prevalence of STDs in the social networks from which they come and the transmission of STDs among prisoners (Moran and Peterman, 1989). Within prisons, unprotected sex, intravenous drug use, and tattooing are potential modes of transmission of STDs, including HIV infection (Doll, 1988; Dolan et al., 1995; Hammett et al., 1995). A wide range of unprotected consensual and nonconsensual sexual activity occurs among prisoners and between prisoners and staff (Mahon, 1996). Although transmission of STDs has been documented among prisoners (Moran and Peterman, 1989; Mutter et al., 1994), it is unclear if prisoners in correctional facilities are more likely to acquire STDs, including HIV infection, during incarceration or outside in the community (Dolan et al., 1995). While it is possible that the frequency of unprotected sexual intercourse or injecting drug use among prisoners is typically higher while they are not in confinement (Decker et al., 1984; Horsburg et al., 1990), some prisoners have high rates of risky behaviors while incarcerated. For example, one study of male Tennessee prisoners showed that 37 percent of prisoners reported using intravenous drugs while not incarcerated compared to 28 percent who reported such use while in prison, and 7 percent reported engaging in same-sex intercourse while not incarcerated compared to 18 percent who reported such intercourse in prison (Decker et al., 1984).

Correctional systems are more focused on HIV education than for other STD educational programs. A 1994 survey revealed that 75 percent of state and federal correctional systems and 62 percent of city and county systems reported providing instructor-led HIV education (Hammett et al., 1995; CDC, 1996b). In addition, 35 percent of state and federal correctional systems and 7 percent of city and county systems reported peer-led educational programs in at least one facility. In contrast, 49 percent of state and federal systems and 48 percent of city and county systems reported instructor-led STD education.

The National Commission on Correctional Health Care recommends that all inmates be screened for STDs and that a comprehensive education program and "appropriate protective devices" to reduce the risk of HIV/STDs be provided (NCCHC, 1992, 1994). In 1994, 82 percent of state and federal systems and 34 percent of city and county systems reported policies for screening all incoming inmates for syphilis, gonorrhea, and/or chlamydial infection (Hammett et al., 1995). Screening and follow-up treatment of prisoners for STDs are difficult because of the rapid turnover of inmates, and innovative screening programs are needed. An example of such a program for rapid screening and treatment for syphilis is presented in Box 3-1.

Very few correctional facilities provide access to condoms. Facility administrators commonly cite the potential use of condoms as weapons or to conceal drugs or contraband as a reason for denying access (Hammett et al., 1995). In addition, some prison administrators are concerned that providing condoms contradicts official policies that prohibit sexual activity among prisoners. Two state correctional systems (Mississippi and Vermont) and four local jail systems (New



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