Controlling the Spread of HIV in Prisons A new study, conducted by the Center for Disease Control, dispels some myths about HIV transmission in jail, and offers evidence for crafting new solutions to stop its spread.
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Controlling the Spread of HIV in Prisons

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Controlling the Spread of HIV in Prisons

MICHEL MARTIN, host:

A new study by the Centers for Disease Control on prevention on male prisoners in Georgia challenges some of the myths about HIV transmission in jails. The study also provides important new evidence for preventing the spread of the virus inside and outside prisons.

HIV is nearly five times more prevalent in the prisoner population than in the general population. For more on the research and its implications, we are joined by Patrick Sullivan, the CDC epidemiologist who led the study. He joins us from his office in Atlanta.

Welcome.

Dr. PATRICK SULLIVAN (Center for Disease Control): Thanks for having me.

MARTIN: And also we're joined by Barry Zack, the executive director of Centerforce, an NGO that offers educational and health programs for prisoners and their families. He joins us from his office in San Quentin, California.

Welcome to you also.

Mr. BARRY ZACK (Centerforce): Honored to be here. Thank you.

MARTIN: Okay, Mr. Sullivan, let's start with you. Why did you conduct this study? What did you want to learn and what did you find out?

Dr. SULLIVAN: Well, we were invited by the Georgia Division of Public Health to assist them to look at a group of inmates who had become infected with HIV in the prison system. And specifically, they asked for our help in characterizing the men who got infected, understanding the circumstances that were associated with those infections and for making prevention recommendations based on our findings.

What we found was that transmission in the prison setting in Georgia wasn't rare, but neither did it appear to be rampant. And I think some of the things we found may challenge some preconceptions that people have.

For example, among the men who reported sex with other males in prison, the inmates characterized most of that sex as consensual. I think we see depictions of prison rape sometimes in the popular media, and there's a lot of appropriate concern about prison rape, but according to our data, most of the sex that occurs is characterized as consensual by the inmates.

MARTIN: Very interesting point. But by consensual, do you mean truly consensual? Do you mean trading for favors?

Dr. SULLIVAN: Well, you make a great point, which is that the meaning, the context for consent to sex in prison is probably different than it is in other settings. We asked the men how they characterized sex and they could characterize it as consensual as being in exchange for some commodity like cigarettes, like protection, or candy, or they could characterize it as rape, and they most frequently characterized it as consensual.

But I think we recognize from our conversations with these men that the issue of consent in prison is a continuum with a lot of shades of gray.

MARTIN: Let me just pause here briefly to say you're listening to TALK OF THE NATION from NPR News.

Mr. Zack, does that finding comport with your knowledge of the way prisons work? Does that sound right to you?

Mr. ZACK: Absolutely. I mean, I think the most important point here is sexual behavior happens everywhere. Prison is one of those locations. And two, within an incarcerated, in the prison population, the concept that, you know, of sexual behavior is truly a continuum. How does one give consent in a place where one is not free?

MARTIN: So what do you think, at the end of the day, I mean this, I found this study fascinating, I have to say, because, just because it did ask questions like what, and your basis, your study group is people who you know did not have AIDS before entering the prison population. Correct, Mr. Sullivan? You had testing to determine that they had continual negative tests and so you're pretty positive that they got, that they were exposed to the virus while in the prison population, right?

Dr. SULLIVAN: Correct. All of these men had a negative HIV test on their way in to prison, and had continuous incarceration until the first positive test.

MARTIN: So how do you, when you're talking to people about such an intimate subject, are you concerned at all about the accuracy of self-reporting? I mean one could envision a scenario where someone wouldn't want to admit to having been raped.

Dr. SULLIVAN: That's true, and that's always a limitation when you ask people to report about their own behaviors. But when you look at how commonly these risk behaviors were reported among the men, even if there is some underreporting, I think it should challenge us to say how do we take these data and turn them into prevention programs?

And particularly, in this group of men, we know both from the, what they reported in the interviews and from other data, that the men who enter prison, as you mentioned at the, on the introduction, are more likely to be infected with HIV then the general population on their way in.

In this study, of all the men who were infected with HIV in the Georgia prison system, over 90 percent of them had HIV when they came through the door on their way in to prison.

So prisons offer a unique opportunity to intervene with a group of people who have high risk before they come in, may be hard to reach in their communities, and importantly are going back to their communities. Ninety-seven percent of the men who come into prison will go back out into the communities. And so we think this is a tremendous opportunity to equip them with the knowledge, the skills, the tools that they need to protect themselves while in prison. But also, wouldn't it be great to feel like when they went back out into communities that they were equipped with those skills to protect their risk partners in communities?

MARTIN: We only have a very short amount of time left for the entire program. So Mr. Zack, I want to ask you, how does your organization work with prisoners in San Quentin prison to stop HIV transmission?

Mr. ZACK: Well, for the past 15 years we've been training prisoners to be, at a number of different prisoners, to be peer-health educators. I think one of the primary obstacles here is that the whole, this whole system is based on mistrust. So our whole program is based on having peers teach their peers about, whether it be HIV or hepatitis, some of the primary health concerns that the prison population has.

They, in turn, help, you know, educate their peers on how diseases are transmitted, modes of, you know, how to prevent it, and then access to care and treatment. They are trusted, and they're creative in their delivery. I mean, they really speak to what's happening on the inside. So in many states where condoms, for example, are not available, you know, there are other strategies, other vehicles for prevention. And you know, its all relative. They're the ones that can disseminate this message.

MARTIN: Patrick Sullivan is the chief of the Behavior and Clinical Surveillance Branch in the Division of HIV/AIDS Prevention at CDC. He joined us from his office in Atlanta.

Thank you so much.

Dr. SULLIVAN: Thank you.

MARTIN: And Barry Zach is the executive director of Centerforce. He joined us from his office in San Quentin, California.

Thank you also for joining us.

Mr. ZACK: Thank you.

MARTIN: This is TALK OF THE NATION from NPR News. Neal Conan will be back on Monday.

I'm Michel Martin, in Washington.

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