Incarcerated people are frequently denied the same standard of care received by the rest of the community, according to Linda Frank, a US-based researcher who presented her findings at Thursday morning's session on care in special populations. Frank's study identified multiple barriers to treatment in prison populations, including care providers' assumptions that incarcerated substance abusers cannot handle complicated drug regimens. Providers' lack of cultural awareness, too, can stand in the way of adequate care -- especially since a large number of incarcerated people in the US are African-Americans or Latinos.

Within the correctional system itself, perhaps the biggest barrier to adequate care stems from the inmates' lack of control over medication administration. Other barriers such as the stigmatisation of HIV-positive inmates, both by staff and peers, can dissuade inmates from seeking care. For example, prisoners with HIV are seen by other inmates and staff as "receiving special attention" which can lead to retributions. Or they are placed in special housing units, where they are isolated and denied access to standard rehabilitation or recreational programmes.

A follow-up intervention programme within another US-based study, HIV Epidemiological Research (HER), demonstrated that "if you work with HIV-positive and at-risk women prior to their release from prison, and link them up with community resources, they will follow through with medical care," said Tim Flanigan. "This demonstrates that community care providers must enter the institution to form links with the women" before they are released. "The time of imprisonment is really an opportunity to make connections, to provide hope, and to decrease the rate of further incarceration" as well as improve their overall health

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