More than 1.75 million people, about 1% of the US population, are estimated to be in jails or prisons. Compared to the general population, incarcerated persons have disproportionately high rates of a number of infections, including human immunodeficiency virus (HIV), hepatitis В virus (HBV), tuberculosis, and sexually transmitted diseases. The prison is a setting in which persons are accessible and can be enumerated for disease surveillance. This accessibility, however, must be balanced by overriding concerns for the protection of this population, protection that is necessary because of the inherent nature of the prison setting. Canadian Pharmacy

Since 1976 (Estelle v Gamble, 429 97 [US 1976]), every jurisdiction is responsible for providing health care to its prisoners. Standards for care are provided by such agencies as the National Commission on Correctional Health Care, but screening for infectious diseases such as HBV and HIV and the availability and use of follow-up services varies considerably among jurisdictions and facilities. For example, in a recent survey, the California State Prison System reported testing for HIV in the following circumstances: at the request of the prisoner, for clinical indications, and following involvement in an incident. Other states in the survey reported a variety of circumstances for HIV testing, from testing all inmates to testing random samples of inmates. Because of a law passed in 1988 in California, correctional medical personnel are required to provide lists of known or suspected HIV-positive prisoners to correctional staff. Voluntary testing for HIV, identification of HIV status, and engagement in HIV-related care by persons entering prison may be influenced by perceptions of discrimination as well as the reality of prison officials using this information to make decisions about housing and segregation, work assignments, and visiting privileges.

In light of the evidence of high prevalence in their sample, Ruiz and his colleagues conclude that risk factor evaluation at entry and inmate education and counseling are important in preventing HIV, HBV and hepatitis С virus (HCV) infections. For HBV, the availability of vaccination enables correctional medical personnel to encourage screening of appropriate target groups, and standards for care encourage the provision of vaccination to susceptible persons, and education and counseling to those who are seropositive.

Opportunities for therapeutic intervention exist, but so do dilemmas in providing therapies in prison. There are promising studies of medical interventions among HIV-positive prisoners, and work is under way to identify specific groups that would benefit from treatment with inter¬feron for HCV. Inmates may stay long enough to complete a course of therapy for certain infectious diseases. In the case of chronic conditions that require long-term or even lifelong therapy, however, the correctional facility represents a starting point for care that must be continued after release. A number of models of interaction between correctional health and public health have demonstrated the benefits of collaboration to improve the continuity of care between the correctional facility and the community. Prison and jail inmates have disproportionately high rates of a number of infectious diseases related to both socioeconomic factors and risk behaviors of this group. Studies such as that of Ruiz et al are important contributions to understanding the epidemiology of disease by estimating the magnitude among high-risk groups. Although the prison population is a sentinel site for surveillance, the nature of incarceration and prison life emphasize the necessity for protection. As more and improved therapies emerge, screening may be more widespread in prisons, thereby increasing the ability to identify persons who would benefit from therapy or interventions to reduce the risk of disease. Correctional health care systems may be the setting for initiation of care that, in combination with public health and community care, has an important positive impact on the lives of prisoners.