Staff of the New York Prisoner's Rights Project (PRP) oppose singling out inmates for epidemiologic studies of HIV infection. Prisoners, they argue, offer no particular characteristics unavailable in the free population, except that they can be conveniently studied. According to PRP staff, convenience should not be a governing factor in the approval of such research [citation omitted].
Among the recent studies are the surveys on AIDS in correctional institutions conducted by Abt Associates under contract to the National Institute of Justice (Hammett et al., 1989; Moini and Hammett, 1990). These surveys of various prison systems provide information on policy trends related to such issues as housing and segregation of prisoners with HIV/AIDS, AIDS education, conjugal visitation, and health care access. In most cases the data compiled represent the official responses of correctional administrators, however, and actual practices within institutions may diverge from stated policy. Other sources of information are also available. The subject of HIV in prisons has been given much attention in state legislatures (Gostin, 1989). Litigation concerning HIV in prisons has continued unabated throughout the epidemic, and judicial opinions and court records tell much of the story of AIDS in prisons (see Greenspan, 1989; Gostin, 1990; Gostin, Porter, and Sandomire, 1990). Prisoners have challenged specific practices related to attempts to control the spread of HIV.1 Prisoners with HIV disease have sued to protest their segregation from the general prison population (Branham, 1990), and HIV negative prisoners have sued to try to force the segregation of those with HIV disease. In some lawsuits, HIV treatment has become part of larger claims related to the adverse consequences of overcrowding on environmental health and safety, medical care, and violence within institutions. In addition to court battles, journalistic accounts also offer powerful, if impressionistic, evidence of the impact of HIV on prisons (Applebome, 1989; Boodman, 1989; Lambert, 1989), as do writings of prisoners themselves (Starchild, 1989).
When evidence from all of these sources is adduced, it is not a simple matter to sort out the impact of HIV on prisons versus that of overcrowding, other threats to health and safety, and the lack of funds, equipment, and trained health care personnel. Some aspects of prison life related to transmission of HIV, such as drug use and sexual activity behind bars, are not readily subject to scrutiny. Institutional administrators, who control the access of researchers to prison facilities, are reluctant to even admit that such activities occur. Prisoners themselves are unwilling to share information about activities that might subject them to further sanctions. Information about the impact of AIDS on jails and juvenile detention centers is especially difficult to obtain, partly because of the rapid turnover of people detained in those institutions.