AIDS in Prisons
Originally published by The New York Times, May 21, 2001
Tens of thousands of prisoners around the country are infected with the virus that causes AIDS, making prisons one of the most potentially dangerous incubators of the epidemic. The infected inmates need health care that is often unavailable in prison, and their fellow prisoners need protection from contracting the virus. The concentration of people with the AIDS virus in prisons means that healthy inmates run an increased risk of catching the disease by having sex or sharing hypodermic needles with them—behaviors that are illegal but widespread in American prisons.
Theoretically, every prisoner with AIDS is entitled to state-of-the-art medical care. In practice many do not get it. Nor do the prisons provide adequate tools to slow the spread of the virus. Only a few prison and jail systems in the country offer condoms for safer sex or bleach to disinfect needles. This is shortsighted. Officials should not only work to reduce prisoners' risk of catching AIDS in prison, they should also help a captive audience learn about safer practices in a way that would stick when the inmates returned to the community.
New York State estimates that there are about 9,000 H.I.V.-infected inmates statewide—more than 1 percent of the 850,000 H.I.V.-infected Americans. But the amount of AIDS transmission in prison is unknown.
There are no recent studies, largely because corrections officials do not let researchers study the extent of illegal behavior in their institutions. But there is anecdotal evidence that people have gotten H.I.V. in prison, and it is very likely that the number is high. One Tennessee study found that 28 percent of inmates reported injecting drugs in prison. Since needles are rare behind prison walls, they are almost always shared, accelerating the spread of AIDS. Consensual homosexual relations are widespread in prison, and so is forcible sex. A 1982 study by the Federal Bureau of Investigation found that 9 to 20 percent of federal inmates had been raped. The AIDS rate is seven times higher in state and federal prisons than in the population as a whole—because prisoners have high rates of drug use, are unlikely to practice safe sex or use clean needles, and have sex and drug partners with high rates of infection.
Most prisons ignore these risks. Among state systems, only Vermont and Mississippi offer inmates condoms. Four urban jail systems do the same—New York, Washington, San Francisco and Philadelphia. Even fewer systems offer bleach. While New York State officials say condoms are generally prohibited because they can be used for drug smuggling, the state does give inmates condoms for conjugal visits, and has had no problems.
Jurisdictions that offer condoms to all prisoners also report that condoms are not misused. Prison officials may be reluctant to offer condoms or bleach because they do not want to be seen as encouraging sex or drug use or acknowledging illegal activities.
There is more of a consensus on the need to provide AIDS education and care, but these programs are underfinanced and inadequate virtually everywhere. New York State officials say that financing for AIDS in prison has gone from $40 million to $70 million annually in the past few years, but a 1999 report by the New York State AIDS Advisory Council said programs were still inadequate. Prison doctors and nurses lack training in dealing with AIDS, the report concluded, and health care and access to up-to-date AIDS treatment vary greatly from prison to prison. The study also pointed out the need to prepare prisoners for release.
Education about AIDS prevention is often not done in a way that resonates with prisoners, and such programs need to be linked with health care on the outside so that patients on antiretroviral drugs continue their treatment. The vast majority of prisoners will eventually go back into the community. Prison offers the opportunity to give these high-risk people the medical care and AIDS education they will not get once outside.
