Washington, detention facility, many of whom were sex workers, tested positive for chlamydial, gonorrhea, or both (Bell et al., 1985).

In detention facilities, if STD education is provided, it is usually incorporated into HIV education programs. In 1994, approximately 57 percent of state juvenile detention facilities provided instructor-led HIV education and 7 percent provided peer-led education programs (CDC, 1996b). Only one county correctional system reported making condoms available in its juvenile detention facilities (i.e., Alameda County, California) (Widom and Hammett, 1996).

Adults in Detention

The number of prisoners in the United States is at record levels. A total of 1,104,074 persons were in state or federal prisons in June 1995 (U.S. Department of Justice, 1995). From 1990 through 1995, the number of prisoners grew at an annual rate of 7.9 percent. Inmates in correctional facilities have high levels of communicable diseases, including tuberculosis, hepatitis B virus infection, and HIV infection and other STDs (Glaser and Greifinger, 1993). A study of 6,309 men at the main jail facility for men in Los Angeles County used a rapid test for syphilis to show that the rate of infectious syphilis was 507 cases per 100,000 persons. This was more than 11 times higher than the rate in the general county population (Cohen et al., 1992). Results of routine testing for STDs between 1993 and 1994 show that up to 17 percent of inmates were infected with syphilis, up to 32.5 percent were positive for gonorrhea, and up to 4.4 percent were positive for chlamydial (Hammett et al., 1995). Female detainees are at high risk of STDs because many are involved with drugs and exchange sex for drugs or money. For example, among women prisoners at Rikers Island in New York, 57 percent were jailed because of drug-related offenses and 80 percent had cocaine in their urine at the time of their arrest (Holmes et al., 1993). In 1988, 35 percent of a sample of female inmates at Rikers Island were positive for human papillomavirus (9 percent had abnormal Pap smears) (Bickell et al., 1991); 27 percent had positive cultures for chlamydial; 16 percent were serologically positive for syphilis; and 8 percent had positive cultures for gonorrhea (Holmes et al., 1993).

The prevalence of HIV infection among incarcerated persons in the United States, like other STDs, is many times higher than in the general population (Hammett et al., 1995; CDC, 1996b). Comparing the HIV seroprevalence among entrants into 10 federal and state prisons to the seroprevalence among first-time blood donors, the prevalence among male and female detainees is more than 50 and 130 times, respectively, the rate among blood donors (CDC, 1992b). Anonymous serosurveys of inmates throughout the United States indicate that anywhere from less than 1 percent to as high as 25.6 percent of inmates are HIV-positive and that female inmates often have higher infection rates compared to men (Hammett et al., 1995).

The prevalence of STDs among incarcerated persons reflects both the high



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