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

Why Cut Social Security while NOT taxing Wall Street?

Dear GAA Reader,

Dean Baker wrote an instructive article for the Huffington Post asking why older persons must endure possible cuts to Social Security while the Wall Street bankers who brought on the Wall Street collapse in 2008 smile easily as they rake in more money.

Baker says, "Since Social Security benefits account for more than 70 percent of the income of a typical retiree, President Obama's proposed Social Security adjustment would reduce benefits by an average of 3%."

According to Baker's research, "a wealthy couple earning $500,000 a year would see a hit to their after-tax income of just 0.6 percent from the tax increase that President Obama put in place last year." Small change for them!  While the rich have little pain, most US  seniors will feel the hurt as their Social Security check drops 3%.

Do you think that US seniors should pay for the current economic crisis?  If you say "no", then support Senator Tom Harkin's proposed legislation that would put a .03% tax on stock trades and other financial assets. Such as measure, Dean says, could raise $40 billion per year or over $400 billion over a decade once it went into effect.

If you think these are good ideas, share them with your colleagues, friends and family. Ask them to write their Congressional Representatives and urge them to enact legislation that Harkin proposes.

We older persons must stand up to support ideas and policies that assure fair,  just and adequate incomes for all of us.  We are many.  We can do it!

Have a good week!

Susanne Paul for Global Action on Aging

Immigrants to the US and Social Security: Ripe for Ageism and Disabilty Bias

New America Media reveals a new version of Old Bias:

SAN FRANCISCO--As the debate over immigration reform tugs predictably back in Washington, an undercurrent of ageism and disability bias has been flowing beneath more obvious racial and class implications.

Take, for instance, the recent USA Today op-ed co-authored by former U.S. Sen. Jim DeMint, R-S.C., now president of the conservative Heritage Foundation, which warned, “The truly enormous costs come when unauthorized immigrants start collecting retirement benefits.”

DeMint and his colleague continued, “Social Security, Medicare, food stamps and other entitlement programs already impose huge, unfunded liabilities on taxpayers.” The op-ed goes on to declare that “an amnesty” proposed for 11 million unauthorized immigrants will add significant taxpayer costs because unauthorized immigrants average only a 10th-grade education.

Doing the Right Thing

Rather than being a burden, however, according to the Social Security Administration’s chief actuary, those presumed drains on the system have been a boon. They add $15 billion a year to Social Security in payroll taxes, only taking out $1billion annually in benefits. In the long term, immigration reform would modestly cut Social Security’s deficit, not worsen it.

According to Pew Research, that’s partly because of future rising income and home ownership levels for those immigrants’ children.

“Those opposed to immigration reform have attempted to use vital programs, like Social Security, as an economic excuse to avoid doing the right thing,” said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM).

In a policy brief last week, NCPSSM cited Edward Alden of the Council on Foreign Relations, who has said that immigration reform would actually lead to higher wages and allow immigrants to pay more towards Social Security.

"They’re going to pay more into the Social Security system. The CBO has run these numbers in the past, in the short-run there’s a big boost for the Social Security system," Alden said

White House and Senate ‘Roadmaps’

According to a new policy analysis by the National Hispanic Council on Aging (NHCOA) and National Council on Aging (NCOA), today’s approximately 11 million unauthorized immigrants include 1.3 million individuals ages 45-54, and another half million who are 55 and older.

NHCOA’s Jason Coates and NCOA policy analyst Joe Caldwell examined “roadmaps” to citizenship outlined so far by the White House and the Senate’s bipartisan “Gang of Eight,” with legislation to come in a few months.

Both proposals signal long waits before eligible immigrants could even apply for lawful permanent resident status (green cards) and citizenship. And their access to health care and economic security benefits, especially important to elders and those with disabilities, is in doubt.

Under the current proposals, unauthorized immigrants could end up waiting a decade or more to qualify for health care and other safety-net programs.

While the Senate plan would link the waiting period for being able to apply for green cards to some assurance of border security, the White House has proposed allowing undocumented immigrants provisional status for six-to-eight years before they could become permanent residents. (Both the administration and Senate frameworks would expedite the process for “DREAMers,” agricultural workers, and highly skilled immigrants with advanced degrees in such areas as science and technology.)

Once an immigrant waited through those years on provisional, or temporary status and qualified for a permanent status (the green card), he or she would begin the five-year process toward naturalization. During that time, the White House and Senate proposals would deny them access to federal benefits, such as Medicaid, Supplemental Security Income and the Supplemental Nutrition Assistance Program (food stamps). President Obama’s proposal would deny access to subsidies under the Affordable Care Act. People could have to wait more than a decade for assistance.

Older adults would also have to wait that long to access Medicaid, which is the primary payer of long-term care in the U.S. States can waive the five-year waiting period normally required once someone becomes a permanent resident, but only for pregnant women and children, not for individuals with disabilities or seniors.

Statistics show that six-in-ten undocumented Hispanics is without health insurance.

They would also have to wait another five years -- that is about a decade after starting on the path to citizenship -- to qualify for federal Medicare.

Many of those 11 million undocumented people are overrepresented in low-paying and often physically demanding occupations, frequently incurring high rates of work-related injuries, and contributing to high rates of disability and chronic conditions over time.

Looming Shortage of Care Workers

The NHCOA-NCOA report also calls on the government to strengthen and stabilize the shrinking direct-care workforce, such as the nursing aides who assist patients with such crucial daily activities as getting dressed, taking medication, preparing meals and managing money.

The advocacy groups say reforms should afford these workers the same streamlined and expedited visa process as those proposed for scientists, engineers and workers in other high-need areas, because the nation is facing a looming shortage of care workers.

The paper explains that as the U.S. population ages, U.S. demand for long-term care will leap from today’s 12 million to 27 million by 2050. The country will need 1.6 million additional direct-care workers by 2020 and 3 million by 2030.

Immigration reform is vital for meeting that projected need, say NHCOA and NCOA, because almost one in four current direct-care workers is foreign born. About half today are naturalized citizens and others have legal status, “but a significant portion is estimated to be unauthorized.”

Policy changes offering these workers authorized immigration status would improve the quality of care, says the paper, by allowing for improved background checks, providing workers opportunities for training and career advancement, building registries to assist individuals and find workers, and enabling workers to legally drive.

“Comprehensive immigration reform will help millions come out of the shadows. Many of the half million older adult immigrants [among them] have worked for decades and contributed millions to Social Security,” said NHCOA’s Jason Coates. Rather than begrudging them income and health security protections they have earned, he added, “We should reward their contributions to the to the United States.”