One day when I was in second grade, I cut myself in class. I can’t remember how I did it; probably, it was a papercut from a book or a project I was working on. What I do remember is the brief spark of pain followed by the brightly-beading red blood, raising my hand patiently until the teacher could come over to my desk. I held the cut hand for her attention and she recoiled, pulling away from me like I was toxic.
My cut was followed by making all the children around me move away, and then I was sent to the nurse’s office. She wore gloves while she cleaned the miniscule cut and then she bandaged it carefully even though it had stopped bleeding by then. When I got back, my desk and chair smelled of bleach, and I had to stand awkwardly while they dried, the other students staring at me nervously, waiting for me to be integrated back into the herd. Wanting things to be normal.
This was the school’s policy for dealing with classroom injuries. It was the early 1990s, HIV/AIDS was raging, and no one seemed to be able to decide how to stop it. Thus, everyone was assumed to be a carrier of the deadly virus, every classroom injury a potential catastrophe. And the hypervigilance in turn made everyone terrified of blood and bleeding people, deeply afraid that the virus might be lurking everywhere. On the playground, the rumours spread; you could pick up the virus from sharing a drink with someone, from hugging, from using a public toilet. It was a mythical monster that some of us knew in real life, too, friends and family members dying by inches of the vicious wasting disease once it took hold.
Last December, I wrote about the ACLU’s suit against Alabama, one of the two holdout states when it came to segregating HIV+ prisoners from the general population. After losing in the suit, the state is now in negotiations to implement a plan for integration and managing health care needs for such prisoners. Meanwhile, South Carolina, the other state that was digging in its heels over segregation practices, is preparing to end segregation of its own HIV+ prisoners after 15 years of forcing them away from the general population, supposedly for protection, treatment, and safety, though of course the politics there are far more complex.
HIV remains a deeply feared and stigmatised virus despite the huge body of research that surrounds it. Some of that has to do with the early response to HIV, which classified it as a virus that attacked gay men and junkies, people regarded as the garbage of society. The government was slow to act, HIV spread further and further through the population, and the general public acquired some decidedly peculiar and hateful ideas about HIV, which made it hard to get testing and treatment.
For people in prison, access to health care is already limited. For poz prisoners, that can be even worse, which may run counterintuitive to how you think it should be unless you know how the prison system works. In prisons, health care is limited to people who behave ‘well,’ and can be denied or granted at a whim; a guard can refuse a prisoner medication, can decide that a transfer to the clinic is too risky. A prison can be in lockdown, making it impossible for a prisoner to see a doctor or get to a hospital. Expensive medications like those needed to treat chronic HIV infection to keep it from progressing may not always be accessible.
And when supplies of medication are unstable, or a patient’s medications are constantly switched without careful monitoring and regulation, the results can be rather catastrophic. HIV+ prisoners can come out of prison with more complications than they had going in, that much closer to developing full-blown AIDS. And their isolation from the general population also includes isolation from socialisation, reintegration opportunities, and other resources intended to prevent recidivism and help prisoners when they get out.
Add that to the epidemic of prison rape and you have a recipe for disaster; prisoners know that reporting sexual assault and rape by guards can lead to reprisals, and when their lives hang on the ability to access lifesaving medications or see doctors for regular treatment, they may remain silent. That’s why HIV spreads through prisons, why people enter prison without HIV and leave with it, and one reason why HIV ravages the Black community, because so many young Black men wind up in prisons, where they become vulnerable to HIV infection.
Yet, South Carolina isn’t dropping the policy right away. It’s taking its time with implementation, which seems like a sound idea on the surface. It wants time to train personnel and implement procedures to increase safety. However, some of the attitudes from prison officials are as outdated, ineffective, and dangerous as the policy itself; their beliefs seem bent on the idea that they can dictate what happens in prisons while ignoring inconvenient facts, like the fact that sex in prisons often is nonconsensual and involves guards, making an argument over condoms pointless and offensive. (Aside from which, condoms should be accessible to all who need them, including, yes, prisoners.)
Or the fact that if there are genuine worries about prisoner-to-prisoner transmission, prisons need to become safer places, where guards are disciplined for abusive behaviour, where prisoners have resources for reporting and asking for help, where prisoners have access to all the health care they need. Acting like prisoners are at fault for the spread of HIV is a gross misinterpretation of the situation, and one with potentially fatal consequences for residents of the US prison system.