HIV, Prisoners, and Human Rights

November 2016 - Structural Prevention

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Rubenstein, L.S., Amon, J.J., McLemore, M., et al. The Lancet (July 2016), 388: 1202–14, doi:10.1016/S0140-6736(16)30663-8.

This review focused on criminal laws, policies, and practices around law enforcement and judicial systems, and their effect on rights to HIV prevention and treatment among incarcerated people at risk of or living with HIV. Nearly half of all new HIV infections occur among key populations, who are often arrested without reason, do not receive pretrial release, and are subject to biased sentencing and higher likelihood of imprisonment. Punitive law enforcement practices, such as exchanging sex for freedom, using possession of condoms as proof of sex work, and criminalizing harm reduction services, increase prisoners’ HIV risks. Prolonged incarceration periods increase HIV risk and reduce access to HIV treatment. Prisoners also face human rights violations, including overcrowding, sexual violence, and inadequate health care (including discontinuity of health services), that further increase their vulnerability. The quality of prison health services is low due to structural barriers, inadequate staffing, non-alignment between prison services and national standards and negative attitudes among providers. Often, HIV testing lacks confidentiality, and treatment and associated laboratory testing are not available. Limited discharge planning and linkages to post-prison clinical services lead to reduced adherence to HIV treatment and increased virologic failure, particularly among minority populations. The authors concluded that a foundational step is to address factors that lead to disproportionate incarceration of individuals at risk for HIV, as a way to minimize imprisonment and improve HIV outcomes.

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