course, defined by the doctrinal commitments of the various faiths, as well as by the attitudes of their congregations.

Because of the role of religious institutions in U.S. society, as well as the large number of people who identify with some religious group in the United States, it is important to elucidate the role that religious organizations have played in the epidemic and to understand the importance of taking their response into account in efforts to understand the impact of AIDS in American society. Overall, as the second decade of the epidemic begins, religious organizations have only begun to contribute to efforts to contain the epidemic or to deal with some of the social issues that surround it.

Correctional Systems

Approximately 1 million individuals are currently confined in prisons and local jails in the United States—426 out of every 100,000 residents. They are disproportionately black men, for whom the rate is 3,109 per 100,000. Since the beginning of the HIV/AIDS epidemic, the population in federal prisons and in prisons in the District of Columbia and 18 states has doubled. In California and New Jersey, two states hit particularly hard by the epidemic, the number of inmates tripled during the same period. The incarcerated population in the United States comprises in large part impoverished individuals from urban areas. Almost one-half of all prisoners are black. Not only are the majority of prisoners members of racial and ethnic minority groups, they are also overwhelmingly poor.

As the nation's prison population has burgeoned, so too has the population of inmates with HIV disease. The seroprevalence status of all inmates is not known, but it is certainly highly variable by region. In New York State prisons, approximately 17-20 percent of prisoners are HIV positive, which is probably the high end of the distribution. The question of whether to screen inmates for HIV antibodies has arisen with particular urgency in the prison setting, with no general resolution.

The question of whether to segregate HIV-positive inmates has been answered variously in different prison systems. In addition to concerns about transmission through forced or consensual sex, much attention has been paid to highly unlikely modes of transmission—casual contact or assaultive behaviors by HIV-positive inmates. Other potential mechanisms of disease spread are unique to prison culture and difficult to evaluate. At least 20 state prisons segregate all prisoners with AIDS, 8 segregate those with AIDS-related complex, and 6 segregate inmates who are HIV positive but not symptomatic. Segregation decisions have been justified on the grounds of inmate security, reducing the risk of transmission, or availability of specialized services. However, there is also widespread evidence that segregation is harmful, denying prisoners access to a range of services and exposing



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