Drug Use, HIV, and the Criminal Justice
About 80 percent of prison and jail
inmates have serious substance abuse problems. Many also have
or are at high risk of having HIV or hepatitis. Substance
abuse treatment and HIV services can help inmates and others
under correctional control. They also can help inmates’
families, corrections staff, and the community at large.
Drugs and Criminal Justice are
Important Issues for the Nation
The United States has the largest number of people under criminal
justice control of any nation in the western world.
At the end of 1999, 6.3 million people,
or more than 3 percent of all U.S. adult residents, were under
the control of the criminal justice system. More than 1.3
million were in federal or state correctional facilities.
About 600,000 were in county or city jails. The
remainder—more than 4 million—were on parole or probation
or under some other form of court-ordered community
supervision. Nearly 126,000 juveniles were in correctional
Many inmates are drug users who
are in prison or jail because of drug-related offenses.
More than one-fourth of all inmates are
in prison or jail because of arrests related to using,
possessing, or trafficking drugs.
Between 1980 and 1996, the prison
population tripled, in large part because of convictions
associated with drugs.
A substantial majority of inmates—men
and women—have serious drug problems. Many have problems
with alcohol as well:
1997, more than 83 percent of all state prisoners
(837,300) and more than 73 percent of all federal
prisoners (64,000) reported past drug use. A third of
state prisoners and a fifth of federal prisoners said they
were using drugs at the time they committed the offense
for which they were in prison.
- Data from 35 sites across the country on the drug use
of adults who have been arrested show that in most of the
sites, more than 60 percent test positive for at least one
drug (arrestees are tested for cocaine, marijuana,
methamphetamines, opiates, and PCP, among other drugs).
hepatitis, and sexually transmitted diseases (STDs) are big
problems for inmates.
inmates are at high risk of becoming infected with HIV,
hepatitis, or STDs. Many others are already infected. This is
because of past and continuing risky drug use (sharing
syringes and other injection drug equipment) and sexual
behaviors (multiple sex partners, unprotected sex, and
untreated STDs). Data from 1999 show that HIV and AIDS rates
among inmates are very high:
- 9,723 prison and jail inmates had AIDS—a rate 5
times higher than that of the general population;
- 34,372 prison and jail inmates were infected with HIV.
from 1996 show that STD and hepatitis infections are also
common among inmates:
- 46,000-76,000 had syphilis, 43,000 had chlamydia, and
18,000 had gonorrhea;
- 36,000 had hepatitis B;
- 303,000-332,000 had hepatitis C—a rate 9-10 times
higher than the general population.
inmates have other conditions as well, such as tuberculosis,
mental illness, or other chronic health problems. Many women
inmates have reproductive health needs and histories of
physical, emotional, and sexual abuse.
Criminal Justice System is a Key Setting for Prevention,
Treatment, and Care Efforts
large numbers of drug users in the criminal justice system and
their high risk of getting and transmitting HIV, STDs, and
hepatitis, create an urgent need for:
- comprehensive substance abuse treatment services;
- prevention education and risk reduction counseling;
- expanded care for infected inmates; and
- improved links between services in prisons and jails
and those in the community.
many inmates, the criminal justice system provides a first
chance for basic health care, substance abuse treatment,
prevention education, and counseling and testing. This can
help them break the cycles of addiction, incarceration, and
disease transmission. These services also can benefit
inmates’ families and the larger community through reduced
disease transmission, reduced medical and social welfare
costs, and reduced drug-associated crime.
and the community are closely linked.
wisdom holds that prisons and jails are walled off and
separate from the community. More and more, however, people
are recognizing that this is not true. Many ties connect the
community with prisons or jails. For one thing, inmates are
constantly moving back and forth between corrections and the
- one-half of the people who are booked at a police
station are released into the community within 24-48
- people serve time in prison or jail multiple times for
- almost all prison or jail inmates eventually return to
means that the problems and high-risk behaviors inmates had in
the community come with them to prison or jail. Problems or
risky behaviors begun in prison or jail return with inmates to
the community after release.
links between corrections and communities:
- staff live in the community and come and go between
the facility and the community;
- food, services, and supplies for correctional
facilities come from the community;
- family members and friends visit inmates;
- the correctional facility is an important part of the
local economy in some communities;
- community-based substance abuse treatment, HIV/AIDS,
primary health care, psychosocial support, and education
and training programs serve a growing number of inmates.
is critically important for prisons and jails to provide high
quality prevention, treatment, and care services. It’s also
crucial that inmates receive these services after they are
released. Without the support of these services, inmates going
back to their home communities often return to the behaviors
that led them to prison. This increases the chances they will
use drugs, commit crimes, spread or acquire disease, and
return to prison or jail.
the Need for Treatment and Prevention Services is Challenging
federal and state facilities provide HIV/AIDS education and
treatment programs, case management, and substance abuse
treatment programs. However, significant gaps in coverage
remain. For example, a recent study by the National Center on
Addiction and Substance Abuse at Columbia University (CASA)
found that although 800,000 inmates in correctional settings
would benefit from substance abuse treatment, fewer than
150,000 receive it. Few prison and jail systems have
instituted comprehensive programs, and most prevention
programs focus on education rather than on behavior change.
Several factors contribute to this gap in coverage:
and orientations of corrections and public health are
different. Corrections’ primary mission and
responsibility to society is maintaining security and control
over inmates. Losing control over a facility and its inmates
can cause major problems for the facility. Public health
activities, such as HIV counseling and testing, risk reduction
education, or access to medications, may be viewed as
conflicting with these objectives. Each group must recognize
and respect the priorities and activities of the other.
testing and treatment policies and data collection systems
vary widely. The criminal justice system has many
different facilities and programs, from federal and state
prisons and city and county jails to juvenile facilities,
facilities operated by other U.S. government agencies, and
community-based corrections programs. Policies, practices,
organizational structures, accreditation, and resources vary
widely. As a result, the quality and coverage of programs
differ and data collection and sharing are uneven.
populations, especially in jails, are ethnically diverse and
are constantly changing. The number of inmates with
substance abuse problems, HIV/AIDS or hepatitis infection, or
high risk of infection continues to grow. In addition,
populations change constantly as inmates enter and leave the
system or are moved from facility to facility. These factors
make it difficult for staff to plan and carry out
interventions. Service providers also face challenges in
working with inmates who have educational and literacy
problems as well as differing cultures and languages.