discharge is eliminated because the Federal Bureau of Prisons requires HIV testing for all

inmates on their release. HIV-positive inmates are asked to directly notify sex partners and

significant others of the results. However, the Bureau of Prisons handles only a small percentage

of inmates, and its policy is not the norm.

Treatment for HIV-positive inmates is often inadequate when available. Primary medical care

may be limited to Pneumocystis cariniipneumonia prophylaxis and HIV monotherapy.

Combination therapy may not be available or accessible to inmates, given the cost of

medications, limited storage, refrigeration requirements for some medicines, and the strict

adherence regimen required by combination therapy, which would require round-the-clock

monitoring and assistance by typically unwilling and suspicious security staff.

Although there are large numbers of substance abusers within correctional facilities, less than 15

percent participate in treatment programs. This is partly because of lack of program availability

and the common type of program offered (i.e., 12-Step, abstinence-based.) A 1991 study

reported that only 1 percent of inmates with moderate to severe substance abuse disorders

received appropriate treatment. Many of these treatment programs advocate sexual abstinence

during recovery. Often, these programs offer no or little information about safer sex practices or

advocacy around changing sexual behaviors. When persons with substance abuse disorders in

treatment relapse, as is often the case, they may also engage in risky sexual behaviors. They are

most likely to engage in risky sexual behaviors with sexual partners from similar treatment

networks. These partners may include people who have used syringes, traded sex for money or

drugs, or been victims of trauma. All of these populations are likely to have higher rates of HIV

infection, making transmission likely.

Inmates who do complete or participate in treatment programs often rapidly relapse on discharge.

For inmates who do complete treatment, there are often no aftercare programs to help them

remain substance free. A 1995 study of Hispanic inmates in California State prisons found that

51 percent reported having sex within the first 12 hours after release, and 11 percent reported

injection of drugs during the first day after release.

Adolescents

Adolescents are another group that is experiencing an increase in incidence and prevalence of

HIV. Since 1994, findings from the Monitoring the Future surveys have revealed a dramatic and

sustained increase in consumption of licit and illicit drugs among adolescents--this after nearly

two decades of sustained decrease in drug consumption. Studies also note that teens are having

sex earlier than ever before, often with multiple partners and inconsistent use of condoms,

putting them at greater risk for HIV/AIDS. Beyond this, young people find themselves

marginalized in U.S. society; this is especially true for young gay and bisexual youth, sexually

active young women, and young people of color.

According to the CDC, AIDS is the fifth leading cause of death for Americans between the ages

of 25 and 44 (CDC, 1999f). At greatest risk are young, disadvantaged females, particularly

African American females, who are being infected with HIV at younger ages and higher rates

than their male counterparts (CDC, 1998j). Because of the long and variable time between HIV