AIDS In Prisons Essay Research Paper AIDS — страница 3

  • Просмотров 566
  • Скачиваний 12
  • Размер файла 19
    Кб

recycled, sharpened, and altered implements such as staples and paper clips. Prison wisdom holds that tattooing that causes blood to flow results in the best quality image and is least likely to become infected. Procedures for cleaning these “needles” and syringes in prison vary. Water and matches are generally available. Peroxide, alcohol, or bleach may be available to inmates who work in health-care areas or on cleaning assignments. No prison is known to have a policy of making sterile equipment available to inmates. Although prisoners have been affected by HIV disproportionately in the United States, they have not received commensurate attention. Every jurisdiction is responsible for providing health care to its prisoners. There are no required or generally accepted

standards of care, although several organizations have developed voluntary standards for correctional facilities. None of these standards, however, include any guidelines for medical management of HIV. Medical personnel, public-health advisers, correctional administrators, legislators, courts, and the electorate have developed policies for management of HIV in prisons. Prisons and jails, designed to confine and punish people, many of whom are generally poor and without influential outside advocates, have not voluntarily provided the extraordinary levels of health services patients with HIV require. Prisons have often escaped outside attention to serious failures of care. HIV management practices in correctional institutions vary widely. HIV in prisons raises a number of issues

that do not exist for the general community; one of these is mandatory testing for the HIV antibody. In fact, most public policy debates on HIV in prisons have focused not on care and prevention but on whether to mandate testing. Many jurisdictions require mandatory testing of prisoners and use test results primarily for correctional management purposes. Studies suggest that mandatory testing is less productive and probably less effective in educating prisoners and changing their behavior than voluntary testing and broad education programs. Prison officials use HIV-antibody test results to make decisions about housing and segregation, work assignments, and visiting privileges, among others. It is common practice to bar inmates with HIV (or AIDS) from kitchen work and to serve

them food only on paper plates. In some jurisdictions, results of HIV tests go directly to correctional staffs. Many practices and policies in prison contradict the public health facts: HIV is not transmitted through food, HIV is not acquired through casual contact, and the only truly safe assumption is that everyone may be HIV infected and should be handled cautiously and equally. Confidentiality of medical information in the prison setting is virtually impossible to maintain. Where quarantines exist, confidentiality cannot. In the close and closed system of jails and prisons, confidentiality is commonly breached. Persons other than medical staff may handle medical records, and staff members may not be meticulous about protecting privacy. Once such information is released in a

prison, it travels rapidly. It is hard to find a person in the prison setting who does not believe that he or she has a particular “need to know” who in the institution is infected with HIV. It has been argued that prisoners have a greater need for privacy than those outside because they live in a closed community where violence is common. Prisoners cannot give true, free informed consent. In every area of life inmates bargain for privileges, better conditions, and, ultimately, release. Where HIV testing is not mandatory, prisoners require more information than others to make informed decisions about taking the test or participating in HIV-related studies. To give informed consent, prisoners must understand the institutional consequences of a positive HIV-antibody test

result, such as segregation and loss of access to activity programs, visitation, and jobs. This information has indeed discouraged many prisoners from being tested. Prisoners have a constitutional right to health care that people “on the outside” do not have. Under the Eighth Amendment, inmates are entitled to a “safe and humane environment.” In an important U.S. Supreme Court decision, this right was further defined as prohibiting “deliberate indifference to serious medical need.” A small number of terminally ill patients with advanced AIDS at a few U.S. correctional institutions have been granted compassionate release from prison before the expiration of their sentences. They have been released to families or hospices with access to community health services.