Do condom and needle exchange provision in prisons reduce risky behavior and HIV transmission? A systematic literature review

Prison populations worldwide are disproportionately affected by HIV/AIDS. In the United States alone, the number of inmates with confirmed AIDS is more than two times that of the general population. Furthermore, about one quarter of all HIV infected persons in the United States have a history of imprisonment. Intraprison HIV transmission occurs and is linked to ongoing high risk behavior such as injection drug use associated with sharing of injecting equipment, unsafe sexual activity and tattooing. However, HIV prevention initiatives involving condom and needle exchange programs have not been widely implemented in prisons due to the perception that these would contradict policies that forbid sexual activity and drug use in prison. Systematic review of published literature on the effect condom and needles exchange provision on risky behavior and HIV incidence in prison identified six studies that support the use of these initiatives. Condoms and needle exchange programs promote safer sexual and injecting practices that over time may reduce HIV transmission among inmates. Nonetheless, more studies are needed to assess the long term impact on intraprison HIV seroconversion.