HIV/AIDS and HCV in Prisons
A Select Annotated Bibliography

Housing of HIV-Positive Prisoners

Correctional Service Canada (1994). HIV/AIDS in Prisons: Final Report of the Expert Committee on AIDS and Prisons. Ottawa: Minister of Supply and Services Canada.

At 37-41, contains an analysis of the question whether prisoners with HIV should be housed separately from the general prison population. Recommends that prisoners with HIV or AIDS should be housed with the general population and should have the opportunity to participate in the same educational, job and vocational programs as any other prisoner.

Lines R (1997/98). The case against segregation in "specialized" care units. Canadian HIV/AIDS Policy & Law Newsletter, 3(4)/4(1): 30-32

www.aidslaw.ca/Maincontent/otherdocs/Newsletter/Winter9798/25LINES2E.html.

Patterson S et al. (2000). Drug-susceptible Tb outbreak in a state correctional facility housing HIV-infected inmates - South Carolina, 1999-2000. Morbidity and Mortality Weekly Review, 49(46): 1041-1044.

Segregating HIV-positive prisoners in a South Carolina prison contributed to a tuberculosis outbreak in which 71% of prisoners residing in the same housing area either had new tuberculosis skin-test conversion or developed tuberculosis disease. Thirty-one prisoners, and 1 medical student in the community's hospital, subsequently developed active tuberculosis

Spaulding A et al. (2002). Human immunodeficiency virus in correctional facilities: a review. Clinical Infectious Diseases 35: 305-312.

States that some correctional institutions attempt to segregate known HIV-positive prisoners to "contain" the epidemic - correctional staff might know to be "more careful" around certain persons. According to Spaulding et al, this approach will miss seroconverting persons who are in the "window" period (i.e., the period after infection and before antibodies can be detected by current testing methods). Correctional-officer unions in several countries have lobbied for disclosure of the HIV status of prisoners, but ignoring universal precautions when interacting with HIV-negative prisoners may increase the risk of occupational exposure to hepatitis B and C as well as primary HIV infection by providing a false sense of security.

Compassionate Release, Release Planning, and Aftercare

Compassionate Release

Anonymous (1995). Zambia releases prisoners with HIV. AIDS Analysis Africa, 5(5): 1.

Reports that a spokesperson for the Zambia Prison Service has said that prisoners with AIDS are being released due to the spread of HIV in prisons. Zambian law permits the release of inmates who are terminally ill. A medical examination is required before admission to prisons. If AIDS is detected, the prison authorities recommend release. In 1995, 10 prisoners were released. The exact number of inmates with AIDS is not known but is thought to be very large.

Meerkotter A, Gerntholtz L (2004). Submission on the early release of prisoners with HIV/AIDS to the Jali Commission. Johannesburg: AIDS Law Project and Treatment Action Campaign.

Available via www.alp.org.za/.

Release Planning and Aftercare

Arlene T et al. (2005). The potential use of directly observed therapy (DOT) for the treatment of HIV-positive individuals being released from prison. Journal of Correctional Health Care, 11(2).

HIV-positive individuals being released from prison can have difficulty with adherence to highly active antiretroviral therapy (HAART). This supports the need for programs to improve medication adherence. This study explored the perceived acceptability of HIV directly observed therapy (DOT) among 25 HIV-positive individuals with a history of incarceration. Study subjects were recruited from an urban, hospital-based HIV clinic and completed an interviewer-administered questionnaire. Eighty-four percent felt that DOT would help them in some way and 76% would consider participating in a DOT program. Potential barriers to DOT included frequency of visits and meeting place.

Babaei A, Afshar P (no date) A study of the effects of after-care services on drug demand of drug users after leaving prison and their return rate. Tehran, Iran: Unpublished paper on file with author.

This document summarizes the results of an after-care project undertaken at the Central Prison of Mashhad, Iran. The objectives were to study the effects of after-care services on drug demand and on recidivism of drug users who leave the prison. The study showed a positive effect on both drug demand and recidivism.

Braithwaite R et al. (2003). Corrrection demonstration project: improving continuity of care for HIV-infected offenders returning to the community. Presebtation at the 131^st Annual Meeting of APHA, 15-19 November 2003 (abstract no. 64376).

The Corrections Demonstration Project was funded by the Centers for Disease Control and Prevention and the Health Resources and Services Administration to support demonstration projects within correctional facilities and the community that develop comprehensive medical, mental health, and social services for HIV-infected inmates and those at risk for contracting HIV/AIDS. Specifically, one city and six state departments of public health were funded to offer enhanced discharge planning and community case management services to prisoners who are transitioning into the community. An Evaluation and Program Support was funded to oversee the design of a scientifically sound cross-site evaluation of these projects based on shared instruments. The quantitative evaluation was divided into two parts-aggregate data collection to measure the volume of services provided through all the program components and a longitudinal client-level evaluation of the discharge planning and community case management intervention only. This presentation described clients' self-reported utilization of medical and mental health care services and alcohol and drug treatment during the first six months post-release as compared to their utilization of these services prior to incarceration.

Burrows J et al. (2000). The nature and effectiveness of drugs throughcare for released prisoners. London: Home Office Research, Development and Statistics Directorate (Research Findings No. 109).

Available via http://www.homeoffice.gov.uk/rds/rf2000.html

The authors undertook a study examining the nature of drugs throughcare for severely drug dependent prisoners who were eligible for prison treatment. (Drugs throughcare relates to the treatment and support offered to prisoners making the transition from prison to the community. Most of the prisoners had experienced drug problems before imprisonment. Half were offered help to obtain treatment on release, but only 11% had a fixed appointment with a drug agency. The study points out that unless treatment is maintained in the community, offenders are likely to relapse, returning to crime and to prison. Four months after their release, 86% reported that they had used some form of drug. About half were using heroin every day. The study makes recommendations about how to improve throughcare.

Costall P (1999). After-Care for Drug Using Prisoners in London. A report prepared for the Baring Foundation. London, UK: Cranstoun Drug Services

De Leon G et al (2000). Motivation for treatment in a prison-based therapeutic community. American Journal of Drug and Alcohol Abuse, 26 (1): 33-46.

Current research concludes that participation in post-prison aftercare is critical to the effectiveness of prison-based therapeutic community (TC) treatment. This conclusion makes it imperative to understand the client determinants of retention in prison treatment, particularly continuance in post-prison aftercare. Currently, however, little data exist as to client predictors of seeking and remaining in prison-based TCs or entering post-release aftercare. In the present study, significant relationships were obtained between initial motivation, retention, aftercare and outcomes in a sample of substance abusers treated in a prison-based TC program. Implications are discussed for theory, research and treatment policy.

Flanigan TP et al. (1996). A prison release program for HIV-positive women: linking them to health services and community follow-up. American Journal of Public Health, 86: 886-887.

Good discharge planning, initiated well before prison release, reduced the rate of recidivism at 12 months among HIV-positive Rhode Island women from 39% to 17%

Fox A (2000). Prisoners' Aftercare in Europe: A Four-Country Study. London: The European Network for Drug and HIV/AIDS Services in Prison (ENDHASP), Cranstoun Drug Services.

The purpose of the study is to identify and describe examples of best practices in prisoner aftercare in Austria, Sweden, the Netherlands, and Scotland.

Freudenberg N et al. (2005). Coming Home From Jail: The Social and Health Consequences of Community Reentry for Women, Male Adolescents, and Their Families and Communities. Am J Public Health, 95: 1725-1736.

Each year, more than 10 million people enter US jails, mostreturning home within a few weeks. Because jails concentratepeople with infectious and chronic diseases, substance abuse,and mental health problems, and reentry policies often exacerbatethese problems, the experiences of people leaving jail may contributeto health inequities in the low-income communities to whichthey return.This study of the experiences in the year after release of 491adolescent males and 476 adult women returning home from NewYork City jails shows that both populations have low employmentrates and incomes and high rearrest rates. Few received servicesin jail. However, overall drug use and illegal activity declinedsignificantly in the year after release. Postrelease employmentand health insurance were associated with lower rearrest ratesand drug use. Public policies on employment, drug treatment,housing, and health care often blocked successful reentry intosociety from jail, suggesting the need for new policies thatsupport successful reentry into society.

Grinstead O et al. (1999). Reducing post-release HIV risk among male prison inmates: a peer-led intervention. Criminal Justice and Behavior, 26: 453-465.

Described the HIV risk behavior of men being released from prison and tested the effectiveness of a peer-led prerelease HIV prevention intervention designed to reduce postrelease HIV risk behavior. Male prison inmates within 2 weeks of release were recruited to evaluate a prerelease HIV prevention intervention. A total of 414 Subjects were randomly assigned to the intervention group or to a comparison group. The intervention consisted of an individual session with an inmate peer educator. All subjects completed a face-to-face survey at baseline; high rates of preincarceration at-risk behavior were reported. Follow-up telephone surveys were completed with 43% of subjects. Results support the effectiveness of the prerelease intervention. Subjects who received the intervention were significantly more likely to use a condom the first time they had sex after release from prison and also were less likely to have used drugs, injected drugs, or shared needles in the first 2 weeks after release from prison. Implications for the development, implementation, and evaluation of prison-based HIV prevention programs are discussed.

