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HIV Prevention For Inmates
by Charles E. Clifton
In 1997, 22,518 state
inmates and 1,030 federal inmates were known to be infected
with HIV and 538 inmates died as a result of HIV disease.
By the end of 1997, the rates of confirmed AIDS in prison
(55 per 10,000 inmates) was more than five times the rate
in the general population in the United States (10 per 10,000
U.S. residents age 13 or older).
The majority of positive
inmates in the U.S. correctional system have no idea that
they have HIV until they are incarcerated. For many being
imprisoned provides their first access to healthcare. Michael,
who served a five year sentence in the Mississippi State Prison
at Parchman, was one such individual. “I thought I was the
shit until I was busted. I came to jail 10 years ago. I tested
positive 10 years ago. I couldn’t believe that I was positive.
I ain’t gay. I wasn’t shootin’ up. But there it was—19 years
old, imprisoned for life and HIV-positive. Ain’t that some
shit.”
Michael, who now lives in
Jackson, Mississippi, states that he “ain’t gay.” However,
prior to his conviction, Michael was sexually active with
both men and women, exchanging sexual favors for money, cars,
alcohol and drugs. “I lived the high life at an early age.
Yeah, I got off on my smoke and drink, but you couldn’t tell
me nothin’ back then. I knew it all.”
Drug and alcohol abuse and
addiction was implicated in the incarceration of 80 percent
of the 1.7 million adults incarcerated at year-end 1996. This
included those who violated drug or alcohol laws, were intoxicated
at the time they committed their crimes, stole property to
buy drugs, or reported using drugs regularly.
Michael, like many after
learning that they are HIV-positive, sank into a state of
depression for the first two years of incarceration. “On top
of that,” he continues, “I lived in complete fear of others
discovering my nasty little secret. Slowly I came around.
I know I’ve only lived this long with this disease because
I started to seek medical and psychological help. If I’m going
to be around here for a long time, I have to take care of
myself.”
While it would seem logical
to provide treatment to people while they are incarcerated,
the reality is that few inmates received adequate substance
abuse treatment. Billy Rose, a former inmate from Wisconsin,
states that, “Sadly, many prisoners don’t look for available
help from the support groups already existing in the prisons.
They isolate themselves until it’s too late…until they have
obvious signs of disease. Prison is a horrible place for anyone,
but especially for HIV-positive individuals. It is 100% necessary
for an HIV-positive person to seek out support in order to
survive.”
Many HIV-positive incarcerated
individuals suffer from the horrors of childhood sexual abuse.
The relationship between childhood sexual abuse and high-risk
sexual activity as adults is a case history that isn’t well
documented. (See “Women incest survivors in prison.”) One
HIV-positive inmate from California writes, “You see, as a
child I survived sexual assaults by members of my family.
I go through fits, flashbacks, nightmares, headaches, severe
depressions, and extreme nervousness. I’ve been through a
war…veterans are decorated…they get a Purple Heart. I’m wounded
and mentally disable. I’ve been fighting for my dignity, personal
power, safety and freedom since infancy.” Providing HIV prevention
education while inmates are incarcerated may help them adopt
safer behaviors and reduce their risk of acquiring and transmitting
HIV.
Many correctional institutions
are as large as, and operated like, small towns. And even
though it is prohibited, drug use and sexual activity do take
place in correctional facilities and HIV can be transmitted
through these activities. Larry Baker, an HIV advocate in
the Louisiana State Prison, writes, “Angola [State Prison]
is a city itself, covering 18,000 acres. It has its own Post
Office, hospital, mental health hospital, and fire department,
even its own State Police Department. It operates as the nation’s
largest prison ever in existence, housing 5,200 inmates, including
Louisiana’s only Death Row and location of executions carried
out in the state. We not only have apartments for employees
to sleep overnight in, but also even have a section for employees
to live with their families. Like I said, Angola is a city
itself.”
The primary concern in any
correctional facility is security, which can result in a reluctance
to collaborate with outsiders. However, correctional settings
provide an opportunity to deliver prevention messages to individuals
who can be very hard to reach once they are released. Many
correctional facilities provide voluntary HIV counseling and
testing services, which is a unique opportunity to provide
this service to a high-risk population.
According to the Justice
Department’s Bureau of Justice Statistics, the nation’s prisons
and jails held 1,860,520 inmates at mid-year 1999. If current
growth trends continue, the jail and prison population will
reach two million by the end of 2001. Correctional populations
have higher rates of HIV/AIDS, as well as sexually transmitted
diseases (STDs), tuberculosis (TB), and more risk factors
for these diseases than the general population. Yet, the challenge
of providing effective HIV prevention programs in correctional
settings means that many inmates return to their communities
without adopting safer behaviors.
This text is partially excerpted
from the September 2000 NASTAD HIV Prevention Fact Sheet,
HIV in Correctional Facilities, which was published by
the National Alliance of state and Territorial AIDS Directors,
www.NASTAD.org.
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