Dear Corrections Colleagues,

For the past two decades, people from around the globe involved in the fight to combat the HIV/AIDS pandemic have gathered at two-year intervals at the International AIDS Conference (IAC). Like attendees at typical scientific meetings they trade data and share lessons learned. But those coming to an IAC also know well that there will be much more than PowerPoint presentations to see as clinicians, scientists, activists, industry representatives and policy makers mix and, at times clash as they debate strategies, set policies and launch initiatives to advance HIV treatment and prevention. Past conferences have served as watershed events in the history of HIV/AIDS ushering in the era of HAART in 1996 and focusing the world's attention on AIDS in developing countries in 2000.

The International AIDS Conference (IAC) held in Toronto in August was attended by almost 30,000 people and focused on the urgent need to deliver the promise of therapeutic and preventive advances to those affected by HIV/AIDS. A thread running through much of this conference was the plight of those living with HIV infection and incarcerated in our prisons and jails. During plenary sessions on global AIDS epidemiology, keynote speeches by policy makers and activists and in oral sessions on HIV transmission prevention, the role of incarceration in the spread of HIV and the need to provide quality HIV therapy to those imprisoned was featured. Two sessions of oral presentations were actually dedicated to this theme, reflecting the emergence of incarceration as an item on the agenda of the HIV treatment/prevention communities.

Ralf Jurgens, an IDCR board member, member of the IAC Scientific Committee and a Canadian himself, reports on presentations centering on the nexus between HIV and incarceration. In his report he provides a look at approaches to HIV transmission prevention in prisons and jails that have been explored largely outside the U.S. Some of the strategies he presents, such as those advanced by the World Health Organization (WHO), are controversial and provoke strong responses regarding feasibility and safety. Such responses are expected and, indeed, healthy. The IAC is a platform for the presentation of data that others can use and adapt to meet the needs of those they serve, what works in Moldova may not work in Mississippi but it may be of interest to a jailer in Miami. No matter where you are, join the debate by emailing your letter to editor to me at wohl@med.unc.edu or Anne Degroot at Anne_Degroot@brown.edu

Data on HIV therapeutics could also be found in Toronto and the major clinical trials findings are included in an article accompanying Ralf's report. You will also find a summary of the recent Institute of Medicine report on the ethics of research in prisons - an important report that will have considerable impact on the conduct of research studies in correctional settings.

Lastly, while we were going to press the Centers for Disease Control and Prevention (CDC) made their long-awaited announcement regarding changes to their HIV testing recommendations. These changes include vastly expanding HIV testing and removal of separate written consents and extensive pre-test counseling - considered obstacles to testing. These new recommendations will have tremendous implications for HIV screening in correctional facilities and will be covered in detail in our next issue.

Sincerely,

David Alain Wohl, MD
Associate Professor of Medicine
Division of Infectious Diseases
AIDS Clinical Trials Unit
The University of North Carolina - Chapel Hill

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