Grinstead O, Zack B, Faigekes B (2001). Reducing post-release risk behaviour among HIV seropositive prison inmates: the health promotion program. AIDS Education and Prevention, 13: 109-119.

The authors designed an eight-session prerelease intervention for HIV-positive prisoners to decrease sexual and drug-related risk behaviour and to increase use of community resources after release. The intervention sessions were delivered at the prison by community service providers. The authors found that a prerelease risk reduction intervention for HIV seropositive inmates was feasible. Descriptive results support the effectiveness of the program in reducing sexual and drug-related behaviours and in increasing use of community resources after release. Compared with men who signed up for the intervention but were unable to attend, men who received the intervention reported more use of community resources and less sexual and drug-related risk behaviour in the months following release.

Hennebel L, Fowler V, Costall P. ENDSP 2002 Research Project: Supporting Families of Drug-Dependent Offenders. Connections 2003; 13: 5-6.

Available via http://www.endipp.net/index.php?option=com_remository&Itemid;=39&func;=fileinfo&filecatid;=16&parent;=category.

The aim of the research was to examine support services that are available to families of drug-dependent prisoners in Belgium, The Netherlands, the Czech Republic and Britain. The specific objectives were to explore what support services are currently offered and received by families of drug-dependent prisoners; what types of support are reported as valued and desired by drug-dependent prisoners and their families; and reported outcomes of family support on drug-dependent prisoners. Families, prisoners and services interviewed stated that specific support should be provided to prisoners and families during the three periods of imprisonment: arrest and first months of incarceration; imprisonment; and release. The study makes several recommendations.

Hiller ML, Knight K, Simpson DD (1999). Prison-based substance abuse treatment, residential aftercare and recidivism. Addiction, 94 (6): 833-842.

The study examined the impact of residential aftercare on recidivism following prison-based treatment for drug-involved offenders. It concluded that therapeutic community treatment, especially when followed by residential aftercare, is effective for reducing post-release recidivism rates. Corrections-based treatment policy should emphasize a continuum of care model (from institution to community) with high quality programs and services.

Jarvis LA, Beale B, Martin K (2000). A client centered model: discharge planning in juvenile justice centers. School of Health and Nursing, University of Western Sydney, 47(3): 184-90.

Jouven C (1995). The antennes toxicomanies and the quartier intermédiaire sortants. Report of the 2nd Seminar of the European Network of Services for Drug Users in Prison. Prisoners Resource Service: London, at 20.

In 1985, the Antenne Toxicomanie program was established at Fresnes prison by the Ministry of Health and Social Affairs. This led to the development of 18 other Antennes throughout France. A pre-release program was created at Fresnes in 1992, the Quartier Intermédiaire Sortants (QIS). For several years drug users have been arriving in prison in a worse and worse state, in terms of health (40% of QIS participants are HIV positive), of psychological and social problems. Life outside the prison has become so hellish for the majority of them that release is often more stressful than entering the prison. The recidivism rate has therefore risen. The QIS holds 10 people for the 4 weeks preceding their release. 80% of the participants are drug users. The four weeks are devoted respectively to issues related to health, family, psychology and psychiatry, and to the capacity to be alone. The participants work in groups with workers from outside the prison and play sport in the afternoon. In this program we give the participants back a feeling of being full citizens who have fundamental rights (to housing, to social insertion, to information, to have their say and to have their differences respected). On the whole, this program has had positive results. 80% of those leaving the QIS have followed the plans made for them and 50% of those who were in the habit of returning to prison within six months have not come back. The QIS program is going to be introduced in other French prisons.

Kennedy SS et al. (2004). Improving access to and utilization of health and social services for HIV-infected jail and prison releasees: evaluation results from the Corrections Demonstration Project funded by the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA). The XV International AIDS Conference (Poster Exhibition Abstract no. ThPeE7996).

The Corrections Demonstration Project expands HIV services for inmates and releasees of jails/prisons. Between February 2000 and September 2003, 6 states served 1944 prison inmates and 3335 jail inmates. 49% of prison and 54% of jail clients were released and served in the community. About 20% participated in the evaluation. Prison releasees (n=247) were significantly more likely to see an HIV care provider (p=0.0001), take HIV medicine (p=0.0001) or get drug/alcohol treatment (p=0.02) in the month after release than before arrest. The study concluded that discharge planning can help prison clients learn about and use community services they otherwise would not be able to access. In contrast, jail releasees (n=237) were less likely to use services in the month after release than in the 6 months before arrest. Jail inmates may have had community care more recently and the care provided during short jail stays may have made it unnecessary to seek care immediately upon release. The study recommened that public health agencies, NGOs, jails and prisons should develop transitional programs to provide HIV-positive inmates with intensive case management before and after release to improve access to services. These programs should be tailored to meet the different postrelease needs of jail and prison clients.

Kim JY et al. (1997). Successful community follow-up and reduced recidivism of HIV positive women prisoners. Journal of Correctional Health Care, 4: 1-9.

Klein SJ et al. (2002). Building an HIV continuum for inmates: New York State's Justice Initiative. AIDS Education and Prevention, 14(5 Supp: HIV/AIDS in Correctional Settings): 114-123.

The benefits of public health, corrections, and community-based organization (CBO) collaboration to meet HIV prevention needs of inmates are recognized. Each year over 100,000 inmates, most of whom have a history that put them at HIV risk, pass through the New York State (NYS) prison system. The NYS Department of Health AIDS Institute, the NYS Department of Correctional Services, the NYS Division of Parole, and a statewide network of CBOs collaborate to meet HIV prevention and support services needs of inmates and parolees through a continuum of interventions and services. This article describes the evolution of the prevention, supportive services, and transitional planning continuum. It identifies obstacles to service delivery, describes approaches to overcome them, discusses ways to meet capacity building and technical assistance needs of CBOs, identifies challenges remaining, and provides practical advice from actual experience in NYS.

Lanier M, Paoline E (2005). Expressed needs and behavioral risk factors of HIV-positive inmates. International Journal of Offender Therapy and Comparative Criminology, 49(5): 561-573.

This pilot study compares the needs of HIV-positive male and female jail detainees. Results illustrate surprisingly few differences between men and women and their HIV-related needs. The primary need identified for both males and females was postrelease housing. Somewhat unexpectedly, HIV treatment and care ranked low on the list of needs. The implications of these findings are discussed.

Loingsigh O (2004). Getting Out, Staying Out. The experiences of prisoners upon release. Dublin: Community Technical Aid, 2004.

www.expac.ie/textfiles/Get.pdf

Discusses the range of problems prisoners face upon release (including problems related to drug use and health issues, including HIV and HCV) and recommends that a proper system of information for prisoners upon their release and proper referral to different agencies and supports be set up.

Martin S et al (1999). Three-year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: from prison to work release to aftercare. Prison Journal, 79(3): 294-320.

Myers J et al. (2005). Get connected: an HIV prevention case management program for men and women leaving California prisons. Am J Public Health, 95: 1682-1684.

Individuals leaving prison face challenges to establishing healthylives in the community, including opportunities to engage inbehavior that puts them at risk for HIV transmission. HIV preventioncase management (PCM) can facilitate linkages to services, whichin turn can help remove barriers to healthy behaviour. As part of a federally funded demonstration project, the community-basedorganization Centerforce provided 5 months of PCM to individualsleaving 3 state prisons in California. Program effects weremeasured by assessing changes in risk behavior, access to services,reincarnation, and program completion. Although response ratespreclude definitive conclusions, HIV risk behaviour did decrease.Regardless of race, age, or gender, those receiving comprehensivehealth services were significantly more likely to complete theprogram. PCM appears to facilitate healthy behaviour for individualsleaving prison.

Pratt L et al. (1995). Discharge planning needs of incarcerated women living with HIV. HIV Infected Women Conference, S14.

Incarcerated women living with HIV are reincarcerated many times despite intensive one-on-one discharge planning with their medical provider and with a discharge planning counsellor. The authors explored the reasons why discharge planning that includes linkage with drug treatment programs, housing programs and medical follow up may fail to meet the needs of HIV seropositive women. They interviewed 29 HIV seropositive women who were close to their date of release from prison. 27 (93%) indicated that they had plans for drug treatment after discharge. Eight (28%) of the women were planning to live at a residential drug treatment program, four (14%) were planning to live at their own apartment and 17 (58%) were unable to identify an independent living arrangement. Eight (28%) of the women could not identify someone they could count on for emotional support after discharge. Finally, 16 (55%) had no plans for medical follow up after discharge. The authors will present data on recidivism and on success linkages to services after discharge from follow up interviews conducted six months after each woman's discharge from prison.

Rich JD et al. (2001). Successful linkage of medical care and community services for HIV-positive offenders being released from prison. Journal of Urban Health, 78: 279-289.

