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There are more than two million adults incarcerated in the US and four million more on probation or parole. Rates of HIV are 8 to 10 times higher for incarcerated persons than for the general US population, hepatitis C rates are 9 to 10 times higher, and sexually transmitted disease (STD) rates among men entering jails are as high as 35%. Because many prisoners are serving short sentences for parole violation, and return to prison is common, at-risk individuals move frequently between prisons and their home communities. (National Commission on Correctional Health Care, 2002) There is an urgent need to develop effective, accessible HIV prevention programs and population-specific HIV education materials for prisoners and their partners. Despite this, institutional barriers have impeded development and evaluation of such programs. Prisoners in the US have virtually no access to condoms, bleach, clean syringes, comprehensive HIV prevention education or support for transitioning out of prison. Rules protecting the security of the institution also limit access by community-based organizations (CBOs) and researchers. Staff at Centerforce, a CBO, have provided comprehensive HIV prevention education at San Quentin State Prison since 1986. Since 1992 they have been evaluating many of these programs in collaboration with the Center for AIDS Prevention Studies (CAPS), UCSF.

En los EE.UU. existen más de 2 millones de personas adultas encarceladas y 4 millones más en libertad condicional. Las tasas de VIH son de 8 a 10 veces más altas para los encarcelados que para la población en general; las tasas de hepatitis C son de 9 a 10 veces más altas y las de enfermedades de transmisión sexual (ETS) entre hombres que recién ingresan a la cárcel alcanzan hasta un 35%. Muchos internos tienen sentencias cortas por infringir su libertad condicional y el regreso a la prisión es común, por lo que dichas personas transitan frecuentemente entre la prisión y su comunidad aumentando su condición de riesgo y la de sus familias. (National Commission on Correctional Health Care, 2002) Existe la necesidad urgente de desarrollar programas de prevención del VIH eficientes y accesibles así como materiales educativos específicos para las personas en prisión y sus parejas. Sin embargo, las barreras institucionales han impedido el desarrollo y la evaluación de dichos programas. En EE.UU. los internos prácticamente no tienen acceso a condones, cloro, jeringas limpias, información sobre las formas de transmisión y prevención del VIH o apoyo para la transición al salir de prisión. Las reglas de seguridad de las instituciones limitan el acceso de las organizaciones de servicio comunitarias (OSC) e investigadores. Desde 1986, Centerforce, una OSC, ha proporcionado educación preventiva del VIH en la prisión estatal de San Quintín y desde 1992, ha evaluado varios de sus programas en colaboración con el Centro de Estudios de Prevención del SIDA (CAPS sus siglas en inglés) de UCSF.

By the end of 2002, over 2 million adults were incarcerated in the US, and 93% of those were men. African Americans and Latinos were incarcerated at greater rates than Whites in the US, 7.6 times greater for African Americans and 2.6 times greater for Latinos. Nearly 40% of incarcerated men were under the age of 30. Young men of color are at high risk of incarceration and the health problems related to incarceration. These young men also are our neighbors, frequently passing in and out of jail and prison and returning back to the community. Men who are incarcerated have disproportionate rates of HIV, sexually transmitted diseases (STDs) and hepatitis. Rates of HIV are 8-10 times higher for incarcerated persons than for the general US population; hepatitis C rates are 9-10 times higher, and STD rates among men entering jails are as high as 35%. Men leaving prison face numerous challenges that may impede their ability to protect themselves against these diseases. Men often must re-establish relationships, find employment and housing and deal with addictions and mental health issues. Prisons present a unique opportunity for HIV/STD education and skills building to help men avoid risk after their release from prison.

New HIV infections are decreasing among IDUs. This decrease has been related to the practice of injection risk reduction among IDUs such as the use of needle exchange programs where available. However, recent research has found that sexual risk behavior among IDUs may account for more new HIV infections than injection practices.2 We need to know more about the sexual practices of IDUs. To date, most HIV prevention efforts have focused on how HIV negative people can stay negative. This has overlooked the important role that HIV positive individuals can play in the prevention of new HIV infections. HIV positive people also need support to not spread the virus and to keep themselves healthy (avoid STDs, Hepatitis C, abscesses, etc.). The need for prevention efforts targeting HIV positive individuals has only recently been addressed.

Project Access is a qualitative study of barriers to HIV counseling and testing, and the personal HIV prevention strategies of drug users. Main Findings:

• Drug users’ risk behavior was not directly related to the number of times they had previously tested for HIV.
• Personal prevention strategies and HIV testing patterns are shaped by public health messages, institutional practices, and the concrete realities of living and surviving in impoverished communities.
• Many low-income drug users approach HIV as a chronic illness, one of many life threatening diseases facing their communities. HIV infection was seen as random and unpredictable, the virus was believed to lay dormant and completely undetectable within the body for years, and routine screening (HIV testing) was believed to be a primary means of managing HIV.
• Race, class, and gender inflect individuals’ perceptions, their responses to the threat of HIV, and their motivations for HIV testing.
• Health and social service referrals can play an important role in linking these populations to needed services.