HIV in US Prisons

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

Learn more and see references at:

*http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5515a1.htm

http://www.aclu.org/hiv-aids-prisoners-rights/sentenced-stigma-segregation-hiv-positive-prisoners-alabama-and-south-caro

Dying in Prison - The US' Massive Prison Population is Getting Older

 Prisons across the USA are dealing with an aging group of people. According to a Human Rights Watch study made in 2010, some 26,000 inmates in the USA were 65 and older, and this trend is growing. A new report from the American Civil Liberties Union estimates that by 2030, the over -55 group will number more than 400,000. This projection amounts to about a third of the overall prison population.

More and more older women and men are dying in prison of natural causes. Some grow old and die in prison and some enter prison in such a poor health that they will die before they complete their sentence. According to the National Institute of Corrections, prisoners age 50 and older are considered “elderly” or “aging” due to unhealthy conditions prior to and during incarceration. A study by Brie Williams and Rita Albraldes published as a chapter in the book Growing older: challenges of Prison and Reentry for the Aging Population, found that in addition to the chronic diseases that increase with age, older offenders have problems such as paraplegia because of the legacy of gunshot wounds. Many have advanced liver disease, renal disease, or hepatitis. Still others suffer from HIV-AIDS, and many more endure the effects of drug and alcohol abuse. Living under prison conditions, they are more likely to get pneumonia and flu.

Cells and dormitories are starting to fill up with old, often sick, men and women. They get around in wheelchairs and walkers. They fill the prisons, assisted living wings and hospices faster than the state and federal government can build them. And since they will probably die in prison, they also fill up the mortuaries and graveyards.

Passing on in a Prison

Some prisons have created hospices to respond to the emotional as well as physical needs of the dying. The rules about visitors are usually more relaxed, so that family members can sit at their relative's bedside seven days a week and are permitted to hug and touch their loved one. The “staff” in a hospices are other volunteer inmates who complete a 50 hour training, as well as ongoing training as the need arises. These volunteers will read, pray and write letters for the dying; they also assist the nurses with certain tasks such as preparing baths and changing diapers.

Sadly, even though attempts to try to deal with this growing challenge, it is still far from well working. Most of the time, the care the aging inmate receives is grossly inadequate and very expensive. For the first time some states are considering releasing terminally ill and mentally ill prisoners before they complete their sentence. To me this seems like a good idea.

Compassionate Release?

Compassionate release is a legal system that grants inmates early release from prison sentences on special grounds such as terminal illness or a child in the community with an urgent need for his or her incarcerated guardian. Compassionate release can be mandated by the courts or by Internal Corrections Authorities. Unlike parole, compassionate release is not based on a prisoner's behavior or sentencing, but on medical or humanitarian changes in the prisoner's situation. Why should we let people out from prison?

It is unnecessary to keep the old incarcerated, since there is evidence that demonstrates that recidivism drops dramatically with age. For example, in New York, only 7% of prisoners released from prison at ages 50-64 returned to prison for new convictions within three years. That number drops to 4% for prisoners age 65 and older. In contrast, this figure is 16% for prisoners released at age 49 and younger. Further, the majority of aging prisoners are not incarcerated for murder, but are in prison for low-level crimes. in fact, many aging prisoners are incarcerated for nonviolent crimes.

Keeping people in prison is very expensive. The US spends approximately $77 billion annually to run the penal system. The incarcerated aging prisoners cost far more than younger ones. Specifically, it costs $34,135 per year to house an average prisoner, but it costs $68,270 per year to house a prisoner age 50 and older.

US Federal sentencing laws has been very harsh for a generation. Compassionate release is a humane and practical program and it saves money. Yet, it has not been used very much. In a lot of cases, prisoners and their families don't even know about this program.

Sanna Klemetti

sm.klemetti@gmail.com

For references and to learn more please read:

http://www.aclu.org/files/assets/elderlyprisonreport_20120613_1.pdf

Growingolder: challenges of Prison and Reentry for the Aging Population

Aging in Prison

Recently I attended the monthly general meeting of the New York NGO Committee on Ageing. The topic was “Aging in Prison – a Human Rights Issue.” Two academics who have specialized on treatment of US prisoners presented some of their research. They were:

Tina Maschi, PhD, LCSW, ACSW, who is now Associate Professor at Fordham University Graduate School of Social Services (FUGGS); she’s also a Social Fellow at the New York Academy of Medicine, a Research Scholar at the Ravazzin Center on Aging, and Coordinator for the FUGGS Human Rights and Social Justice sequence. The second speaker, Deborah Viola, PhD., is Associate Professor and Associate Director, Doctoral Program, Department of Health Policy & Management at New York Medical College, and Research Scholar at the Center for Long Term Care Research & Policy.