Project Bridge is a federally funded demonstrationproject that provides intensive case management for HIV-positiveex-offenders being released from the Rhode Island state prisonto the community. The program is based on collaboration betweencolocated medical and social work staff. The primary goal is to increase continuity of medical care throughsocial stabilization; it follows a harm reduction philosophyin addressing substance use. Program participants are providedwith assistance in accessing a variety of medical and socialservices. The treatment plan may include the following: mentalillness triage and referral, substance abuse assessment andtreatment, appointments for HIV and other medical conditions,and referral for assistance to community programs that addressbasic survival needs. In the first 3 years of this program,97 offenders were enrolled. Injection drug use was reportedby 80% of those enrolled. 90% were followed for 18 months,7% moved out of state or died, and 3% were lost to follow-up.Reincarceration happened to 48% at least once. Of those expressinga need, 75% were linked with specialty medical care in the community,and 100% received HIV-related medical services. The article concludes that ProjectBridge has demonstrated that it is possible to maintain HIV-positiveex-offenders in medical care through the provision of ongoingcase management services following prison release. Ex-offenderswill access HIV-related health care after release when givenadequate support.

Richie BE, Freudenberg N, Page J (2001). Reintegrating women leaving jail into urban communities: a description of a model program. Journal of Urban Health, 78: 290-303.

Women are the fastest-growing population in the criminal justicesystem, and jails reach more people than any other componentof the correctional system. About 1 million women pass throughUS jails each year. Most return to their communities withina few weeks of arrest, and few receive help for the substanceabuse, health, psychological or social problems that contributeto incarceration. The authors describe a model program, Health Link,designed to assist drug-using jailed women in New York Cityto return to their communities, reduce drug use and HIV riskbehavior, and avoid rearrest. The program operates on four levels:direct services, including case management for individual womenin the jail and for 1 year after release; technical assistance,training, and financial support for community service providersthat serve ex-offenders; staff support for a network of local service providers that coordinate services and advocate forresources; and policy analysis and advocacy to identify andreduce barriers to successful community reintegration of womenreleased from jail. The authors describe the characteristics of 386 womenenrolled in Health Link in 1997 and 1998; define the elementsof this intervention; and assess the lessons learnedfrom 10 years of experience working with jailed women.

Roberts CA et al. (2002). Discharge planning and continuity of care for HIV-infected prison inmates in the U.S.: a survey of ten states. The XIV International AIDS Conference, Abstract no. MoPeE3794 (Poster Exhibition).

This study examines discharge planning policies and practices for HIV-positive inmates in 10 states. It outlines policy, organizational and operational issues and successful strategies. It found that most of the prison systems offered pre-release discharge planning services to HIV-positive prisoners, but the scope and availability of services varied greatly. Lessons for program design include: dedicating staff to provide pre-release planning; arranging for state public health department collaboration and oversight of continuity of care; and establishing collaborations with CBOs that meet with inmates prior to release and follow up with them in the community. The study concluded that collaboration between corrections, public health, and CBOs is an effective strategy for facilitating continuity of medical and social services for inmates in transition. The discharge plan should cover continuity of care, medications, and connections to case management, housing, benefits and mental health and substance abuse treatment.

Skolnick AA (1998). Correctional and community health care collaborations. Journal of the American Medical Association, 279: 98-99.

Good discharge planning, initiated well before prison release, reduced the rate of recidivism at 2 years for a Massachusetts jail cohort from 72% to 49%.

Vigilante KC et al. (1999). Reduction in recidivism of incarcerated women through primary care peer counseling and discharge planning. Journal of Women's Health, 8: 409-415.

Not only does discharge planning and linkage to community aftercare maintain continuity of medical care, it also facilitates ongoing secondary prevention efforts and may reduce recidivism.

Wolitski RJ & the Project START Study Group (2004). Project START reduces HIV risk among prisoners after release. The XV International AIDS Conference, 2004 (Oral Abstract no. WeOrC1296).

Young men (18-29 years of age) were recruited from prisons in 4 US states and systematically assigned to a pre-release single-session intervention (SSI) or an enhanced intervention (EI). The EI consisted of 2 pre-release, 4 post-release (delivered over 12 weeks), and optional sessions based on participant need. Both interventions addressed HIV, STIs, and hepatitis; the EI also addressed re-entry issues such as housing and employment. Interviews were conducted prior to intervention, and at 1 week, 12 weeks, and 24 weeks after release. 522 men (M age = 23 years, SD = 2.7) were included in the intent-to-treat analysis. Follow-up rates ranged from 79% to 86%. Unprotected vaginal/anal sex during the 90 days prior to incarceration was reported by 86% of men in the EI and 89% in the SSI (OR = 0.78, 95%CI=0.46, 1.32). At follow-up, unprotected vaginal/anal sex was not significantly different before all EI sessions were delivered (69% EI vs 77%, SSI at 12 weeks, OR = 0.55, CI=0.26, 1.16), but was significant at 24 weeks (68% EI vs 78% SSI, OR = 0.40, CI=0.18, 0.87). No significant site difference in treatment effect was observed. Project START demonstrates the feasibility of an intervention that bridges incarceration and re-entry into the community. The EI led to a significant reduction in unprotected vaginal/anal sex among male prisoners, protecting them and their partners from HIV and STIs.

Zack B et al. (2004). Housing is associated with better outcomes among individuals transitioning from prison setting to the community. The XV International AIDS Conference, Abstract no ThPeC7478 (Poster Exhibition).

This study examined whether an intensive case management intervention provided as part of a US demonstration project by the NGO Centerforce was successful in facilitating healthy behavior. The authors examined whether HIV risk and return to prison were reduced by receipt of a range of social services, including HIV prevention counseling. Individuals were enrolled 2 months prior to release in three California prisons and received 5 months of intensive case management (pre and post release from prison). The authors assessed changes in HIV risk behavior, health status, receipt of a range of social services and return to prison or jail with two interviews, administered at one- and ten-weeks post release, and with reports from case managers. They compared 53 men's and 35 women's behavior prior to incarceration to behavior post-release. They found that securing housing, participating in job training and receipt of medical treatment were independently associated with program retention (p<.05). Housing was also associated with a lower likelihood of return to a correctional facility (p<.05). Receipt of prevention counseling was not independently associated with decreases in risk behavior. However, program participants reported greatly decreased drug and alcohol use and sex risk taking during program participation. The authors concluded that participating in an intensive case management program appears to facilitative healthy behavior among individuals transitioning from prison settings to the community. Securing housing in particular is associated with better health outcomes in this population.

Zurhold H, Stöver H, Haasen C (2004). Female drug users in European Prisons - best practice for relapse prevention and reintegration (PDF Version). Hamburg: Centre for Interdisciplinary Addiction Research, University of Hamburg.

Executive summary available at
www.zis-hamburg.de/Female_prisoners_executive_summary_2004.pdf.
This 12-month study provides an overview of current prison policy and practice concerning adult female drug users in European prisons. The objectives were to fill the information gap concerning the extent of the problem; and the availability of drug services for this population across Europe.

Alternatives to Imprisonment

Belenko S (2001). Research on Drug Courts: A Critical Review. 2001 Update. New York: National Centre on Addiction and Substance Abuse.

A review of studies on drug courts in the US. Reports that drug use and crime are usually significantly reduced during participation, but that long-term effects are less clear. Belenko notes that drug court studies continue to be hindered by short follow-up periods and their tendency to infer the success of the drug court by relying on data for those who graduate from the programs, rather than for all those who participate.

European Monitoring Centre for Drugs and Drug Addiction (1998). Study on Alternatives to Prison in Cases of Drug Addiction. Lisbon: EMCDDA.

Available via www.emcdda.eu.int/.

This study on alternative to prison for drug offenders reveals that all EU Member States foresee alternative measures to prison for drug addicts. The research describes the application of such measures and provides elements to enable comparison between legislation and the practical application of alternatives to prison. Until now, few studies have assessed the application of these measures, and evaluating the effectiveness of such measures compared to the results of custodial sentences poses methodological and theoretical difficulties.

Fischer B, Roberts JV, Kirst M (2002). Compulsory drug treatment in Canada: historical origins and recent developments. European Addiction Research, 8: 61-68.

In Canada, illicit drug use and addiction have traditionally been considered as a criminal justice problem and have been addressed from a legal perspective. Over the past century, a medical approach to drug addiction has slowly crept into the criminal justice processing of drug offenders. This has happened through the combination of principles of punishment with principles of addiction treatment in the sentencing of drug offenders to create a distinct application of 'compulsory drug treatment' in Canada. However, this evolution has occurred sporadically over time, with punishment and coercion as predominantly the main approach to dealing with this population. This evolution has recently culminated in Canada with the development of two criminal justice approaches to dealing with the substance use problems of drug offenders that incorporate concepts of punishment and treatment more equally than ever before - conditional sentencing and drug courts. This paper outlines the historical evolution of concepts of 'compulsory treatment', discusses such examples of contemporary 'compulsory treatment' as conditional sentencing and drug courts, and analyses the implications, concerns and challenges associated with these tools currently used in the sentencing of drug offenders in the Canadian context.

