Conducting HIV outreach and research among incarcerated drug abusers: a casestudy of ethical concerns and dilemmas

This case involves the examination of an ethically problematic event that arose while we were conducting an outreach/early intervention research demonstration project targeted at women who exchange sex for drugs. Subjects were drug abusers--primarily crack-cocaine smokers--recruited by outreach workers on 'the street' and in jail. Participants were offered counseling, HIV and syphilis screening, and risk-reduction education. A woman who was a jail inmate tested positive for HIV. In order to obtain medical and other assistance, she would have to reveal her serostatus to jail officials. This could result in isolation and the possibility of harm from others in the jail once the information about her circulated. The case highlights the problems inherent in HIV testing of incarcerated drug abusers, especially in low HIV seroprevalence areas. We recommend that a community empanel a committee composed of substance abuse treatment and medical professionals, civil rights advocates, criminal justice personnel, and ethicists to formulate humane and effective policy in light of its drug abuse and HIV problems and its resources.
An annotated case ofan unexpectedly HIV-positive drug abuser prison inmate who voluntarily participated in an HIV outreach and research program is presented. The case emphasizes on the problems inherent in HIV testing of incarcerated drug abusers. It is suggested that humane and effective policy on drug abuse, HIV problems and research be formulated by a community panel consisting of substance abuse treatment and medical professionals, civil rights groups, criminal justice personnel and ethicists.