Dismantling the Clinic-to-Prison Pipeline: Race, Justice and the Rise of Intersectional HIV Leadership

Charles Stephens
Charles Stephens (Photo
the Counter Narrative Project

As I'm writing this, I carry an awareness that many of us now share: Michael L. Johnson will turn 25 in prison. He has been imprisoned since October 2013, when he was arrested under the state of Missouri's HIV criminalization law. I am also aware that his incarceration and his sentence of 30.5 years in prison indicate the utter failure of our most valued institutions. His sentence is, moreover, an absolutely cruel and unusual punishment -- a point made by the Center for HIV Law and Policy in its amicus brief. But when you are criminalized because of your race, your class, your sexual identity and your serostatus, there is no public empathy for you.

Michael's case offers a stunning example of the horror and injustice of the clinic-to-prison pipeline. Right now in the United States, 32 states and territories (i.e., the U.S. Virgin Islands and Guam) continue to attempt HIV containment through criminalization laws. Because of these laws, many of us live in fear that, through a simple HIV test, we will be fast-tracked not into the health care system, but into a courtroom and into prison. We live in terror that by testing positive, instead of receiving holistic care, treatment and social support, we may receive punishment, isolation, trauma and removal through these laws. Considering the impact of HIV on black communities, and particularly on black gay men -- a community within which, if nothing changes one in two may become HIV-positive in their lifetimes -- we confront the vulnerability of succumbing to these unjust laws from the moment we enter a clinic.

We must do three things:

  1. Intersectional HIV activism: This is our only hope for addressing the socioeconomic factors that contribute to how HIV impacts black communities. This activism would rely both on statistics and our stories to describe social realities. This approach would advocate not only for access to HIV testing, pre-exposure prophylaxis (PrEP), care and treatment, but also against barriers to those resources.

    This activism may look to BYP100's black queer feminist model to understand the forces shaping our social world. This activism doesn't understand our communities as a parade of risk populations, warring with each other over the few resources they throw at us. We are powerful communities and powerful allies with gorgeous histories and cultures. This activism would scrutinize how resources are allocated and how power is concentrated, then insist on investing in movement leadership as much as all-ready-too-large bureaucracies.

    But most critically, intersectional HIV activism would consider, both in theory and practice, how HIV is absolutely a racial justice issue and that, to grapple with HIV in any way -- as a researcher, policy advocate, activist or civil servant -- is to grapple with structural violence.

    To that end, considering how HIV is a racial justice issue and how racism and other forms of structural violence impact our lives is critical to how we think about the path forward. This necessities a discussion and analysis of how disparities in sentencing practices are connected with disparities in health care access and how the denial of and poor access to health care is a form of state violence. To be anti-state violence also means examining how such forms of marginalization and oppression are connected with how HIV impacts our communities.

  2. Reinvest in movement leadership: Large organizations should focus on bringing more diversity to their organizations and on incubating, partnering with and funding grassroots organizations.

  3. Invest in network leadership: Recognizing the immense failure of institutions to protect black folks, we are at a moment when we must accept the pragmatic necessity of incremental reform of institutions and simultaneously work to build our own institutions of community power, both virtual and brick and mortar.

The future of our movement is as an HIV justice movement that considers racism and other forms of structural oppression. The future of our movement is one where HIV justice advocates build coalitions across movements and work powerfully with other movements committed to ending mass incarceration and sentencing disparities.

The fight against HIV criminalization is about sexual freedom and body autonomy, but also at its core a movement to end racism and other forms of structural violence.

Charles Stephens is the founding director of the Atlanta-based Counter Narrative Project.