Fluellen R, Trone J (2000). Do drug courts save jail and prison beds? New York: Vera Institute of Justice.

Available via http://www.vera.org/.

Brief review of research on drug courts and their impact.

Freudenberg N. (2001). Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health. Journal of Urban Health, 78: 214-235.

This review examines the interactions between the correctionalsystem and the health of urban populations. Cities have morepoor people, more people of color, and higher crime rates thansuburban and rural areas; thus, urban populations are overrepresentedin the nation's jails and prisons. As a result, US incarcerationpolicies and programs have a disproportionate impact on urbancommunities, especially black and Latino ones. Health conditionsthat are overrepresented in incarcerated populations includesubstance abuse, HIV and otherinfectious diseases, perpetration and victimization by violence,mental illness, chronic disease, and reproductive health problems.Correctional systems have direct and indirect effects on health.Indirectly, they influence family structure, economic opportunities,political participation, and normative community values on sex,drugs, and violence. Current correctional policies also divertresources from other social needs. Correctional systems canhave a direct effect on the health of urban populations by offeringhealth care and health promotion in jails and prisons, by linkinginmates to community services after release, and by assistingin the process of community reintegration. Specific recommendationsfor action and research to reduce the adverse health and socialconsequences of current incarceration policies are offered.

Goldkamp JM et al. (2001). Do drug courts work? Getting inside the drug court black box. Journal of Drug Issues, 31: 27-72

Hall W (1997). The Role of Legal Coercion in the Treatment of Offenders with Alcohol and Heroin Problems. Technical Report No. 44. Sydney: National Drug and Alcohol Research Centre.

The paper discusses the ethical justification and reviews the US evidence on the effectiveness of treatment for alcohol and heroin dependence that is provided under legal coercion to offenders whose dependence has contributed to the commission of the offence with which they have been charged or convicted. Among the arguments that have been made for providing such treatment under legal coercion is the "desirability of keeping heroin users out of prisons as a way of reducing the transmission of infectious diseases such as HIV and hepatitis."

Kirkby C (2003). Drug treatment courts in Canada: Who benefits? In: Thomas G (ed). Perspectives on Canadian Drug Policy: Volume II. Kingston: The John Howard Society of Canada.

Available at www.johnhoward.ca/document/drugs/perspect/volume2/cover.htm.

Critically explores the question: who benefits from drug treatment courts (DTCs)? It begins with a brief overview of DTCs and the structure they have taken in Canada to date. It then critically examines the claim that DTCs are beneficial to both DTC clients and society, finding that the benefits to both may be overstated by supporters of DTCs. The paper then examines whether there is an alternative explanation for the increasing popularity of DTCs in Canada. Finally, the paper discusses whether there is a better, less intrusive option for achieving the stated goals of DTCs.

Huddleston CW et al. (2005). Painting the Current Picture: A National Report Card on Drug Courts and Other Problem Solving Court Programs in the United States. Volume 1, Number 2. Washington: National Drug Court Institute.

Available via http://www.ndci.org/publications.html

Mauser E, Van Stelle K, Moberg D (1994). The economic impact of diverting substance-abusing offenders into treatment. Crime & Delinquency, 40(4), 568-588.

Recognizing the relationship between substance abuse and criminal behaviour, the Wisconsin legislature in 1989 mandated the establishment of the Treatment Alternative Program (TAP) modelled after the national Treatment Alternatives to Street Crime program. This study evaluates the economic impact of TAP by examining the benefits and costs and cost-effectiveness of diverting offenders from the criminal justice system into substance abuse treatment. The results suggest that the benefit of TAP outweigh its costs in the short run and TAP costs less than incarcerating offenders.

National Drug Court Institute (2002). Drug Court Publications Resource Guide. Fourth Edition. Alexandria, VA: NDCI.

Available via http://www.ndci.org/publications.html

Peele S (2000). Court-ordered treatment for drug offenders is much better than prison: Or is it? Reconsider Quarterly, Winter 2000-2001: 20-23.

Available at www.peele.net/lib/court.html.

Argues that "the idea that treatment in place of prison is inevitably beneficial is so naïve and wrong-headed that it must be challenged each time it is introduced - even when done so by drug policy reformers who are right that imprisoning both casual users and addicts is a horrible mistake." This article describes in both theoretical and practical terms just how ineffective therapy may be, as well as some "truly horrible outcomes" from coercive therapy.

Rydell CP, Caulkins JP, Everingham SE (1996). Enforcement or treatment? Modeling the relative efficacy of alternatives for controlling cocaine. Operations Research, 44:687-695.

Stern V (ed). Alternatives to Prison in Developing Countries. London: International Centre for Prison Studies, King's College, University of London.

See http://www.kcl.ac.uk/depsta/rel/icps/publications.html for order information.

In many developing countries there are few alternatives to imprisonment. In this book Vivien Stern shows that in placing prison at the centre of their legal system many developing countries are following models imposed from elsewhere. Case studies and detailed appendices provide legislative and administrative guidance that will be a valuable tool for practitioners in developing countries and a stimulus to those in the West.

Stevens A (2003). QCT Europe - Review of the Literature in English (MS Word Document). Canterbury, UK: European Institute of Social Services.

www.kent.ac.uk/eiss/Documents/word_docs/English%20short%20review%201.doc

This is a review of the literature that has been published in English on quasi-compulsory treatment (QCT) of drug dependent offenders. QCT is defined as treatment of drug dependent offenders that is motivated, ordered or supervised by the criminal justice system and takes place outside regular prisons.

Wood E at al. (2003). The healthcare and fiscal costs of the illicit drug use epidemic: the impact of conventional drug control strategies and the impact of a comprehensive approach. British Columbia Medical Journal, 45: 130-136.

This review outlines some of the health and fiscal costs of the injection drug use epidemic. Furthermore, it summarizes research to date on the impact and limitations of two of British Columbia's primary conventional approaches to address the drug problem: law enforcement and needle exchange. Finally, it reviews the available research on more controversial programs (such as heroin prescription and safer injecting facilities) that have successfully been employed elsewhere, and argues that a comprehensive approach that incorporates harm reduction programs and expanded drug treatment are required to reduce the fiscal and social costs of the drug use epidemic.

Wood et al. (2004). Inability to access addiction treatment and risk of HIV infection among injection drug users. Journal of Acquired Immune Deficiency Syndrome, 36: 750-754.

94% of the nearly $500 million allocated annually to Canada's illicit drug strategy has been spent on enforcement-based interventions. As a result, lack of funds for addiction treatment has meant demand for substance abuse treatment among illicit drug users has exceeded availability. This study evaluated whether IDUs who reported being unable to access addiction treatment were at elevated risk of HIV infection. A prospective analysis was done of factors associated with syringe borrowing by baseline HIV-negative IDUs among participants enrolled in the Vancouver Injecting Drug Users Study (VIDUS). Overall, 1157 HIV-negative IDUs were enrolled into the VIDUS cohort between May 1996 and May 2002. Unsuccessful attempts to access addiction treatment were associated with reporting syringe borrowing during follow-up. Inability to access addiction treatment was independently associated with syringe borrowing among HIV-negative IDUs at risk for HIV infection. These findings suggest that the limited provision of addiction treatment may result in a major missed opportunity to reduce HIV transmission behavior among IDUs and that the expansion of addiction treatment services has major potential to reduce the substantial human and fiscal costs of HIV infection.

Prison Populations with Particular Needs

This section only contains some of the most relevant resources specific to youth, women, Aboriginal and transsexual/transgender offenders. Other sections in the bibliography, such as the section on HIV and HCV prevalence and risk behaviours, contain additional resources.

Young Offenders

Batelaan L (1996). HIV/AIDS in Youth Custody Settings: A Comprehensive Strategy. Toronto: PASAN.

Available via www.pasan.org.

Contains 37 recommendations about what should be done in young offender facilities to address the issues related to HIV/AIDS.

Bird A et al. (1993). Study of infection with HIV and related risk factors in young offenders' institutions. British Medical Journal, 308: 228-231.

The objective was to estimate the prevalence of infection with HIV in young offenders in Scotland and to obtain information about related risk factors and previous tests for HIV. A voluntary anonymous study was conducted; 421 of 424 male subjects gave saliva samples for testing for HIV and then completed questionnaires about risk factors. 68 (17%) of prisoners admitted misuse of intravenous drugs, of whom 17 (25%) admitted having injecting drugs while in prison. Three subjects admitted having anal intercourse while in prison. No saliva samples tested positive for antibodies to HIV, but 96 prisoners requested a confidential personal test for HIV as a result of heightened awareness generated by the study. The study concluded that voluntary, anonymous HIV surveys can achieve excellent compliance in the prisons, and that the interest generated by the study suggests that prisons may be suitable for providing education and drug rehabilitation for a young male population at high risk for future infection with HIV.

