Background COVID-19 has greatly impacted the health of incarcerated individuals in the US. The goal of this study was to examine perspectives of recently incarcerated individuals on greater restrictions on liberty to mitigate COVID-19 transmission.Methods We conducted semi-structured phone interviews from August through October 2021 with 21 people who had been incarcerated in Bureau of Prisons (BOP) facilities during the pandemic. Transcripts were coded and analyzed, using a thematic analysis approach.Results Many facilities implemented universal “lockdowns,” with time out of the (...) cell often limited to one hour per day, with participants reporting not being able to meet all essential needs such as showers and calling loved ones. Several study participants reported that repurposed spaces and tents created for quarantine and isolation provided “unlivable conditions.” Participants reported receiving no medical attention while in isolation, and staff using spaces designated for disciplinary purposes (e.g., solitary housing units) for public health isolation purposes. This resulted in the conflation of isolation and discipline, which discouraged symptom reporting. Some participants felt guilty over potentially causing another lockdown by not reporting their symptoms. Programming was frequently stopped or curtailed and communication with the outside was limited. Some participants relayed that staff threatened to punish noncompliance with masking and testing. Liberty restrictions were purportedly rationalized by staff with the idea that incarcerated people should not expect freedoms, while those incarcerated blamed staff for bringing COVID-19 into the facility.Conclusions Our results highlighted how actions by staff and administrators decreased the legitimacy of the facilities’ COVID-19 response and were sometimes counterproductive. Legitimacy is key in building trust and obtaining cooperation with otherwise unpleasant but necessary restrictive measures. To prepare for future outbreaks facilities must consider the impact of liberty-restricting decisions on residents and build legitimacy for these decisions by communicating justifications to the extent possible. (shrink)

The HIV/AIDS pandemic, now well into its third decade and spreading in states as diverse as Belarus, Ukraine, Indonesia, and Papua New Guinea, has shown us that we truly are sharing an interconnected world. As we struggle to deal with both ongoing and emerging threats to public health, and to reach just balances of the rights of individuals and communities, it is critically important not to lose sight of the many states where neither the rights of citizens nor the well-being (...) of the community drive policy. Secretive, rights-violating regimes make poor global citizens in a world where new threats can emerge from obscure corners of the world (like occupational exposures in the butchering of masked palm civets or chimpanzees) and spread fast and far. The mishandling of public health threats in such states may be due to incompetence, malfeasance, official denial, censorship of science, bureaucratic inertia, or the desire not to lose face on the global stage. This is true for state failure in an array of other arenas, including economics and development. But public health failures are likely to have effects beyond state borders, and to affect us all. And this may be reason for some hope: outbreaks like SARS cast a bright light on ineffective responses, and may be one more reason for the citizens of the world who live in free societies to be concerned over the fate of those who do not. (shrink)

This special edition ofJLMEcenters on a novel proposal for a national PrEP access program with the potential to break through a failed status quo.