Dear Correctional Colleagues:
True or False?

1. Many incarcerated injection drug users (IDUs) who don't have access to drug treatment or needle exchange will continue to share needles while in jail or prison.

2. Although the "war on drugs" has led to a dramatic increase in the number of incarcerated IDUs, few of these inmates have access to drug treatment while in jail or prison.

3. Correctional officers, janitorial and medical staff, and others working in jails and prisons are regularly stuck with needles discarded by inmates who don't have access to needle exchange or drug treatment.

4. The Centers for Disease Control and Prevention endorses needle exchange as one component of an effective drug policy.

5. Many inmates will have unprotected sex while incarcerated.

6. Condoms are known to be highly effective in preventing the transmission of HIV and other sexually transmitted diseases.

7. Jails and prisons that have made condoms available to inmates have had few or no disciplinary problems associated with condom distribution and use.

Answers:
1: True 2: True 3: True 4: True 5: True 6: True 7. True

Because most of us who practice medicine in correctional facilities are currently prohibited from providing our patients the tools for PREP (pre-exposure prevention), it is our responsibility to be well versed in PEP (post-exposure prophylaxis) for potential bloodborne pathogen exposures. In this month's HEPP Report, Drs. Anne De Groot and Roland Merchant provide an excellent overview of this important topic. It is my hope that some day harm reduction measures will be so fully integrated into correctional health maintenance programs that the information contained in this month's main article will be mostly of historical interest.

Also this month, Dr. Chris Behrens provides the expert response to a PEP case provided by Kate Willner and Dr. Stephen Tabet. After reading this issue, you will have a better understanding of the infectious risks associated with various blood and body fluid exposures, and be familiar with the recommended management of individuals who have been exposed to blood borne pathogens.

Sincerely yours,
Joseph Bick, M.D.

030701
HEPP2003-0701

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