Many HIV-infected persons receive their first introduction to antiretroviral therapy while incarcerated, and the correctional setting provides a unique opportunity to initiate effective antiretroviral therapy and provide interventions designed to maximize treatment adherence. Targets for interventions designed to improve the efficacy of antiretroviral therapy in jails and prisons include education of inmates, formulary committees, and administrative and correctional staff, as well as the development of treatment strategies adapted to the unique aspects and limitations of life in the correctional setting. Perhaps the most comprehensive analysis of the issues raised by HIV/AIDS in prisons has been undertaken by the Canadian Expert Committee on AIDS in Prisons (CECAP). CECAP's final report covers the full range of medical, educational, institutional, legal, and social concerns raised by HIV/AIDS and drug use in Canadian prisons. The report advocates a strong public health approach to HIV/AIDS in prisons and contains 88 recommendations designed to protect the health of prison inmates and staff. A summary of these recommendations is presented in this article. This article also summarizes the findings on the current prevalence of HIV/AIDS among State and Federal prison inmates from the ninth National Survey of HIV/AIDS, STDs, and TB in Correctional Facilities in the United States. Rapid advances in anti-HIV treatment will mean longer survival for HIV-infected inmates; it also means, however, that society will continue to bear the ever-increasing costs of providing health care for inmates with HIV infection. This article also discusses policy and ethical implications of inmate participation in experimental therapies and clinical trials. 3 tables and 7 references