Calzavara LM et al. Prevalence and predictors of HIV and hepatitis C in Ontario jails and detention centres. Final report. HIV Social, Behavioural, and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto, 8 February 2005.

(see also supra, under "HIV and HCV Prevalence and Risk Behaviours)

Carelse M (1994). HIV prevention and high-risk behaviour in juvenile correctional facilities. AIDS Health Promotion Exchange, (4): 14-16.

Cope N (2000). Drug use in prison: the experience of young offenders. Drugs: education, prevention and policy, 7(4): 355-366.

This article explores young offenders' drug use in prison. Qualitative research with prisoners highlighted the importance of understanding drug use in prison as a continuum of behaviour, where prisoners' drug use inside was related to their drug use before custody. The prisoners made choices and decisions around their drug use inside, considering the compatibility of drugs with the prison environment and their need to seek the 'right high'. Availability of drugs was crucial and the article discusses the routes of drug supply into prison via visits and the informal prison economy, where the distribution of drugs was facilitated by close prisoner friendship networks.

Crosby R et al. (2004). Health risk factors among detained adolescent females. American Journal of Preventive Medicine, 27(5): 404-410.

This study aimed to identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. 197 adolescent females (aged 14 to 18 years) were recruited in eight detention facilities. The study concluded that preventive medicine programs for adolescent females in detention facilities are warranted.

Freedman D et al. (2005). Environmental barriers to HIV prevention among incarcerated adolescents: A qualitative assessment. Adolescence, 40 (158): 333-343.

The purpose of this research was to identify environmental factors that influence incarcerated adolescents' risk for HIV/STDs.

Johnson PT et al. (2004). Treatment need and utilization among young entering the juvenile correction center. Journal of Substance Abuse Treatment, 26(2): 117-122.

Relatively little is known about the substance abuse treatment need patterns and experiences of youth incarcerated in the United States juvenile justice system. To address this issue, four analytic questions concerned with understanding the predictors of treatment need and utilization patterns among adolescents entering the juvenile corrections system are examined. Data analyzed were collected as part of a face-toface survey of 401 youth who entered the Illinois juvenile correctional system in mid-2000.

Magura S et al. (1994). Intensive AIDS education for male adolescent drug users in jail. Journal of Adolescent Health, 15: 457-463.

The purpose of this study was to conduct and evaluate an intensive AIDS education program for incarcerated male adolescent drug users. The study was conducted in New York City's main jail facility for detained and sentenced male youths ages 16-19. A four-session, group-orientated AIDS education program based on Problem-Solving Therapy was conducted. The program was voluntary and all youths on designated dormitories were invited to participate. The evaluation compared youths participating in the AIDS education with waiting list controls who were discharged or transferred before they could be offered the education. Behavioural outcomes for AIDS education participants and controls were determined at a five-month follow-up after release from jail. Behaviours were measure through personal interviews at baseline and follow-up. High rates of HIV risk behaviours were documented, including alcohol, marijuana and cocaine/crack use that may predispose youths to sexual risk-taking: practice of heterosexual anal sex; multiple and high-risk sexual partners; and no, or inconsistent use of condoms. Education participants as compared with controls were significantly more likely to increase their condom use, to increase positive attitudes towards condoms, and possibly to decrease high-risk sexual partnerships. However, other sexual risk variables and substance use were unchanged. The study concluded that intensive AIDS education provided in jail can be useful in reducing certain HIV risk behaviours of criminally-involved male adolescents.

Ogilvie EL et al. Hepatitis infection among adolescents in the Melbourne Juvenile Justice centre: Risk factors and challenges. Youth Studies Australia, 19(3): 25-30.

In order to describe patterns of infection with, and risks for, hepatitis A, B and C viruses in male adolescents in the Melbourne Juvenile Justice Centre, the researchers used a cross-sectional serosurvey for hepatitis A, B and C among 90 of the MJJC residents aged 15 to 18 years. The findings show that the residents are vulnerable to exposure to blood-borne viruses from an early age, posing a challenge for health education programs. According to the authors, an opportunity exists for harm minimisation and prevention of the spread of blood-borne viruses within the first year of injecting drug use in this population.

Peres CA et al. (2002). Developing an AIDS prevention intervention for incarcerated adolescents in Brazil. AIDS Education and Prevention, 14(5 Suppl: HIV/AIDS in Correctional Settings): 36-44.

The objective of this study was to investigate knowledge, attitudes, and practices regarding AIDS among incarcerated male adolescents in Brazil and to develop an AIDS prevention intervention for this population. A questionnaire administered to 275 boys in São Paulo covered demographic and social characteristics, drugs, and HIV risk perception and behavior. Subsequently, the study collected qualitative data on the development and implementation of a prevention program. 98% of adolescents were sexually experienced, most initiating by age 13; 22% were fathers. Injection drug use was reported by 5.5%, 12% had exchanged sex for money, 35% had more than 15 partners and 8% had homosexual experience. Although 72% had used condoms, only 9% used them consistently, and only 35% used one in their last intercourse before incarceration. Predictors of condom use included carrying condoms and endorsing the statement "I would use condoms with my girlfriend." Many said their lives include other risks more important than AIDS, such as survival in the crime scene. Initial efforts at prevention based on commonly used approaches of providing information to guide future rational decisions generated limited participation. However, when we worked with them to develop interventions based on their interests and needs, using modalities such as music, hip-hop arts, graffiti, and helping them to create an AIDS prevention compact disk, they responded with enthusiasm. These incarcerated adolescents are at extremely high social risk and report high levels of risk behavior for HIV infection. Interventions for these youth were better received when developed in collaboration with them and based on their beliefs, aspirations, and culture. The intervention that resulted went beyond AIDS to include issues such as violence, drugs, sexuality and human rights.

Siddiqui QU et al. (no date). Peer education programme for juvenile's jail detainees-a unique experience. Juvenile Jail, Karachi, Pakistan; Sindh AIDS Control Program, Karachi, Pakistan.

Templeton DJ (2005). Sexually transmitted infection and blood-borne virus screening in juvenile correctional facilities: A review of the literature and recommendations for Australian centres. J Clin Forensic Med, August 3.

Juveniles in custody are disproportionately affected by sexually transmitted infections (STI) and blood-borne viruses (BBV) due to high rates of risk behaviours. A literature review was undertaken with the aim of providing evidence-based recommendations on STI/BBV screening in Australian juvenile correctional facilities. Relevant research was identified using Premedline and Medline databases, followed by a manual search of reference lists in relevant articles identified in the database search. A total of 36 relevant publications were identified and reviewed. The review showed that STI/BBV knowledge in incarcerated youth is poor and accompanied by high rates of sexual and blood-borne risk behaviours. The prevalence of these infections is considerable. High rates of asymptomatic gonococcal and chlamydial infections exist, which can be easily diagnosed on self-collected specimens using new nucleic acid amplification technology. HIV infections are rare although continued vigilance is needed in view of substantial risk factors for infection. Hepatitis C prevalence is high, although much lower than that of adult prisoners, signifying a possible window of opportunity for Hepatitis C prevention. Many remain at risk of Hepatitis B, and it is important to assess the need for vaccination in this group. It concluded that screening for STI/BBV in incarcerated juveniles is of major public health importance and all individuals should be offered screening in conjunction with risk-reduction education during their admission to juvenile detention centres.

Teplin LA et al. (2003). HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy. American Journal of Public Health, 93(6): 906-12.

Teplin LA et al. (2005). Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees. Psychiatric Services, 56 (7): 823-828.

This study determined the prevalence of HIV risk behaviours of 800 randomly selected juvenile detainees aged ten to 18 years who were initially arrested between 1997 and 1998. The sample included 340 females and 460 males. The study concluded that the juvenile justice and public health systems must provide HIV/AIDS interventions as well as mental health and substance use treatment.

World Health Organization. Promoting the Health of Young People in Custody.

Available in English and Russian via http://www.hipp-europe.org/resources/INDEX.HTM.

A Consensus Statement of the WHO Regional Office for Europe which draws attention to the principles, policies and practices which member countries agree provide the best chance to maintain the health and wellbeing of young people in custodial settings.

Women Prisoners

Boyne SM (1991). Women in prison with AIDS: An assault on the Constitution? Southern California Law Review, 64: 741-796.

The note focuses on the problems women living with HIV/AIDS face in prisons in the US. It argues that the collective harm experienced by women prisoners differs from that of their male counterparts, and includes some examples of the harm that women have experienced.

Braithwaite RL et al (2005). Health disparities and incarcerated women: A population ignored. Am J Public Health, 95: 1679-1681.

Braithwaite RL et al (eds) (2005). Health Issues Among Incarcerated Women. Rutgers University Press.

Contains a chapter on HIV/AIDS-related needs.

Canadian HIV/AIDS Legal Network (2004). Women prisoners and HIV/AIDS (Info sheet 11 in the series of info sheets on HIV/AIDS in prisons). Montreal: The Network, third revised and updated version.

