The prison system in the United States is in a perennial state of health crisis, because the environments in prisons lend themselves to the transmission of disease, adequate treatment is not provided, and there are few commonsense measures in place to prevent infections. HIV/AIDS are not the only conditions common in prisons; prisoners are also much more likely to have various forms of hepatitis along with other infectious diseases. To be in prison is to have a much higher statistical chance of HIV/AIDS infection, for a variety of reasons, and the United States has not dealt with this problem in any meaningful way.
The issue starts long before people enter the prison. Injection drug use continues to be one of the leading modes of transmission of HIV, and injection drug use also radically increases the chance that someone will end up in prison at least once. Many prisoners enter the system with active infections not just from drug use but also from unprotected sex or exposure to body fluids during fights and other violent activities. Once they get into the system, they don’t receive the care they need, and they also endanger seronegative prisoners.
Health care standards in US prisons are revoltingly low, especially when it comes to the management of chronic illness. Many prisons don’t provide regular medical care to their inmates, which can include HIV maintenance medications as well as medical checkups. Treatment may be contingent on good behaviour, the will of the guards, or conditions in the prison; if a facility is on lockdown, for example, a prisoner can’t be transported for a medical appointment or may not be given medication.
Thus, people with previously well-managed cases of HIV tend to decline in prison, and people who lacked access to health care before arriving in prison do even worse. Incarceration also adds emotional and physical stress, which can contribute to further complications for HIV-positive prisoners. HIV may progress to full-blown AIDS in these conditions, which makes prisoners vulnerable to a host of medical problems like serious infections. When these aren’t identified or treated, the patient’s physical condition further declines, and the end consequence can be death.
For people with active HIV infections who enter the prison system, the sentence can be one of death. Death rates can climb in facilities where basic HIV care isn’t provided to control infections and keep prisoners comfortable, let alone when patients develop AIDS and require more advanced medical interventions. People with HIV may pass through the prison system more than once, developing complications that threaten or shorten their lives each time and leaving them more vulnerable to problems in the future. In a landscape where health care for prisoners is treated like a shocking luxury rather than a human right, it can be difficult to advocate for better medical care for people who enter the prison system with chronic illnesses.
In prison, people may contract HIV infections through drug use, unprotected sex, and violence. Preventative measures could radically reduce the rate of HIV infection in prisons, but there’s been considerable resistance to such measures. In the case of providing clean needles and condoms, for example, it’s virtually impossible to overcome social attitudes about prisoners. Administrators may argue that the provision of safe injection kits poses a safety threat in addition to encouraging prisoners to use injection drugs; rather than facing the fact that drugs exist in the prison system and are impossible to eradicate, they may want to pretend that the problem doesn’t exist. Offering condoms to prisoners is also challenging, especially since prison rape is a systemic problem and few rapists take the time to put on a condom.
Addressing violence to reduce the risks for prisoners is also challenging because of the structure of prison environments and the prison system as a whole. Violence is often considered par for the course, and the focus may be on reacting to it when it occurs, rather than taking a proactive approach to prevent it. The management of prisons is focused on punishing inmates, not on protecting them, and identifying factors that might contribute to violence is not a high priority for prison officials and administrators.
For members of the population who are especially vulnerable to violence, like people with disabilities and trans prisoners, just leaving the cell can be a dangerous gamble. Since prison is considered a place for punishment, not one for people to have a chance for genuine reform and change, the attitude that such risks should simply be accepted rather than dealt with is widespread. After all, the logic goes, if prisoners don’t want to be abused and don’t want to contract chronic infections, they shouldn’t have committed the crime that landed them in prison in the first place.
Adequate screening may not be provided, making it difficult to identify cases of HIV as soon as they present. Consequently, prisoners who are infected while incarcerated may not get early treatment, which can make a radical difference in overall outcome. In addition, they may not be aware of their HIV status upon leaving prison, and could endanger others by failing to take precautions. This ensures that the legacy of HIV in prisons spreads beyond their walls, targeting populations outside the prison.
Given the racial and social inequalities that determine who ends up in prison and for how long, there are also serious concerns about how prison-associated HIV infections propagate themselves through communities outside the prison system. This is a system that endangers young people of colour, particularly men, and it does so not just by trapping them in the cycle of the justice system, but by giving them diseases that could kill them and refusing to provide treatment.
There’s no reason to tolerate the excessively high HIV/AIDS rate in prison, unless you think prisoners aren’t human beings.