HIV-Positive Inmates: The Neglected Population

The New York Times applauds a bill in the New York legislature which establishes State Department of Health oversight on prison HIV and hepatitis programs. The Times makes the case for paying more attention to HIV-positive prison inmates, listing the costs of neglect:

Failing to test, counsel and treat these inmates makes it more likely that they will spread infection once they are released and suffer catastrophic illnesses that shorten their lives and drive up public health costs.

Sadly, the most persuasive arguments, to many, are those that have nothing to do with the prisoner’s well-being. The Times knows it does well to mention the spread of infection and the cost to the state.

Many people don’t believe that a prisoner has the right to good health and a decent quality of life. It has always been difficult to advocate for prison reform of any sort; as the Times points out, corrections officials “tend to rebel against oversight of just about any kind.”

But apathy or hostility from the public is just as damning to the cause. Many people believe that their tax dollars shouldn’t go towards the health of those behind bars. There’s a sense—not always spoken, but implied—that a person in prison deserves to be there, and therefore doesn’t deserve health care, preventive or otherwise. If a prisoner contracts HIV in prison, that’s his problem. If a prisoner doesn’t always receive her HIV medicine, then maybe she should have done more to stay out of prison in the first place.

Of course, those who object to financial support of prisoners should perhaps advocate for the abolition of prisons, since our tax dollars are already going toward feeding and lodging prisoners. The problem is that life-saving health services are marginalized in the process, as Laura Whitehorn points out in Real Health:

In a 1995 AJPH article, Alan Berkman, MD, said, “Politicians allocate more money to build prisons, but [not] for [prison] health care. The result is less money each year for greater numbers of sick prisoners. The public health implications are obvious.” 

Whitehorn also points out that, according to a report that appeared in the American Journal of Public Health this April, prisoners in this country are twice as likely to have HIV as non-prisoners, and 55 percent more likely to have diabetes.  HIV/AIDS advocates have long argued for condoms in prisons and have been mostly refused by prison officials, who answer that sex in prison is illegal. Governor Schwarzenegger twice vetoed a California bill that would have allowed health organizations to distribute condoms in prisons, but in 2007, he encouraged the California Department of Corrections and Rehabilitation to develop a pilot program in one prison to try out condom distribution.

We all know how effective the legislation of sex is, and so prevention in prisons is a good step. But inmates also need testing, treatment, and counseling. Reentering public life is difficult enough for a former prisoner—doing so when you’re HIV- or hep C-positive is especially difficult, and this difficulty is felt not only by the former inmate, but by all of us.


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  • shawn-syms

    Yes, the common perception is that both prisoners and people with HIV “deserve” their fate, and together they are a cruel double whammy leading too often to early mortality. And when people are denied their meds, this not only damages their own health but makes them more infectious (in the presence of risk behaviours between themselves and others).

    Another key piece of the puzzle is the high incidence of sexual assault in prisons, whether between prisoners or against prisoners by guards and other staff (see the group Just Detention International for more on this point). When you add to that consensual sex and needle drug use that will happen in the absence of condoms or clean-needle provision, it’s a recipe for disaster where everyone loses.

  • salfieri

    It is crucial that we begin to raise public awareness about the quality of healthcare in prison and the fact that 97% of men and women in prison will return to their communities. Often unresolved prison health care becomes the communities burden with rising emergency room cost to taxpayers. The bill currently on the Governor’s desk makes good fiscal sense and I am hopeful that he will support oversight of HIV and hepatitis C care in prison.

    Serena Alfieri, Associate Director of Policy
    Women in Prison Project
    Correctional Association of New York