A 2-page info sheet about what must be done to address the issues women prisoners face in the context of HIV/AIDS. Available in English and French via www.aidslaw.ca/Maincontent/issues/prisons.htm. A revised version in Russian will become available in 2006. The second, 2001 edition, is also available in Romanian.

De Groot AS, Cuccinelli D (1997). Put her in a cage: Childhood sexual abuse, incarceration, and HIV infection. In: Manlowe J, Goldstein N (eds). The Gender Politics of HIV in Women: Perspectives on the Pandemic in the United States. NY: New York University Press.

De Groot AS, Leibel SR (1998). Reports from the New England Regional Symposium on HIV Infection among incarcerated women. J. Correctional Health Care, 5(2): 125-127.

De Groot AS, Leibel SR (1998). The need for Compassionate Care: HIV Infection Among Incarcerated Women. Medicine and Health, 81(6): 209-211.

De Groot AS, Leibel SR, Zierler S (1998). A Standard of HIV care for incarcerated women: Northeastern United States' Experiences. J Correctional Health Care, 5(2): 139-177.

De Groot AS et al. (1998). Setting the Standard for Care: HIV Risk Exposures and Clinical Manifestations of HIV in Incarcerated Massachusetts Women. New England Journal of Criminal and Civil Confinement, 24: 353-378.

De Groot AS, Liebel S (2002). Women in Prison. A Standard of HIV Care. In: Altice F, Selwyn P, Watson R (eds). Reaching in, Reaching out. Treating HIV/AIDS in the Correctional Community. Chicago: National Commission on Correctional Health Care.

DiCenso A, Dias G, Gahagan J (2003). Unlocking Our Futures: A National Study on Women, Prisons, HIV, and Hepatitis C. Toronto: PASAN.

The most comprehensive Canadian report on HIV, HCV, and incarcerated women. At www.pasan.org.

Fink MJ et al. (1998). Critical prevention, critical care: gynecological and obstetrical aspects of comprehensive HIV prevention and treatment among incarcerated women. J Correctional Health Care, 5(2): 201-223.

Harris RM et al. (2003). The interrelationship between violence, HIV/AIDS, and drug use in incarcerated women. J Assoc Nurses AIDS Care, 14(1): 27-40.

Hutton HE et al. (2001). HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners. Psychiatric Services, 52(4): 508-513.

Jordan K et al. (2002). Lifetime use of mental health and substance abuse treatment services by incarcerated women felons. Psychiatric Services, 53(3): 317-325.

Lapidus L et al (2004). Caught in the net: The impact of drug policies on women and families. New York: American Civil Liberties Union, Break the Chains, and The Brennan Center at NYU School of Law.

Available via http://nicic.org/Library/020392.

The adverse impacts of drug policies on women and their families are documented. Sections of this report are: executive summary; women and drugs - defining the problem; the historical context of drug policies; today's drug laws - widening the net; the impact of incarceration on women, children, and families; and conclusion and final recommendations. "Women's incarceration for drug offenses not only fails to address the issues which likely contributed to their involvement with drugs, it often exacerbates them."

Magura S et al. (1995). Evaluation of an AIDS education model for women drug users in jail. International Journal of Addiction, 30 (3): 259-273.

This paper reports outcome results of an AIDS education program for drug-using women in jail, of whom the majority were current drug injectors, had high-risk sexual partners, and never used condoms for insertive sex. The women participated in four small-group health/HIV education sessions. Education participants and controls were followed-up 7 months after their release from jail; the two groups did not differ significantly on drug or sex-related HIV risk behaviours at follow-up. However, being in drug dependency treatment (primarily methadone maintenance) at follow-up was associated with reduced heroine use, crack-use, drug dealing, and criminal activity. The study concluded that although improved HIV education in jail is important, better networks of community resources, including more accessible community drug dependence treatment, must also be developed to support drug-dependent women after their release from jail.

McCaa Baldwin K, Jones J (2000). Health Issues Specific to Incarcerated Women: Information for State Maternal and Child Health Programs. Women's and Children's Health Policy Center, Johns Hopkins University, School of Public Health.

Available via www.med.jhu.edu/wchpc

McClelland GM et al. (2002). HIV and AIDS risk behaviors among female jail detainees: Implications for public health policy. American Journal of Public Health, 92(5): 818 - 825.

This study examined the sexual and injection drug use HIVrisk behaviors of 948 female jail detainees. It concluded that many women at risk for HIV - womenwho use drugs, women who trade sex for money or drugs, homelesswomen, and women with mental disorders - eventually willcycle through jail. "Because most jail detainees return to theircommunities within days, providing HIV and AIDS education injail must become a public health priority."

Mullings JL, Marquart JW, Brewer VE (2000). Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners. Child Abuse Negl, 24(5): 677-688.

National Minority AIDS Council. Women & HIV/AIDS in Prisons and Jails.

Published by the US-based National Minority AIDS Council (NMAC), this 20-page booklet addresses issues and challenges confronting incarcerated women living with HIV. For copies, see www.nmac.org or call NMAC at 1-202-483-6622.

Rehman L et al. (2004). Harm reduction and women in the Canadian national prison system: policy or practice? Women and Health, 40(4): 57-73.

The paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and HCV prevention, care, treatment and support. In-depth interviews were conducted with 156 women in Canadian national prisons. Emergent themes highlighted a gap between access to harm reduction in policy and in practice. Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre-and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada.

Stevens J et al. (1995). Risks for HIV infection in incarcerated women. J. Women's Health, 4(5): 569-577.

Zurhold H, Stöver H, Haasen C (2004). Female drug users in European Prisons - best practice for relapse prevention and reintegration (PDF Version). Hamburg: Centre for Interdisciplinary Addiction Research, University of Hamburg.

Executive summary available at www.zis-hamburg.de/Female_prisoners_executive_summary_2004.pdf.
This 12-month study provides an overview of current prison policy and practice concerning adult female drug users in European prisons. The objectives were to fill the information gap concerning the extent of the problem; and the availability of drug services for this population across Europe.

Aboriginal Prisoners

Barlow JK, Serkiz J, Fulton A (2001). Circle of Knowledge Keepers: Training Kit for Inuit, Metis and First Nations Offenders as Peer Educators & Counsellors. Ottawa: Canadian Aboriginal AIDS Network.

National training program for Aboriginal peer education in prison. Prepared by the Canadian Aboriginal AIDS Network for CSC.
Available via www.linkup-connexion.ca/
catalog/index.cfm?fuseaction=
viewProducts&SubExpandList=&ExpandList=9.

Canadian HIV/AIDS Legal Network (2004). Aboriginal prisoners and HIV/AIDS (Info sheet 11 in the series of info sheets on HIV/AIDS in prisons). Montreal: The Network, third revised and updated version.

A 2-page info sheet about what must be done to address the issues Aboriginal prisoners face in the context of HIV/AIDS. Available in English and French via www.aidslaw.ca/Maincontent/issues/prisons.htm.

Correctional Service Canada (1994). HIV/AIDS in Prisons: Final Report of the Expert Committee on AIDS and Prisons. Ottawa: Minister of Supply and Services Canada.

See pages 114-118 for a discussion of issues of relevance to Aboriginal offenders.

Day C, Dolan K (2001). Characteristics of indigenous injecting drug users in Sydney: gender, prison history and treatment experiences. Best Practice Interventions in Corrections for Indigenous People. Canberra: Australian Institute of Criminology.

Day C, Ross J, Dolan K (2003). Characteristics of indigenous injecting drug users in Sydney, Australia: prison history, hepatitis C testing and drug treatment experiences. Journal of Ethnicity in Substance Abuse, 2(3): 51-58.

Australian Aborignials are overrepresented in prisons and tend to be overrepresented in studies of IDUs. The aim of this study was to examine differences between Aboriginal and non-Aboriginal IDUs in terms of gender, prison history and hepatitis C status and testing. Secondary analyses were conducted on data from three cross-sectional studies of IDUs. These studies employed similar methodologies, with recruitment being through needle and syringe programs, methadone clinics, snowballing and street intercepts. Aboriginal people were overrepresented in all studies, were more likely to have been incarcerated and to report heroin as their drug of choice than non-Aboriginal IDUs. Females tended to be overrepresented among Aboriginal IDUs, were more likely to have been incarcerated and had a longer period of time since their last hepatitis C test than non-Aboriginal female IDUs. Aboriginal people are overrepresented among IDUs in Sydney. Given their greater risk of incarceration, particularly among females, Aboriginal IDUs were at greater risk of hepatitis C exposure than non-Aboriginal IDUs. The prison setting provides an opportunity to promote drug treatment and hepatitis C testing, though more needs to be done to reduce drug use and incarceration.

Gossage JP et al. (2003). Sweat lodge ceremonies for jail-based treatment. J Psychoactive Drugs, 35(1): 33-42.

Lines R (2002). Action on HIV/AIDS in Prisons: Too Little, Too Late - A Report Card. Montreal: Canadian HIV/AIDS Legal Network.

