Correctional officers in HIV/AIDS care in the prison system: a literature review

This is a narrative literature review, whose bibliographical search was carried out using controlled and free vocabularies, derived from the words “correctional officer” and HIV/AIDS. The survey was carried out in the LILACS, MEDLINE, Embase, CINAHL and Scopus, Academic Search Premier and SocINDEX databases using the Boolean operators AND and OR. Studies published in Portuguese, English and Spanish that answered the study’s guiding question were included. Duplicate articles, those that did not answer the study question and secondary studies were excluded.

Results

A total of 3,036 publications were retrieved that went through three selection stages, which resulted in nine studies included in the review. Four main roles played by correctional officers in HIV/AIDS care in the prison system were identified: regulation of access to medical services; collaboration and performance of HIV transmission prevention activities in prisons such as condom distribution; carrying out health education actions; monitoring inmates in consultations, examinations and admissions outside the prison; and drug replacement planning.

Conclusion

Correctional officers are expected to assist healthcare professionals in HIV/AIDS prevention and treatment, referral and monitoring of inmates to care within and outside the prison system, distribution of condoms, carrying out health education actions and help in forecasting of medicines.

Prisions; HIV; Acquired immunodeficiency syndrome; Delivery of health care; Communicable disease control

Acronym	Description	Keywords
P	Population	Correctional officer
I	Interest	Assistance provided in HIV/AIDS
Co	Context	Prision system

Controlled vocabulary (in bold)/Free vocabulary (Portuguese)	Controlled vocabulary (in bold)/Free vocabulary (English)	Controlled vocabulary (in bold)/Free vocabulary (Spanish)
Síndrome de Imunodeficiência Adquirida aids SIDA Síndrome da Deficiência Imunológica Adquirida Síndrome de Deficiência Imunológica Adquirida Síndrome da Imunodeficiência Adquirida Síndrome de Imunodeficiência Adquirida Vírus da Imunodeficiência Humana Vírus de Imunodeficiência Humana	Acquired Immunodeficiency Syndrome AIDS AIDS Vírus AIDS Víruses HIV Human Immunodeficiency Virus Acquired Immune Deficiency Syndrome Acquired Immuno Deficiency Syndrome Acquired Immuno-Deficiency Syndrome Acquired Immuno-Deficiency Syndromes Acquired Immunodeficiency Syndromes Immuno-Deficiency Syndrome, Acquired Immuno-Deficiency Syndromes, Acquired Immunodeficiency Syndrome, Acquired Immunodeficiency Syndromes, Acquired Immunologic Deficiency Syndrome, Acquired Syndrome,Acquired Immuno-Deficiency Syndrome, Acquired Immunodeficiency Syndromes, Acquired Immuno-Deficiency Syndromes, Acquired Immunodeficiency	Síndrome de Inmunodeficiencia Adquirida SIDA Síndrome de Deficiência Inmunológica Adquirida Síndrome de la Inmunodeficiencia Adquirida Síndrome de Inmunodeficiencia Adquirida VIH Virus de Inmunodeficiencia Humana Virus de la Inmunodeficiencia Humana Virus del SIDA
Agente de Segurança Penitenciária* Agente de segurança penitenciário Agente penitenciária Agente penitenciário Agentes penitenciárias Agentes penitenciários Inspetor penitenciário Guarda prisional Carcereiro Inspetor penitenciário	Penitentiary Security Officer* Penitentiary agent Penitentiary agents Prison guards Prison guard Prison agents Correctional officers Correctional officer Correctional workers Prison officer Prison officers Prison inspector Jail officers Jail officer Jailer Jailor Warder Workers prison	Oficial de seguridad penitenciaria* Agente penitenciaria Agente penitenciario Agentes penitenciarias Agentes penitenciarios Guardia penitenciario Oficial correccional Guardia de la prisión Guardas de prisión Carcelero Inspector penitenciario

