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Am J Public Health. 2003 October; 93(10): 1617.
PMCID: PMC1448017


We read with interest and concern Braithwaite and Arriola’s “Male Prisoners and HIV Prevention: A Call for Action Ignored” in the May 2003 issue of the Journal.1 While we appreciate their insights into the custodial barriers and underfunding for medical care that characterize HIV prevention for male prisoners, we take issue with their first recommendation.

We are opposed to the call for mandatory HIV testing in prisons, despite the fact that 16 states are already doing it. We find it shocking that this policy suggestion was put forth in the face of the information presented briefly in the paper. The authors’ recommendation leaves us wondering if they have ever spoken to any prisoners or advocates.

The authors acknowledge that confidentiality is “very difficult to protect” in prison. This is only one of the reasons why the APHA Task Force on Correctional Health Care Standards concluded that mandatory testing should not be recommended. The APHA Standards for Health Services in Correctional Institutions states: “Mandatory determination of HIV antibody status is only appropriate for prospective donors of blood or other biologicals.”2(p69)

In California, male prisoners identified as HIV-positive are segregated from other prisoners and suffer discrimination and substandard programming opportunities. Those with high security status are housed in Corcoran, a notoriously brutal and medically negligent facility.

The first recommendation should be that the public health community vigorously engage corrections departments and become involved in the overall care and treatment of prisoners with HIV/AIDS. Public health departments should offer free, independent, anonymous HIV testing with pre- and posttest counseling in the prison setting. Such an intervention, combined with ongoing HIV education by peer educators, would guarantee that prisoners would come forward willingly to be tested.

We who routinely visit prisoners agree with the APHA standards, the World Health Organization, and the sentiment of the public health community that mandatory testing has no place in a rational and decent public health effort in penal facilities. HIV/AIDS in prison must be treated in the same manner as it is treated in the community—which, among other things, precludes the use of mandatory testing.


1. Braithwaite RL, Arriola KR. Male prisoners and HIV prevention: a call for action ignored. Am J Public Health. 2003;93:759–763. [PMC free article] [PubMed]
2. Standards for Health Services in Correctional Institutions. 3rd ed. Washington, DC: American Public Health Association; 2003.

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