Reviews Aboriginal HIV/AIDS programs in Canadian prisons. Available at www.aidslaw.ca/Maincontent/issues/prisons/reportcard/toc.htm.

McCaskill D, Thrasher M (1993). Final Report on AIDS and Aboriginal Prison Populations for the Joint Committee on Aboriginal AIDS Education and Prevention.

An early report on Aboriginal people and HIV/AIDS in prisons.

Warhaft B (1998). Aboriginal People and HIV in Prison - The Report. Vancouver: Public Policy Program, Simon Fraser University.

The report of a conference on Aboriginal people and HIV in prisons, held in October 1997.

Transgender/Transsexual Prisoners

Prisoners with HIV/AIDS Support Action Network (1998). HIV/AIDS in the Male-to-Female Transsexual and Transgendered Prison Population: A Comprehensive Strategy. Toronto: PASAN.

Available via www.pasan.org/PASAN.htm.

Discusses the risk of HIV infection for transsexual and transgendered prisoners, summarizes the major issues confronting male-to-female transsexual and transgendered prisoners, and makes recommendations for action in the following areas: prevention of HIV transmission; injection drug use and HIV; medical and support services; human rights and confidentiality; and aftercare.

Stephens T, Cozza S, Braithwaite RL (1999). Transexual orientation in HIV risk behaviours in an adult male prison. Int J STD AIDS, 10(1): 28-31.

The study examined the consequences of being a self-reported transsexual male and HIV risk behaviours in a state penal system. The specific research question was whether or not sexual orientation of inmates influences the level to which they evidence HIV risk behaviours. A total of 153 participants volunteered to participate in the study of which 31 described themselves as being transsexual. Based on risk ratios and using transsexual inmates (TIs) as the reference group, they were 13.7 times more likely to have a main sex partner while in prison [95% CI=5.28, 35.58]. Moreover, TIs were 5.8 times more likely than non-transsexual inmates (NTIs) to report having more than one sex partner while in prison [95% CI=2.18, 15.54]. The authors concluded that TIs require more preventive support than NTI prisoners. In addition to TIs being protected from assault and battery by NTIs, they need social support and carefully developed preventive informational materials.

Varella D et al (1996). HIV infection among Brazilian transvestites in a prison. AIDS Patient Care STDS, 10(5): 299-302.

See supra, section on "HIV and HCV Transmission."

Legal, Ethical, and Human Rights Issues

Essential Resources

AIDS Law Project (2004). Your Rights in Prison. Johannesburg: ALP.

Available via http://www.alp.org.za/

A booklet looking at issues prisoners face regarding HIV, what are their rights, and how to protect themselves. The publication is also aimed at people working with prisoners.

Betteridge G, Jürgens R (2004). Prisoners, HIV/AIDS, and Human Rights. Montréal: Canadian HIV/AIDS Legal Network.

Discusses the legal responsibilities of prison systems. Available via www.aidslaw.ca/Maincontent/issues/prisons.htm.

Canadian HIV/AIDS Legal Network (2004). A moral and legal obligation to act (Info sheet 12 in the series of info sheets on HIV/AIDS in prisons). Montreal: The Network, third revised and updated version.

A 2-page info sheet arguing that prison systems have a moral and legal responsibility to prevent the spread of infectious diseases among prisoners, and to provide care, treatment, and support equivalent to those available outside. Available in English and French via www.aidslaw.ca/Maincontent/issues/prisons.htm. A revised version in Russian will become available in 2006. The second, 2001 edition, is also available in Romanian.

Joint United Nations Programme on HIV/AIDS (1996). United Nations Commission on Human Rights (Fifty-second Session, item 8 of the agenda). HIV/AIDS in Prisons - Statement by the Joint United Nations Programme on HIV/AIDS (UNAIDS). Geneva.

This Statement by UNAIDS to the Commission on Human Rights argues that the treatment of prisoners in many countries constitutes a violation of the prisoners' human rights. UNAIDS urges all governments to use the World Health Organization's guidelines in formulating their HIV prison policies and offers their assistance to any government wishing to implement these guidelines.

Jürgens R, Betteridge G (2005). Prisoners who inject drugs: public health and human rights imperatives. Health & Human Rights, 8(2): in print.

United Nations (1990). Infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in prisons: Resolution 18 of the Eighth United Nations Congress on the Prevention of Crime and the Treatment of Offenders, Havana, Cuba, 27 August-7 September 1990. In Report of the Eighth United Nations Congress on the Prevention of Crime and the Treatment of Offenders. U.N. Doc. A/CONF.144/28 of 5 October 1990.

Other Resources

Arnott H (2001). HIV/AIDS, prisons, and the Human Rights Act. Eur Hum Rights Law Rev, 1: 71-77.

The article considers practice in the treatment of HIV positive prisoners, in light of the rights contained in the Human Rights Act, and of international standards. In particular, it considers the practice of the prison service in relation to measures to prevent the spread of HIV, including the provision of condoms and needle exchange programs, and considers the extent of positive obligations on the prison service to take such preventative measures. The adequacy of medical care available to HIV positive prisoners, and the obligations on the prison service in relation to medical confidentiality, are also examined. The author assesses the possibilities for legal challenges under the Human Rights Act, and suggests that the Convention may be a useful tool for policy development in this area.

Comment (1989). AIDS behind Bars: Prison Responses and Judicial Deference. Temple Law Review, 62: 327-354.

The comment examines the courts' tendency toward deference to the branches of government that are charged with prison administration and contends that "[i]n some cases, this policy of deference to the legislative and executive branches, which are by definition more prone to the prejudices and panic of the electorate, has led to hasty decision-making that results in the use of the most extreme responses to the AIDS epidemic in the prison setting." The author concludes by saying that courts need to give up their restraint and, "through critical, investigative, and thorough examination of prison administration action, can ensure that individual rights do not become secondary to public fear and ignorance."

Dubler NN, Sidel VW (1989). On Research on HIV Infection and AIDS in Correctional Institutions. The Milbank Quarterly, 67(2): 171-207.

The article discusses the problems involved in conducting research on prisoners. It concludes that, although a prison setting precludes voluntary and uncoerced choice, prisoners should be permitted to choose to participate in research, including therapeutic trials with no placebo arm that hold out the possibility of benefit.

Fleischner R (2004). Challenges to inadequate treatment, mandatory testing, and segregation of inmates with HIV/AIDS. Northampton, MA: Center for Public Representation.

A fact sheet available via http://www.centerforpublicrep.org/cat/770

Elliott R (1996). Prisoners' Constitutional Right to Sterile Needles and Bleach. Appendix 2 in R Jürgens. HIV/AIDS in Prisons: Final Report. Montréal: Canadian HIV/AIDS Legal Network and Canadian AIDS Society.

Available in English and French: www.aidslaw.ca/elements/APP2.html

Do prisoners have a right to the means that would allow them to protect themselves against contracting HIV and other diseases in prisons? Can prison systems be forced to provide condoms, bleach, and sterile needles? Can and should the law be used to achieve change in prison HIV/AIDS policies? The article discusses these questions. In particular, it analyzes whether denying prisoners access to sterile needles is a violation of their constitutional rights.

Hale J, Young A (1992). Policy, Rights and the HIV Positive Prisoner. In: Wheeler S, McVeigh S (eds). Law, Health and Medical Regulation. Dartmouth Publishing Company.

Hammett TM, Dubler NN (1990). Clinical and Epidemiological Research on HIV Infection and AIDS among Correctional Inmates. Evaluation Review, 14(5): 482-501.

An article about the involvement of prisoners in clinical and epidemiological research, concluding that access to validated treatments and those still under investigation should be a choice for inmates as it is for others with HIV infection.

Kelly J (1992). AIDS, prisoners and the law. New Law Journal, 7 February: 156-158 & 165.

Similarities and differences between English and New York prisons are examined, with a focus on segregation of prisoners living with HIV/AIDS and participation in conjugal visits between such prisoners and their spouses. The article concludes that "without recognition that the spread of AIDS, injecting drug use and homosexual sex are connected, ex-prisoners will return to society and help to spread HIV."

Kerr T et al. (2004). Harm reduction in prisons: a "rights based analysis". Critical Public Health, 14(4): 345-360.

Kloeze D (2002). Inmate sues the Correctional Service of Canada. In Jürgens R (ed). HIV/AIDS in prisons: New developments. Canadian HIV/AIDS Policy & Law Review, 6(3): 13-19, at 13-15.

www.aidslaw.ca/Maincontent/otherdocs/Newsletter/vol6no3-2002/prisons.htm

Knepper K (1995). Responsibility of correctional officials in responding to the incidence of the HIV virus in jails and prisons. N.E.J. on Crim & Civ. Con., 21: 45.

Jacobs S (1995). AIDS in correctional facilities: Current status of legal issues critical to policy development. Journal of Criminal Justice, 23(3): 209-221.

Lazzarini Z, Altice FL (2000). A review of the legal and ethical issues for the conduct of HIV-related research in prisons. AIDS & Public Policy Journal, 15(3/4): 105-135.

