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'Out of Flames and Fear': How People With HIV Forced California to Reform HIV Care in Prisons

May 24, 2017

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Brian Carmichael

Brian Carmichael, one of the imprisoned leaders of a campaign to change prison health care in California. Courtesy of Brian Carmichael.

"Imagine a prison, one single prison, where hundreds and hundreds of inmates died." That's how Brian Carmichael describes the California Medical Facility in Vacaville during the late 1980s and early 1990s.

Carmichael's education around HIV and AIDS began in 1987 at California's Folsom Prison. It started when Carmichael's friend Rick received a visit from his wife, who told him to get tested for HIV. Rick did and, when his test came back positive, Carmichael recalls, "guards came onto the yard in HAZMAT suits, handcuffed him and took him to R&R (Receiving and Release) where he was transferred to CMF-Vacaville [the California Medical Facility]." There, he was placed in a segregated unit for people with HIV.

Less than a day after Rick's transfer, prison guards returned to his cell in Folsom and ordered the other men to remove all of his belongings from it. The men refused and, says Carmichael, were ordered again, this time at gunpoint. The men dragged Rick's possessions -- his mattress, his clothing, his photos and everything else -- to the yard in front of the cellblock. Then, using the gasoline from a prison lawnmower, the guards set everything alight.

"Everyone ran," recounts Carmichael. "Not from the flames, but from the fear that now AIDS was floating in the smoke and air."

Out of the flames and fear, Carmichael, then in his early 20s, became an HIV activist and educator. He says he was "determined to learn everything I could about HIV/AIDS and keep it from killing me or any more of my friends."


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Segregated HIV/AIDS Unit: "Death Row"

Two years later, in October 1989, Carmichael was transferred to Vacaville for a psychiatric evaluation. There, he walked by the segregated HIV/AIDS unit every day. "Most of the guards referred to these units as 'Death Row' or worse," he says. Those in the unit were not allowed to work, which meant that they were unable to earn work credits to reduce their prison sentences. They were not allowed to go to the yard or mess hall. Instead, their few activities were limited to that unit or a small fenced-in area just outside it. The prison had one dedicated HIV physician, German Maisonet, M.D., whom Carmichael describes as "an absolute hero." But Maisonet was both overworked and frustrated that prison administrators ignored his warnings and efforts to develop a five-year plan to address HIV in the prison system.

The inaction led to deaths -- and many of them. "These weren't peaceful, dignified deaths," Carmichael points out. "They were horrible, agonizing and torturous deaths. People screaming in pain, begging for attention, often locked alone in punishment cells -- or even those 'fortunate' enough to be in the prison infirmary, they were verbally abused, ignored and isolated, dying in fear."

Seeing the treatment of Rick and others isolated in the HIV unit dissuaded many, including Carmichael, from even getting tested. "I'm afraid to test!" Carmichael remembers telling a reporter from Bay Area radio station KPFA . "I see how all these other guys are doing the socially responsible thing and getting tested, and then they get punished and start losing privileges, visits, jobs that reduce your prison sentence. So, I'm not sure if I'm HIV-positive or not." Carmichael was not alone in his fears; many others, both in California and prisons across the nation, were hesitant to get tested and be subjected to similar punitive measures.


Round-the-Clock Vigils

But, Carmichael wasn't afraid to help those with HIV and AIDS. Father Patrick Leslie, the prison's Catholic chaplain, had recently implemented Pastoral Care Services (PCS), which trained people to visit sick and dying people in the prison's hospital and HIV segregation units. Carmichael and Laos Schuman, whom Carmichael had met on his first day behind bars in 1983, signed up. "We wanted to make sure that no one else there died alone in a cell, begging for help, attention, comfort … just company," he recalls. The work wasn't easy; when a person neared death, Carmichael, Schuman and other PCS volunteers signed up for round-the-clock vigils. "We would sit in shifts, 24 hours a day, and never leave their side until the next guy showed up."

