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!
Sanna
Klemetti
smklemetti@gmail.com
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