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According to Rich, the transmission of HIV while in prison or jail is not as big a risk factor as transmission afterwards; sex, sexual assault, and needle sharing does occur, but it appears to occur at lower levels than on the outside. Still, the lack of condoms, PrEP, and needle exchanges means that when sex and drug use does occur in jails and prisons, the activities can be riskier than they are on the outside. Only about one percent of prisons offer condoms, and needle exchanges are “virtually nonexistent” according Leonard Rubenstein, the director of the program on human rights, health, and conflict at the Johns Hopkins Bloomberg School of Health. Prisoners often resort to creating their own improvised condoms with items like rubber gloves to prevent transmission. Researchers say offering condoms in prisons and jails would mean authorities would be acknowledging that disallowed behavior occurs under their watch. If condoms are a stretch, PrEP may be a long ways off from entering America’s incarceration system.

When incarcerated people lack prevention methods and experience gaps in HIV treatment, this has serious repercussions for people outside of prisons as well. Researchers believe part of the reason HIV rates are so much higher for black women, for example, is because black men are incarcerated at high rates; they experience a higher risk of exposures to HIV and a greater chance that there will be gaps in health care that would prevent HIV transmission once they’re released. “We were having a hard time understanding why rates were going up for Latinas and African American women,” says Laurie Shrage, a professor at Florida International University who has studied HIV in prisons. “Prison is the missing link.”

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Image: By Luis Argerich from Buenos Aires, Argentina – End of the world prison, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=7140237

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