Under Lock and Key:
|Illustration by Elton Tucker|
Sheryl is a 15-year-old African-American youth from the Bronx. She is not preparing for her sweet-sixteen party this October when her birthday comes. Nor is she looking forward to getting together with her friends and family to celebrate this rite of passage into womanhood like many other girls her age. Sheryl will be doing none of this while serving time in a state-operated youth lock-up for juvenile criminal offenders.
She probably spent the time before her birthday in October, preparing for a court appearance to determine her placement in future months. Complicating her placement decisions, is the fact that Sheryl is one of a growing number of youths with HIV/AIDS living in youth lock-ups.
Sheryl comes from a family infected with HIV/AIDS, and is an orphan of the AIDS epidemic. While in the care of her custodial aunt, she turned to delivering street drugs for the neighborhood dealers rather than going to school. This course of events has brought her to where she resides now: under lock and key.
Aside from providing an environment for the further spread of infection among inmates, these lock-ups fail to provide the necessary remediation programs for criminal youths.
The problem then becomes twofold:
For infected youths, chronic illness sometimes entails recurrent or chronic stresses, such as hospitalization, poor self-esteem, loss of peer status, decreased competence, impaired bodily functioning, and possible disfigurement. HIV-infected youths are usually exposed to other family members who are dying or have HIV/AIDS, and may react to the impending or actual loss with marked behavioral disturbance, despair, detachment, as well as helplessness, hopelessness and depression.
Alfreda, an 18-year-old Hispanic female, contracted AIDS while in a youth lock-up in her teens. She is one of many youths who are left only minimally supervised during the night shift in many lock-ups. She describes the sexual environment as one of experimentation and curiosity. "We did it to fight the boredom, to give us something to do," she describes. Alfreda returned from the lock-up to her neighborhood where the same problems existed with scars of incarceration, but also with the physical reminder of her unsafe sexual exploits while in the lock-up.
What is it about the teen years that puts this group at such risk for HIV infection? Engaging in high-risk behaviors, such as unprotected sex accompanied by experimentation with alcohol and drugs, increases the likelihood of spreading the infection further in this age group. Although intravenous drugs account for only a small proportion of the spread of infection, the use of other drugs and alcohol can lead to impaired judgment and unsafe sexual practices. These unsafe practices exert a differential effect on the sexes.
Among adolescents, there is not the same discrepancy in rates of infection between males and females as exists in adults. The infection rate is now greater among young adolescent females than in males of the same age. One reason for this is the role that heterosexual sex plays in the transmission of the virus among adolescents. The increasing rate of infection among teen women will, in turn, lead to an increase in the number of children born to infected mothers. This leads to an increased risk of infection for future generations.
Special help is what 14-year-old Carlos could have used while serving time for possession of stolen property. Looking back on this as a 20-year-old, he states, "No one told me what I should do to survive on those streets. I just knew that when I got out, I would need to steal again to survive." He did steal again, and became a repeat offender. He is not sure when or how he contracted the virus, and despite being in several lock-ups on several occasions, he received no education regarding HIV/AIDS, safer sex and needle use. "It's as if we are not going through any sexual stuff. It was ignored."
Carlos is not unlike others who have graduated from the juvenile justice system unserved, unchanged and left with too much to cope with on their own.
Below is a list of recommendations for remediation services for HIV-infected youth in juvenile lock-ups:
If we, as a society, are truly committed to the future, as delivered by our children, we must address the needs of this growing population of infected individuals. We cannot let incarcerated youths become yet another forgotten part of the HIV/AIDS epidemic.
Mental health services, including bereavement counseling, for various age groups and cultural backgrounds: Serious mental health needs should be addressed during and after the period of incarceration. Many of these youths come from homes affected by HIV/AIDS, and could benefit from counseling designed to help them grieve their losses. Special attention should be paid to cultural issues and the means of infection, as these issues result in different clinical presentations in adolescents.
Transitional services for youths after discharge from the lock-up and aftercare planning with special attention to AIDS specific services: After serving time, many youths are not quite ready to return to their community or family of origin. Many should never return to communities and families that present ongoing dangers and result in recidivism. Transitional programs are needed to transition the youth into productive, responsible life situations.
Confidential testing, counseling and HIV-prevention services for the incarcerated to prevent the further spread of infection: In an attempt to stop the further spread of infection, education directed at prevention should be available for incarcerated youths. Confidential testing and counseling should be available for youths, pending consent from the legal guardian. The combination of education, testing and counseling will assist in quelling the spread of infection in these facilities.
Dominic J. Carbone, Ph.D., is a psychologist and Chair of the Board of Body Positive, Inc.