This article describes barriers to access to clinical trials, the demographics of HIV/AIDS in prisons in the US, the unique situation posed by the potential for HIV-related research in prisons, and examines the history of prisoner research in the US. It considers both ethical and legal responses to clinical trials in prisons, makes recommendations for conditions necessary to conduct ethical research in prisons, and calls for more cooperation between prison systems and HIV/AIDS clinical trials researchers to make expanded access to clinical trials a reality.

Malkin I (1995). The role of the law of negligence in preventing prisoners' exposure to HIV while in custody. Melbourne University Law Review, 20: 423-480.

The author analyzes the role of the law of negligence in preventing prisoners' exposure to HIV while in custody. He argues that the unwillingness of prison systems to take all reasonable and necessary steps to reduce the possibility of transmission of HIV in prisons amounts to careless conduct, and that prison systems must be made accountable for this conduct through the use of a legal action in negligence.

Malkin I (1997). Australia - Not giving up the fight: prisoners' litigation continues. Canadian HIV/AIDS Policy & Law Newsletter, 3(2/3): 32-33.

www.aidslaw.ca/Maincontent/otherdocs/Newsletter/Spring1997/23MALKINE.html

The New South Wales (NSW) Supreme Court had to deal with a legal claim for damages instituted by an inmate who claimed to have contracted HIV in prison as a result of negligence on the part of those responsible for administering and managing the New South Wales prison system - the NSW Government.

McLeod, C. (1996) Is there a right to methadone maintenance treatment in prison? Canadian HIV/AIDS Policy & Law Newsletter, 2(4), 22-23.

Mosoff J (1992). Do the Orthodox Rules of Lawyering Permit the Public Interest Advocate to "Do the Right Thing"?: A Case Study of HIV-Infected Prisoners. Alberta Law Review, 30(4): 1258-1275.

The author explores the area of public interest litigation using her experiences as counsel for an HIV-infected prisoner.

Note (1987). AIDS in Prisons: Are We Doing the Right Thing? New England Journal on Criminal & Civil Confinement, 13: 269.

Note (1988). Sentenced to Prison, Sentenced to AIDS: The Eighth Amendment Right to be Protected from Prison's Second Death Row. Dickinson Law Review, 92: 863-892.

The author argues that HIV prevention programs have a constitutionally mandated place within the US prison system, born out of a prisoner's right to personal security. According to the author, prison officials who ignore the risk and fail to respond to it with appropriate protective policies violate the constitutional proscription against cruel and unusual punishment. She points out that "a sentence of imprisonment should not carry with it a sentence of AIDS," but then argues that, to ensure that it does not, prison officials need to take "affirmative action consisting of mass screening, privilege-conscious segregation, and informative training." Such coercive measures would be costly, ineffective in preventing HIV infection, and are overly intrusive of HIV-infected prisoners' rights. They have been nearly universally rejected.

Note (1989). AIDS in Correctional Facilities: A New Form of the Death Penalty? Journal of Urban and Contemporary Law, 36: 167-185.

The article addresses the question of prison authorities' liability for HIV transmission in prison. It wrongly argues that "[s]egregating inmates with AIDS in medical infirmaries and housing seropositive and ARC inmates together provides protection to all inmates."

Parts M (1991). The Eighth Amendment and the Requirement of Active Measures to Prevent the Spread of AIDS in Prisons. Columbia Human Rights Law Review, 22: 217-249.

Potler C, Sharp V, Remick S (1994). Prisoners' access to HIV experimental trials: legal, ethical, and practical considerations. Journal of Acquired Immune Deficiency Syndromes, 7(10): 1086-1094.

See supra, section on "care, support, and treatment for HIV and HCV."

Sinkfield RH, Houser TL (1989). AIDS and the criminal justice system. The Journal of Legal Medicine, 10(1): 103-125.

This early article addresses a wide variety of legal and policy issues that have arisen in the criminal justice system as a result of HIV/AIDS: testing for HIV antibodies, housing of infected prisoners, confidentiality of medical information, criminal provisions regarding transmission of HIV, and consideration of HIV status in sentencing, probation, and parole decisions.

Takas M, Hammett TM (1989). Legal Issues Affecting Offenders and Staff. Washington DC: US Department of Justice. National Institute of Justice AIDS Bulletin May 1989.

Summarizes legal developments in the US and their policy implications in the following areas: preventing the spread of HIV in prisons; rights of offenders living with HIV/AIDS; legal issues regarding staff; public safety issues.

Valerio Monge CJ (1998). HIV/AIDS and human rights in prison. The Costa Rican experience. Med Law, 17(2): 197-210.

Examines different types of situations dealing with HIV/AIDS in prison and reviews the international recommendations and the way the Costa Rican legal and penitentiary system have adopted them in accordance with its legal system and national prison characteristics.

Valette D (2002). AIDS Behind Bars: Prisoners' Rights Guillotined. The Howard Journal, 41(2): 107-122.

Examines, in the light of international experiences, how the European Convention on Human Rights may be used to secure prisoners' rights in the context of AIDS.

Young A, McHale JV (1992). The dilemmas of the HIV positive prisoner. The Howard Journal of Criminal Justice, 31(2): 89-104.

Examines the approach taken to the care of HIV-positive prisoners in England in the light of arguments about prisoners' rights. Four areas are examined: testing for HIV antibodies; confidentiality of information concerning HIV positive prisoners; the contrast in care facilities provided to those with HIV inside and outside prison; the involvement of HIV-positive prisoners in experimental drug trials. Concludes by examining the role of a rights-based analysis when determining policies of care for HIV-positive prisoners.

Periodicals

AIDS Policy & Law

A US biweekly newsletter on legislation, regulation, and litigation concerning AIDS. Contains short summaries of US developments, mainly lawsuits.

HIV/Policy & Law Review

Available in English and French at www.aidslaw.ca/Maincontent/otherdocs/Newsletter/newsletter.htm.

Required reading for all those working on, or interested in, HIV/AIDS in prisons. Provides regular updates and feature articles on policies and programs from around the world.

Infectious Diseases in Corrections Report (formerly HEPP Report)

Available via www.idcronline.org.
Provides HIV updates designed for practitioners in the correctional setting. Targets correctional administrators and HIV/AIDS care providers, with up-to-the-moment information on HIV treatment, efficient approaches to administering such treatments in the correctional environment, and US and international news related to HIV in prisons. Published monthly.

International Journal of Prisoner Health

Additional information available at www.tandf.co.uk/journals/titles/17449200.asp

An international journal aiming to act as a forum for the discussion of a wide range of health issues that affect both prisoners and prison staff.

Websites

Canadian HIV/AIDS Legal Network
www.aidslaw.ca

Contains many reports and articles on HIV/AIDS in prisons, in a special section at www.aidslaw.ca/Maincontent/issues/prisons.htm.

Centerforce
www.centerforce.org/

Centerforce provides services for prisoners, ex-prisoners, and family members of prisoners in California. Their website contains a great list of links, as well as many articles, particularly on education and aftercare issues.

Corrections HIV Education and Law Project
http://www.correcthelp.org/

CorrectHELP's mission is to advocate for HIV-positive prisoners in Los Angeles, US, reduce the spread of HIV in prisons and jails and reduce the recidivism rate for individuals infected with HIV.

European Network on Drugs and Infections Prevention in Prison
http://www.endipp.net/

Among other things, contains the "Digest of research on drug use and HIV/AIDS in prisons" published in its 8^th edition in July 2005.

Human Rights Watch
http://hrw.org/

See, in particular, the sections on "Prison conditions and the treatment of prisoners" and the "HIV/AIDS" section.

International Centre for Prison Studies
http://www.kcl.ac.uk/icps

Irish Penal Reform Trust
http://www.iprt.ie/

Contains a large number of resources on prisons and prisoners' rights, including HIV/AIDS-related issues, as well as a good list of links to websites of other organizations.

Medical Advocates
http://www.medadvocates.org/marg/incar/main.html

The "prisoners" page contains a list of scientific articles on health issues concerning prisoners.

National Hepatitis C Prison Coalition
www.hcvinprison.org

Contains a collection of US corrections HCV treatment guidelines.

Penal Reform International
http://www.penalreform.org/

Contains a lot of information about prison reform activities relevant to HIV/AIDS, as well as some specific documents on HIV/AIDS, such as a report on HIV/AIDS in prisons in Malawi.

Prisoners' HIV/AIDS Support Action Network (PASAN)
www.pasan.org

Contains policy documents and reports, educational materials for use in prisons, and the quarterly bulletin Cell Count.

The Body
www.thebody.com/whatis/prison.html

The Body is one of the HIV/AIDS "super-sites." Their prison reference page provides links to a number of articles and publications.

World Health Organization Regional Office for Europe
http://www.euro.who.int/prisons

The section of the website devoted to the " Health in Prisons Project" contains information about the project, as well as many publications. See also www.hipp-europe.org