Both then and now, prisons across the nation routinely stop all activity several times a day for "the count," a process through which each and every incarcerated person is counted to ensure that no one has escaped. The count typically requires that every person be in their housing unit or cell, but in Vacaville, prison staff allowed PCS volunteers to be counted in the hospital room so that they did not have to leave a dying man alone, even for an hour. They weren't the only ones to join. Among the other volunteers were Charles Perry, whom Carmichael describes as a "big, violent, tough guy," who was living with AIDS himself, and Peter Yvanovitch, who played both chess and piano.


The AIDS Quilt Goes to Prison

Bringing comfort to those dying of AIDS wasn't their only aim. Once Carmichael, Schuman, Perry and Yvanovitch saw the conditions inside the segregation units and the treatment meted out to those with HIV, they wanted to expose these conditions. The four began writing to reporters, politicians and attorneys. They reached out to the NAMES Project and asked whether the AIDS Quilt could be brought to Vacaville. The Project agreed, marking the first time the AIDS Quilt was brought inside a prison. The men at Vacaville, meanwhile, decided to make their own panel to commemorate those who had died inside the prison. Instead of making several 6-by-3 foot panels, the men made one 12-by-12-foot panel listing the names of 96 men who had died from AIDS-related complications at Vacaville. Carmichael notes that, from their own records along with those of Maisonet and Father Leslie, they knew that more than 200 people had died, but in the end, they were only allowed to sew in 96 names. "Still, try to imagine that," he challenges, "200 or even 96 guys dying in one prison." (In contrast, between 2001 and 2012, California's 33 prisons altogether had 114 AIDS-related deaths.)

In February 1992, the AIDS Quilt arrived at Vacaville. But, prison security took precedence, and the quilt was searched, panel by panel. Carmichael recalls that drug-sniffing dogs walked across the panels checking for drugs. For Carmichael, the blatant disrespect was symptomatic of the entire prison culture towards HIV and AIDS. "That's what we were up against, every day, trying to get access to the segregation units, hospitals, etc.," he reflects. But, despite this, Carmichael remembers that the display was a huge success. Hundreds of people came through the chapel to view the dozens of panels exhibited. "Everyone was crying, and it was another life-altering event for a lot of us," he says. At that event, Maisonet also dropped a media bombshell: He was resigning in protest of the prison's continued disregard for the well-being and care of people with HIV and AIDS.


Refusing Food and Medication to Demand Better Treatment and Hospice Care

Carmichael says that from that event emerged plans for a hunger strike to demand not only better HIV treatment, but also the establishment of a prison hospice. The inside activists met with activists from ACT UP and formulated a plan. ACT UP agreed to press local media to pay attention to the deteriorating conditions inside Vacaville, send out press releases and helped build support for the men's actions inside. Meanwhile, Carmichael wrote to reporters, lawyers and politicians whose addresses he could get his hands on, sending information and documentation about conditions inside the prison. When the Senate Rules Committee held its required hearing to confirm a new Vacaville warden, ACT UP marched in protest in Sacramento.

Three months later, Vacaville had four deaths from AIDS-related complications. On September 19, 1992, people inside Vacaville began refusing their medications, effectively launching a medication strike. Carmichaels says strikers included not only the 275 people on the HIV unit, but also dozens of lifers, drag queens and psych patients. "That first day, it was incredible," he recalls. "More than half of the prisoners who took ANY medication in the prison refused." Given that Vacaville was a medical facility, that meant that at least half of the 3,000 people were participating. They demanded an outside investigation into both the deaths and the medical and custodial staff who were assigned to care for the men when they died. They also demanded a legislative review of the prison's compassionate release policies and practices, a meeting with the director of the California Department of Corrections, and the establishment of a hospice inside Vacaville.

The medication strike lasted for over a month, though some participants tapered off when their medication refusal began severely impacting their health. Even after the first ten days, over 100 people were still refusing their medications.

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