General Facts

The US population makes up about 5 percent of the world’s population. About 10 million people are imprisoned world-wide. Surprisingly, 25 percent of those are “doing time” are held in US prisons. Among them, 16 percent of the 10 million are 60 years and older. The US exceeds all nations in the number of old people incarcerated in its prisons. At present, the older population is the most rapidly growing group in US prisons. In fact, the number of older prisoners is growing faster than the number of older persons in the US population. In the US, 756 human beings out of every 100.000 people are incarcerated.

Why are there so many people in US prisons?

One would think since the US has the largest prison population in the world that the nation must be home to very dangerous criminals who everyone would agree are “bad” people. But wait a minute, are they?

About three decades ago the US introduced a “tough on crime” policy. State and federal legislators adopted laws that increased the likelihood and length of prison sentences, by including mandatory minimum sentences and three strikes laws. It seems a bit strange that while the crime rate had declined since the 1980's; nevertheless the US prison population grew six-fold.

It is very interesting that the US has privately owned prisons. The two largest private prison companies combined to bring in close to $3,000, 000, 000 in revenue in 2010. Earlier in the 1980's, there were no privately owned prisons in the US. Since then the number of incarcerated people has exploded. It does not take a genius to see what is going on here.

Last year the largest private prison in the US, Corrections Corporation of America (CCA), received $ 74 million of taxpayers’ money to run immigration detention centers. There are numerous reports on human rights’ abuses in these private prisons. For example, when auditors visited one private prison in Texas, they “got so much fecal matter on their shoes they had to wipe their feet off on the grass outside.” The prisoners were literally living in their own excrement. To make a phone call to a lawyer or loved ones, the CCA charges its inmates $ 5 per minute, yet the prison only pays inmates who work at the facility $1 per day. To me, it looks like the more people the “justice system” can put behind bars, the more money the private prisons will make.

A lot of people go to US prisons because of drug crimes. Examining who actually goes to prison because of a drug crime speaks very loud. About 14 million whites and 2.6 million Afro-Americans report using an illicit drug. While five times as many whites are using drugs as African Americans, yet African Americas are sent to prison for drug offenses at 10 times the rate of whites. African Americans serve virtually as much time in prison for a drug offense (58.7 months) as whites do for a violent offense (61.7 months). Surely this is not “equal treatment under the law.” One out of every 12 Afro-American men of working age is in prison. These statistics tell us that if you commit a drug crime and are not white, you will go to prison. If you are white, it is considered a public health problem.

What are the problems facing an older population behind bars?

Prisons in general are designed for the young and able-bodied. For example, when people grow older they have different medical and health needs than the young. Older persons are more likely to develop disabilities that require the use of assistive devices such as glasses, hearing aids, wheelchairs, walkers and canes. As in the community, the elderly in prison suffer from falls, which contribute to hip fractures and high health costs. Even if these conditions are provided for, many elder inmates are confined in facilities that cannot meet the structural or programmatic needs of mobility-impaired persons. Because of their higher rates of illness and impairments, older prisoners incur medical costs that are three to nine times higher than those of younger prisoners. In general a younger prisoner costs about $22.000 per year while an older person can cost as much as $65,000 per year.

It is also documented that the older prisoners “age” about 15 years faster than people who are not incarcerated.

Sooner or later, one of two things will happen to an aging prisoner. Either he/she will die in prison, or will be released. Neither of these alternatives has gained that much attention. Reentry into society is very difficult for any former prisoner. Older persons face additional challenges. Older women and men find it extremely hard to find work, housing and transportation, as well as necessary medical and mental healthcare. Some have the assistance from former friends and family, but many have lost contact with their families because of the length of time incarcerated or the nature of their crimes.

As the number of older prisoners increases, so too does the number of men and women dying of natural causes behind bars.

For references and more information please visit:

Human Rights Watch's report “Old Behind Bars”

Statistics 

Sanna Klemetti

s.klemetti@globalaging.org