HIV/AIDS in Prison: Crisis of the Confined

Some people have always been genuinely interested in what transpires behind prison walls. For the ill informed, one perception or another is available for the taking. Those of us doing time are routinely probed about prison. The probers are intrigued for a variety of reasons: some because they believe in prison reform, others because they want more stringent policies implemented, and still others look to confirm or dismiss what they have viewed on programs (e.g., the HBO series Oz) that supposedly depict prison life. In most instances, though, one's interest is usually spiked out of pure curiosity. At any rate, when questions are posed about prison, it is necessary to be completely candid, so as to debunk the prevailing misconceptions.

Since I'm an HIV/AIDS peer educator, I focus here on sincere inquiries that have been made about HIV/AIDS in prison. I think it is safe to say as a preliminary matter that this conundrum is seen differently based on one's perspective. Not surprisingly, people in the same prison have dissimilar views about many of the same issues. One thing is clear, however. According to the NYS Department of Health, the number of people suffering from HIV/AIDS in NYS prisons is approximately 12,151, with HIV reported cases are on the rise.

How does this large segment of HIVers in prison deal with the disease? From my observations, mostly in private. The elephant [HIV] in this living room [prison] is colossal but conspicuously avoided. In other words, the disease's presence is apparent, but a great deal of ignorance is still pervasive. HIVers are still unfairly treated, which leaves them more apt to keep their status concealed, and justifiably so.

I can recall an instance in the Prisoners for AIDS Counseling and Education (PACE) office when several of my colleagues and I were having an intense discussion about HAART. At one point during the discussion, we were interrupted by a team member who offered some insight we didn't know he possessed. He casually explained the pros and cons of HAART based on his personal experience. Everyone in the room was surprised by this unexpected revelation. As we sat there mesmerized, he went on to reveal how he contracted HIV by injecting heroin indiscriminately for many years. He also told us about how he would faithfully visit his HIV-positive girlfriend in the hospital, until she died from an AIDS-related illness. By this time, we had unconsciously gone from a healthy debate to a therapeutic counseling session.

I asked our colleague what prompted him to suddenly inform us of his status. He responded that he felt comfortable and believed his status would be kept in confidence. And, more importantly, there was no fear of him being stigmatized. In a moving gesture, he thanked us because he felt like a burden had been lifted from his shoulders. In turn, we commended him for being courageous enough to share his story with us.

I recount this incident to demonstrate the trepidation that exists among HIVers when it comes to revealing their status, even to those with whom they are closely associated, and to illustrate the need for us to be more compassionate and non-judgmental. This is essentially what the PACE program enables us to do: improve out situation in an insensitive place.

One thing certainly worth mentioning here is the prevalent misconception about transmission of HIV in prison. Is HIV being transmitted via the most common routes: unprotected sex between men and IV drug use? Absolutely. But I have been in prison for over eleven years and some of my colleagues have been in prison for over twenty years, and we can say that these acts are not nearly as prevalent as they are depicted in movies and on television.

Over 27,000 people entered NYS prisons in 2002 and approximately 28,000 were released. In addition, while the average prisoner serves less than five years, more than 50% of ex-prisoners commit crimes again within three years. It is therefore reasonable to conclude that men and women are entering the system infected with HIV and, due to the long incubation period, are leaving prison without even knowing they are infected. Under these circumstances, HIV is being spread unwittingly by those who make irresponsible decisions. The number of HIVers in prison is increasing as a consequence, and more infected individuals are being released back into their communities. Is this uncommon? Not necessarily, because in many respects prison is a revolving door of infectious diseases.

According to CDC report authored by Dr. Robert Greifinger, formally the Department of Correction's chief medical officer, and cited by Fox Butterfield in a New York Times article ["Infections in Newly Released Inmates Are Rising Concern" dated January 28, 2003], an inordinate number of inmates are leaving prison with one infectious disease or another. In 1996 alone, 1.3 million releasees had hepatitis C; 155,000 had hepatitis B; 12,000 had tuberculosis; 98,000 had HIV; and 39,000 had AIDS. Presumably, the numbers for 2003 are considerably higher. Hence, providing counseling and education about infectious diseases and risky behaviors needs to be a priority for prison administrators. From the standpoint of the PACE program, an important aspect of AIDS education is encouraging those at risk for HIV to get tested.

Unfortunately, that is where a major dilemma lies, in our reluctance to get tested for HIV, or other potentially life-threatening diseases. This unwillingness to be more proactive when it comes to our health care is perilously imprudent.

HIV/AIDS in Prison: Crisis of the Confined

On one hand, some HIVers contend that the care they receive swings like a pendulum from reasonable to grossly inadequate, depending usually on the health care provider or their placement in a particular facility. Indeed, the medical department is known for its ineptness and its indifference to prisoners' medical needs. On the other hand, however, we sometimes transfer blame, such as for a death, serious ailment, or late diagnosis of a terminal illness, to the medical department unjustifiably. Clearly we have only ourselves to blame when we neglect our health care and compound this problem by continuing to engage in risky behaviors. Although prison officials have care, custody, and control over our bodies, this doesn't mean that we should abdicate responsibility for our physical and mental well being.

What I have basically come to understand is that prison is a microcosm of the larger society. Prison certainly has its own idiosyncrasies, but the problems with HIV/AIDS in prison seem to parallel those in the community. However, since we are a marginalized group, not much interest is paid to the problems of prisoners, as if dodging them will make them disappear and prevent them from resurfacing in the community.

Improving the lives of HIVers in prison is important. Addressing the treatment of prisoners in general is, however, a prerequisite to achieving this objective. But with rehabilitation abandoned and prison sentences intended purely for punishment, improving the treatment of prisoners seems nowadays to be a low priority.

As for AIDS -- no matter if it rears its ugly head in America's prisons, in inner-city communities, or in suburbia -- it is unfortunately still considered by many to be someone else's problem. I am reminded of the thought-provoking words of Martin Niemoller during World War II, re-stated here to fit a contemporary issue:

"... they came first for the poverty-stricken, and I didn't speak up because I wasn't poor. Then they came for the gays and lesbians, and I didn't speak up because I wasn't gay. Then they came for the anti-war crusaders, and I didn't speak up because I wasn't against the war. Then they came for the suffers of infectious diseases, and I didn't speak up because I was disease-free. Then they came for me, and by that time no one was left to speak up."

Ronald F. Day is a peer educator for the Prisoners for AIDS Counseling and Education (PACE) Program at Eastern Correctional Facility in Napanoch, New York.