The issue of HIV/AIDS among inmates continues to pose a public health risk. This delicate issue is one which requires a more comprehensive approach even as international funding to combat HIV/AIDS continues to dwindle.

Global research indicates that correctional administrators continue to struggle with meeting the needs of inmates with HIV/AIDS. This situation is further complicated by the fact that there is a taboo culture which prohibits open discussions about sexual issues behind bars.

HIV hit prisons early and hit them hard. Data indicates that the rates of HIV infection among prisoners in many countries are significantly higher than those in the general population. While most of the prisoners living with HIV in prison contract their infection outside prison, before imprisonment, the risk of being infected in prison is heightened.

The importance of implementing HIV interventions in prisons was recognised early in the epidemic. After holding a first consultation on HIV in prisons in 1987, World Health Organization (WHO) responded to growing evidence of HIV infection in prisons worldwide by issuing guidelines on HIV infection and AIDS in prisons in 1993. With regard to health care and prevention of HIV, the guidelines emphasised that, “All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination, in particular with respect to their legal status or nationality.” This was recently reaffirmed in the 2006 framework for an affective national response to HIV/AIDS in prisons, jointly published by the United Nations Office on Drugs and Crime, WHO, and United Nations Programme on HIV and AIDS.

Since the early 1990s, various countries have introduced HIV programmes in prisons. However, many of them are small in scale, restricted to a few prisons, or exclude necessary interventions for which evidence of effectiveness exists. There is an urgent need to introduce comprehensive programmes, (including information and education, particularly through peers; needle and syringe programmes; drug dependence treatment, in particular opioid substitution therapy with methadone and/or buprenorphine; voluntary counselling and HIV testing; and HIV care and support, including provision of antiretroviral treatment) and to scale them up rapidly.

Jamaica has made attempts to expand its HIV/AIDS programme in prisons, but these efforts need to be sustained if the gains made are to be lasting. At a time where there is a small window of opportunity to benefit from the little international funding that is still available for HIV/AIDS programmes, the Government should seek to tap into this funding and direct it towards correctional facilities.

Prisoners eventually return to the communities from which they come and they carry with them everything they would have picked up in prison. Scaling up AIDS/HIV intervention in prisons is therefore in the best interest of not only the prison community but also the fragile health system and the nation at large.

Carla Gullotta is executive director for Stand Up for Jamaica, a human-rights groups that carries out rehabilitation work with inmates in the island’s correctional facilities. Send comments to the Observer orsufjmedia@gmail.com.