Sex prevalent in prison incarcerated black men report, posing challenges for HIV prevention, treatment

While sex is prohibited in U.S. prisons, sexual encounters are commonplace and few inmates express concern about getting or spreading HIV, according to a study of incarcerated Black men by Tawandra Rowell-Cunsolo, PhD, Assistant Professor of Social Welfare Science at the Columbia University School of Nursing.

The study, presented this month at the annual meeting of the American Public Health Association (APHA) in Boston, asked open-ended questions about sexual behavior. Many of the respondents said that deprivations of prison life promote same-sex encounters and that, although they have been exposed to prison rape, most of the sexual behavior within the institution is consensual. Some also expressed negative attitudes toward men having sex with men.

To prevent HIV in prisons and curb its spread once inmates are sent home, we need a better understanding of how Black men perceive sexuality while they're imprisoned, Rowell-Consolo said.

Recent advances in HIV prevention and treatment haven't permeated the U.S. prison system, where inmates already at high risk for developing HIV often lack access to basic prevention and don't get tested for the virus. Previous research into the spread of HIV within the prison system has shown that inmates have much higher infection rates than the general population, but hasn't provided a clear picture of what interventions might be most effective in this environment.

"These are people who can benefit from education and outreach while they're in prison, but there's also a much larger public health issue at stake here," Rowell-Cunsolo said. "These are people who are going to come out of prison, and preventing the spread of HIV in prison becomes a larger community issue once these men return home."

Over 1.6 million individuals are currently in the federal prison system, and at current incarceration rates one in three Black men will be in prison at some point in their life. In the study presented at APHA, Rowell-Cunsolo surveyed 63 Black inmates at one of the largest maximum-security male prisons in the U.S. and asked about their sexual behavior within the institution. Two-thirds of the prisoners at the facility were Black, and more than half were incarcerated for the most violent crimes, including murder, armed robbery, forcible rape and aggravated assault. Most of the respondents were married and had at least one child.

Only about half of U.S. prisons offer HIV testing, according to an analysis of prison-based HIV research published over the past decade that Rowell-Cunsolo also presented at APHA. Since knowledge of HIV status has been associated with behavior changes that can limit spread of the virus, testing programs in prisons should be expanded, she said.

"There are some prison systems that distribute condoms or have a needle exchange program to prevent the spread of HIV, but for the most part this isn't done because it's seen as supporting behavior that's explicitly against the rules in prison," Rowell-Cunsolo said. "That makes basic sex and HIV education really important. Some of these men have been incarcerated since before the AIDS epidemic hit the scene and they literally don't know how it spreads or how to protect themselves."

Each year, an estimated one in seven people with HIV passes through a correctional facility, according to the U.S. Centers for Disease Control and Prevention. More than 1.1 million people in the U.S. are now living with HIV, and almost one in 5 of them don't know they're infected, according to the APHA.