Worldwide, rates of HIV infection in inmate populations are much higher than in the general population. Inmates continue to use drugs, and efforts to eliminate drug use within prisons are ineffective and unrealistic. Intravenous drug use is also common within prisons and the scarcity of needles often leads to needle sharing. Although sexual activity is believed to be a less significant risk factor than sharing injection equipment, it also puts prisoners at risk of contracting the HIV virus. In addition, prison life encourages the establishment of homosexual relationships. The ECAP report took a strong public health approach to the problem of HIV and AIDS in prison, and a harm reduction approach to the problem of drug use among inmates. Recommendations were made in the areas of HIV testing, confidentiality of medical information, consensual sexual activity, intravenous drug use, and health care. While the Correctional Service has accepted and implemented many of these suggestions, it has been criticized for rejecting some critical parts of the ECAP plan. 65 notes