Black men make up a large proportion of HIV-positive men in prison, where sex between inmates is common and concern about the spread of the virus is limited. This is according to a Columbia University School of Nursing study presented at the annual meeting of the American Public Health Association in Boston. The topic is of concern not only for the risk of HIV passing between inmates, but also for the risk to the general public upon their release.

Researchers took a survey of 63 black inmates at one of the largest maximum-security prisons for men in the country, where two-thirds of the prisoners are black. Many of the inmates described how the depravations of prison life fueled sex between men. While prison rape takes place, the men said, most of the sex is consensual. Some of the men had negative things to say about men who have sex with men.

“These are people who can benefit from education and outreach while they’re in prison, but there’s also a much larger public health issue at stake here,” Tawandra Rowell-Cunsolo, PhD, an assistant professor of social welfare science at Columbia and the study’s lead author, said in a release. “These are people who are going to come out of prison, and preventing the spread of HIV in prison becomes a larger community issue once these men return home.

“There are some prison systems that distribute condoms or have a needle exchange program to prevent the spread of HIV, but for the most part this isn’t done because it’s seen as supporting behavior that’s explicitly against the rules in prison. That makes basic sex and HIV education really important. Some of these men have been incarcerated since before the AIDS epidemic hit the scene and they literally don’t know how it spreads or how to protect themselves.”

To read a release on the study, click here.