Potent new antiretroviral combinations have contributed to dramatic decreases in HIV progression, AIDS incidence, hospitalization, and increased survival. These successes are not equivalent for all sectors of the community-namely for HIV-infected minorities, women, and injecting drug users-all of whom are more highly represented in correctional settings. Thus, prisons and jails are important for the initiation of antiretroviral therapy; however, considerable obstacles to providing this care exist. Antiretroviral therapy is not uniformly efficacious; the lack of benefit for some is primarily related to non-adherence. Non-adherence with HIV therapy may lead to decreased clinical benefit and development of drug-resistant HIV strains. We must use what we already know about adherence and develop multi-faceted interventions that target the patient, the health care setting, the clinician, and, for prisoners, the correctional environment itself. While the challenges may seem daunting, this article addresses the many issues correctional environments face in optimizing antiretroviral therapy for prisoners.
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