HIV and HCV in U.S. Prisons: Debunking the Myths
Data show that, much like HIV, the majority of HCV infections happened before serving time in jail or prison. A 2002 CDC report estimated that 72 to 86% of injection drug users are infected with HCV. Since the vast majority of HCV infections are due to injection drug use, an untreated person is very likely to pass the virus on to a partner or another user. After being released from prison, many untreated users will continue to inject, often sharing needles and likely infecting others with HCV. As HCV cycles through communities of injection drug users, many of whom are arrested and imprisoned, the infection rates in prisons remain high. And the longer inmates are denied proper HCV treatment, the worse the epidemic gets.
HIV and HCV transmission does occur in prisons and jails, but it happens less often than most think. Sexual activity occurs in prisons between inmates, between inmates and staff, and during conjugal visits. Sex can be consensual or by sexual assault. There is little supervision during most prison activities, so it can happen often. Condoms and other preventive barriers are often not available to inmates, so the risk of HIV and HCV transmission during sexual activity is high. Injection drug use also continues within the prison system, and since there are usually no syringe exchange programs in U.S. prisons, most inmates end up sharing needles.
For most injection drug users in prisons and jails, however, the risk of infection was present long before their imprisonment. Many users have very little access to health care or HIV and HCV testing in their home communities. Many have been unknowingly living with an infection for quite some time. Drug treatment programs are also severely lacking in communities with high rates of injection drug use, and partners of drug users are often subject to the same risks of infection through sexual contact.
The high rates of HIV and HCV infection in prisons seem to be a result of who gets sentenced. Out of the 1.7 million people in prisons and jails in 2000, 1.4 million were imprisoned due to possession or sale of narcotics, crimes to support their addiction, or offenses in which drug use was a factor. In that same year, 24% of inmates in state prisons and 14% in federal prisons had a history of injection drug use, while 340,000 state inmates and 170,000 federal inmates had shared needles at some time. If such a high proportion of people in prison have a history of drug use, and specifically injection drug use, prisons are bound to have higher rates of HIV and HCV infection than the general population.
State and federal prisons should be concerned with protecting inmates from HIV and HCV infection, but they also need to address the stigma and homophobia that inmates are faced with. For inmates who enter prison already living with one of these viruses, confidentiality is of utmost importance. When HIV-positive inmates receive HIV meds, they should never have to wait in a separate line from their peers, which puts them at risk of ridicule, isolation, and severe emotional and physical abuse. Similarly, prison officials should be well trained in the need for confidentiality and sensitivity toward HIV- and HCVpositive inmates. They should also be sensitive to the needs of lesbian, gay, bisexual, and transgender inmates since HIV stigma is still linked with this community. HIV stigma and homophobia only serve to push sexual activity and drug use further underground, putting inmates at greater risk of being infected or infecting others.
In addition, prisons should increase education about HIV and HCV prevention and care. For prisoners who have never received adequate health care and comprehensive sexual education, the prison could be a turning point in their lives. If prisons use this unique opportunity to reach out to inmates, they could keep inmates healthier long after they leave the facility. This information could then serve to lower infection rates when prisoners return to their communities.
Passing out condoms and clean syringes could also have a positive impact on communities affected by high incarceration and injection drug use rates. The more people who leave prison HIV- and HCV-negative, and the more people living with an infection who leave prison healthier and more knowledgeable, the healthier their communities will be.
These communities could also see a dramatic drop in the spread of HIV and HCV if incarceration becomes less common. The "stop-and-frisk" policies that target people in these communities are often driven by racism, homophobia, and transphobia, and create unstable and unsafe environments for the most vulnerable populations.
Lastly, the instability in some communities that is driven by incarceration and fuels the spread of HIV and HCV is made even worse by high rates of recidivism (going back to jail or prison). The constant cycling in and out of prison leaves a community devastated. But this could be prevented with the proper resources. Research shows that if prisons educate inmates and assist them in finding employment, they are much less likely to return to prison. If real opportunities were provided on a large scale, communities could begin to see much lower prison rates and, as a result, HIV and HCV infections. When communities are educated, the virus is less likely to spread.
By addressing the health and prevention needs of prisoners and their communities, prisons can help end the cycles of HIV and HCV infection.
Elizabeth Lovinger is a Policy Associate at GMHC.
This article was provided by ACRIA and GMHC. It is a part of the publication Achieve. Visit ACRIA's website and GMHC's website to find out more about their activities, publications and services.
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