A UNAIDS "Best Practice" report noted that prisons are ideal environments for HIV transmission, since they are often overcrowded, filled with violence, tension, and fear, and boring. "Release from these tensions, and from the boredom of prison life, is often found in the consumption of drugs or in sex," the report said.

"Poverty is a defining characteristic of both prisoner and HIV positive populations alike," noted another report, "HIV/AIDS in Prison: Problems, Policies and Potential," compiled by the Pretoria-based Institute for Security Studies. "Policies to address HIV transmission in prison cannot be effective without immediate and urgent prison reforms," the report stressed. "Overcrowding, corruption, and gangs are the primary culprits behind rape, assault, and violence in prisons, and this environment is horrifying, even without the risk of HIV infection."

In southern Africa, according to the UNAIDS report, appalling prison conditions, coupled with inadequate nutrition and health services, exacerbate the incidence of AIDS. TB is also a serious problem. People with HIV are particularly vulnerable to TB, and can transmit the disease to non-HIV-positive inmates.

STDs are another problem. Lack of information, education, and proper medical care can lead to untreated STDs, which increase a person's vulnerability to HIV through sexual contact, UNAIDS warned. Most prison authorities in southern Africa refuse to provide condoms to inmates, according to the report, even though they know that sexual activity occurs in prison.

"Recognizing the fact that sexual contact does occur and cannot be stopped in prison settings, and given the high risk of disease transmission that it carries, UNAIDS believes that it is vital that condoms, together with lubricant, should be readily available to prisoners. This should be done either using dispensing machines, or supplies in the prison medical service," the report stated.