symptoms or when body fluids have been exchanged in detectable incidents such as fights.

Because two-thirds of inmates are black or Latino men, the consequences of unprotected sex in prisons have been particularly devastating for minority communities. HIV rates have skyrocketed among young gay men and the female partners of ex-cons. As of 2003, African Americans and Latinas accounted for 83% of all new AIDS cases among women in the United States.

And it's not just the inmates and their outside partners who are at risk. In a Centers for Disease Control and Prevention study of HIV in Georgia's state prisons, many men who became infected said their partners were prison staff members

Waters is calling for HIV testing to become part of the comprehensive medical exam inmates receive upon entering prison; counseling would be provided before and after the test. The bill also would beef up HIV education for inmates and confidentiality training for prison staff. The Congressional Budget Office estimates that it would cost $750,000 to $2 million annually.

When announcing the bill, Waters lambasted national leaders, African Americans in particular, for their "morally reprehensible" silence on the subject of HIV/AIDS. Fear of testing and of being stigmatized shouldn't block real-world efforts to halt the spread of HIV, she warned.

Yet that's what happened last fall, when Waters first proposed the bill. The American Civil Liberties Union, gay rights advocates and some members of Congress quickly lined up against the idea of mandatory testing, arguing that HIV-positive inmates endure violence and discrimination. But deliberate and potentially life-threatening ignorance is not the solution to that problem.

Making HIV tests automatic for a high-risk, captive population is vital not just for the health of inmates and their partners but for policymakers in understanding what goes on in the nation's disgracefully dysfunctional prisons. Now if only the state of California would follow suit.

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