Segregating HIV+ Prisoners: An Outdated Practice

In 2012, only two US states still segragated HIV+ prisoners from the general population: Alabama and South Carolina. The ACLU took Alabama to court in September to challenge their policy in the hopes of pushing a judge to order the state to end it, on the grounds that it’s discriminatory and inhumane. It’s also utterly ridiculous, but that of course is not much of a legal argument so I doubt it came up in the ACLU’s case, given that their attorneys tend to be less hot-headed than I am and their goal is to actually win cases.

When the HIV/AIDS crisis first began in the 1980s, a lot of mistakes were made. The highly stigmatised disease was unknown and deeply feared, and public health policy as well as institutional health policy reflected that. Numerous prisons separated their poz populations because they didn’t want the disease to spread, and since they didn’t understand precisely how transmission worked and who might be at risk, keeping people isolated seemed like the best policies. As researchers uncovered more about the virus and how it progresses in the human body, prisons began slowly relaxing their segregation rules, though some took longer than others; Mississippi, for example, stopped the practice in 2010.

Yet, two states decided to hold out to the bitter end in defiance of all medical evidence, compassion, and legal precedent. The CDC have argued compellingly that the practice is no longer necessary and can in fact be harmful to prisoners, and that it’s time to allow them to live in the general population, receiving treatment and monitoring as appropriate. With the right medical care, the condition is less of a death sentence than a chronic illness, and prisoners who are aware of their status and getting care can take steps to reduce risks to other inmates; though, of course, prisons still balk at the idea of providing condoms and other safer sex supplies along with drug injection kids, which would radically reduce the risk of disease transmission.

Segregation doesn’t just mean living in a different area of the prison. It also means not having access to the same services as the general population. That can include tools like vocational training, substance abuse counseling, and more. These prisoners are receiving less care and treatment than their counterparts, and prisons bizarrely argue that this is ‘better’ for them, despite the fact that limiting chances can increase risks. For example, drug users may be tempted to return to drug abuse in prison without counseling, and won’t have resources to support themselves and get stable as they prepare for release. Likewise, prisoners who don’t have access to education may have fewer chances on the outside, which can increase the probability of recidivism.

Notably, prisoners even wear special armbands to make sure everyone knows they live in the segregated dormitory for HIV+ prisoners, singling them out even more. Under these circumstances, it’s hard to believe that prison officials can keep straight faces when they claim that this is reasonable or fair; it’s not just discriminatory but outright hateful, and it violates all pretense of medical privacy. The fact that it has persisted for so long illustrates the lack of interest the general public has in prison issues and the human rights of people trapped in the prison system.

And you can’t talk about the segregation of poz prisoners without delving into the racial aspects of the problem, because in both South Carolina and Alabama, the Black population is bearing the brunt of the HIV/AIDS crisis. Nearly half of HIV/AIDS patients nationwide are Black, and over 30% of incarcerated males are Black as well. These numbers are both grossly disproportionate when it comes to representation of the Black community in the general population and that is not a coincidence.

HIV/AIDS education, prevention, diagnosis, and treatment don’t reach the Black community as thoroughly as they should, and many campaigns are actually actively alienating because they refuse to recognise the complex social history of the Black community in relation to the medical establishment. Many Black folks have good reason not to trust the white-dominated medical community, and aren’t impressed with ‘outreach’ efforts that don’t include this history and don’t engage directly with communities. When HIV/AIDS workers dismiss Black communities as stubborn or unreasonable, they miss the fact that they’re the ones who refuse to consider the community issues they’re facing and work with people where they are. And, of course, the ‘justice’ system in the US is deeply skewed against people of colour, particularly Black men, which means that you’re much more likely to land in jail or prison if you happen to be a member of that particular demographic.

This double whammy of stats means that the overall HIV+ population in prisons is higher than that in the general population, and that Black men are heavily overrepresented in it. As we talk about desegregating the prison population to fully integrate HIV+ prisoners, we also need to engage with these facts and challenge the underlying problems leading to high HIV/AIDS rates in prisons and in the general populations. Because there’s no good reason so many young Black men should be acquiring HIV infections at such a high rate, and there’s no good reason for so many Black men to wind up in the prison system.

Will South Carolina remain the lone holdout with an outdated policy, or will it, too, fall? And will the larger issues here be tackled, or are they going to be quietly swept under the carpet for lack of interest in or ability to cope with them?