Authors/Journal/Year/Country	Study design	Objective	Total (n)	Measuring instrument	Main results
MacGregor ⁽¹⁹⁾ /Times Higher Education Supplement/2003/Zambia	Case report*	Report about the project “In But Free: Prevenção de AIDS nas Prisões”, which aims to promote HIV/AIDS prevention in prisons, using both inmates and officers as key agents.	Not applicable	Not applicable	Officers’ role: - act as a counselor in the development of actions to prevent the transmission of HIV in the prison system. (the article did not present details of this performance)
Todrys et al. ⁽²⁰⁾ /Journal of the International AIDS Society/2011/Zambia	Mixed method	Better understand the relationship between prison conditions, criminal justice rights and HIV and tuberculosis prevention, treatment and care in Zambia.	Prisoners (n=246)/Correctional officers (n=31)	Interviews	Officers’ role: - ensure methods of preventing HIV transmission in prisons; - control access to care. Negative aspects: they are not qualified and trained to assess and determine if medical consultations are necessary.
Topp et al. ^(21)/ Health Policy and Planning/2016/Zambia	Qualitative	Explore and describe the institutional and social dynamics that influence prisoner health and access to health care in Zambia.	111 interviews (79 prisoners and 32 with correctional officers)	Semi-structured interview	Officers’ role: - choose the cell’s captain, who, together with officers, controlled prisoners’ access to health services; - encourage the planning of HIV clinic visits and drug replacement; - monitor the prison inmates to any external public health center or hospital. Negative points: - bribery within prisons to access services.
Godin et al. ⁽²²⁾ /Canadian HIV/AIDS Policy & Law Review/2001/Canada	Qualitative	Identify the factors that influence correctional officers to agree or refuse to make available the tools needed to prevent HIV transmission among prisoners.	957 officers	Questionnaire (does not show details)	Officers’ role: - distribute preventive measures necessary to prevent HIV transmission in prisons (condoms, tattoo equipment and sterile syringes). Positive points: - Women, singles, people working in federal institutions and people working in women’s prisons are more in favor of distributing such measures. Negative points: - only 21.4% are in favor of playing this role. People who have undergone HIV training and have been exposed to the risk of HIV infection are more opposed. - officers do not consider themselves as “preventive agents” and suffer social pressure not to exercise this function.
Van Der Meulen et al. ⁽²³⁾ /Canadian Journal of Criminology and Criminal Justice/2018/Canada	Qualitative	Build a dialogue with the Canadian Correctional Service regarding prison data reduction measures – Prison Needle and Syringe Programs (PNSP).	30 healthcare professionals who care for prisoners and 10 former prisoners	Interviews and focus groups (did not explain the instrument used)	Officers’ role: - work to reduce damage in prisons; - carry out actions to promote the health of prisoners and prevent disease transmission. Negative points: - are resistant and constitute an important barrier to the implementation of harm reduction programs, opposing the administration or support of such programs. Positive points: - are frontline workers in the prison setting and maintain frequent and direct contact with prisoners.
Mitchell et al. ⁽²⁴⁾ /AIDS education and prevention/2015/United States	Qualitative	Better understand the organizational characteristics and processes that lead to successful and unsuccessful implementation of HIV services and treatment in the prison system from the perspective of different and key stakeholders.	17 interviews with Senior Researchers and Executive Sponsors (one from each category and unit - there were 9 units)	Semi-structured interview	Officers’ role: - allow inmates access to HIV prevention group interventions. Negative points: - lack of cooperation and back-up from key actors has become a challenge for the successful implementation of HIV services in the prison system. Positive aspects: by the end of the project, the officers overcame these communication barriers and also met allies who could help in subsequent work
Antonius ⁽²⁵⁾ /AIDS Health Promotion Exchange/1994/Suriname	Case report*	Describe the HIV/AIDS education and support program involving activities for prisoners and COs, using the training of peer educators as a strategy.	Not applicable	Not applicable	Officers’ role: - receive training on the prevention of sexually transmitted infections and HIV/AIDS; - act as facilitators of educational sessions on HIV/AIDS that were held in the prison unit; - participate in the selection and evaluation of educational videos on AIDS and sexually transmitted infections to be presented monthly to inmates. Negative aspects: officers were uncooperative and some were inadequate as educators.
Łukaszek ⁽²⁶⁾ /HIV AIDS Rev/2019/Poland	Descriptive	Define the epidemiological situation on HIV infections in Polish prisons, show the magnitude of risky sexual behavior in prisoners’ lives, which could and still can cause virus infections, show the opinions of COs on the problem of HIV infections. HIV among prisoners (the magnitude of the problem and the Prison Service’s role in HIV prevention).	485 men serving prison terms and 210 Prison Service officers	Self-administered questionnaire prepared by the author - conducted a pilot study before	Officers’ role: - provide condoms to prisoners; however, 87.1% of them thought the execution of such action was inadequate and 66% did not even agree with the purchase, 10% said inmates could buy condoms and only 6.7% agreed to give them away for free; - provide sex education for prisoners; however, only 55.7% of respondents chose to carry out these guidelines and only 16.7% of professionals were strongly convinced of its need.
Mhlanga-Gunda et al. ⁽²⁷⁾ /Int J Prison Health/2020/Zimbabwe	Qualitative	Investigate the current health inequalities of female prisoners and better understand their prison health experiences, continuity of health care in prisons, and in particular, HIV prevention, treatment, support and care in Zimbabwean prisons.	13 key informants for the interviews; 24 female inmates and 24 prison service professionals for the focus groups (each group had six participants)	Structured guides for key informant interviews and focus group discussions	Officers’ role: - provide information on health education; - act in the access of incarcerated women to primary health care, including access to HIV services.

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[1] Corresponding author: Aline Aparecida Monroe E-mail: amonroe@eerp.usp.br