Of the 2.2 million people serving time in US prisons, around 1.5 % of those are living with HIV or AIDS. That number is about four times higher than the infection rate of HIV in the general population. Studies show that most HIV positive inmates are infected before they enter prison. Nevertheless, prison environments offer many opportunities to spread HIV. High risk behaviors such as injecting drugs, tattooing, body piercing and unprotected sex (consensual and rape) are not uncommon in a prison setting.
To give you an idea of the situation, I found a CDC (Center of Disease Control) study carried out in a Georgia State Prison between 1992 and 2005. It showed that 54 inmates (45 cases and 9 control persons) reported having male-male sex while in prison. Some 35 persons (78 %) of the case inmates and four (44%) of the nine control inmates reported no male-male sex after the first six months following incarceration. Among those who reported any male-male sex, 39 said they had consensual sex with other inmates. They exchanged sex for food, cigarettes, money, etc. Rape was also reported. When consensual sex occurred 34 (30%) reported using condoms or other improvised barrier methods (such as a rubber or plastic glove). In “exchange sex,” 21 % said they used improvised methods, but no condoms. No protection was used during rape.*
What has been done in the US about this situation?
Several bills have been introduced to attack this growing problem. It's been clear that the prison authorities must ensure a safe and humane treatment of prisoners who are HIV positive or are living with AIDS. Congresswoman Barbara Lee (CA) has introduced H.R 3053 – to Repeal Existing Policies that Encourage and Allow Legal HIV Discrimination Act (REPEAL HIV Discrimination ACT). And Congresswoman Maxine Waters (CA) has introduced H.R 3547, the Stop AIDS in Prison Act. This legislation calls for a comprehensive policy to provide HIV-testing, treatment and prevention measures for inmates in federal prisons and upon their reentry into the community. It would also require prisons to test inmates upon intake and offer counseling. It also requires frequent HIV/AIDS educational programs for all inmates.
Some state prisons have HIV positive people in separate facilities, arguing that such separation allows them to focus on medical care. The HIV positive inmates and HIV negative inmates mix for education, vocational training, religious and other prison programs. But is such segregation of HIV positive inmates really the solution?
As a matter of fact, separate facilities may well increase the already existing stigma. I believe that separate facilities may well be inhumane and degrading and may violate international law. Even if you are in prison, you should have the right to privacy. It should be the citizen’s right to decide whether to tell others of his/her health status. Laws and regulations that exist regarding HIV status should be the same in prison as in free society.
On the other hand, confidentiality of medical information in a prison setting is hard to maintain. Persons other than of medical staff members may handle medical records. Once such information is released, it travels fast. It has been argued that prisoners have a greater need for privacy than those outside because they live in a closed community where violence is common. Also, if prisons fail to keep medical records confidential, inmates might choose not to get tested, to avoid being victims of this double-sided problem. Prison officials also use HIV tests results to make decisions about housing (separate housing as one option in some prisons), work assignments, and visiting privileges. It's been common to ban HIV positive inmates from kitchen work.
Many inmates report difficulties getting the right medications and at the right time, or at all. To solve this problem, separate facilities might be a solution. Nevertheless, is it necessary to put HIV- positive prisoners in a separate facility simply to assure that they get the right medications at the right time? I am sure the prison system can do better than that. Besides, keeping people in different facilities does not reduce the spread of other sexually transmitted, opportunistic, and blood-borne infections. Such policies do not prevent transmission by inmates who are unaware that they are infected or by HIV-infected correction staff. There is no available data that show the effectiveness of separate housing for HIV positive inmates as an HIV – prevention strategy.
A better solution alongside education and volunteer testing would be to make condoms available in prisons and assure confidential patient care. Such a policy would focus on educating prisoners about how the virus is contracted. And it would demonstrate that HIV-positive people CAN work in a kitchen!
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