HIV, Incarceration and Community: A Paramount Linkage
Spector, Melanie, Corrections Today
HIV/AIDS is the fourth leading cause of death worldwide, (1) and researchers hypothesize that the number of people who will develop AIDS during the 21st century will continue to grow. The Centers for Disease Control and Prevention estimates that the number infected with HIV in the United States exceeds 1 million. (2) And because the impact of HIV disease is disproportionate in economically disadvantaged populations, it is not surprising that the estimated prevalence of HIV infection is considered to be five times higher for incarcerated male populations. (3)
Impact of HIV/AIDS
Acquired Immune Deficiency Syndrome (AIDS) is a collection of symptoms or opportunistic infections occurring from a damaged immune system. It is caused by a retrovirus commonly known as Human Immunodeficiency Virus (HIV), which attacks the immune system, leaving individuals at risk for infections, depression, declining health and untimely death. Immune-compromised people are unable to fight off organisms generally considered normal in the human body.
The social impacts of HIV are excruciating for individuals, families and communities. Those infected face decreased quality of life and loss of jobs, housing and medical insurance. Stigmatization and discrimination aimed at people living with HIV/AIDS is also well documented. Families face poverty, increased stress and dysfunction, and higher medical and legal costs. Communities face the loss of social and economic capital and increased hospital and emergency room expenditures. The astronomical costs of HIV medications pose enormous ethical burdens on communities and medical providers that turn away HIV-positive patients due to limited funding. It is not surprising that a direct correlation has been shown to exist between the prevalence of HIV infection in a country and a decrease in the country's ability to prosper. (4)
Many who are infected with HIV are unaware of the status of their infection and may unknowingly infect others. (5) In 2004, the CDC estimated that 180,000 to 280,000 people living with HIV in the United States are unaware of their infection. More recently, the U.S. Department of Justice estimated that 25 percent of people living with HIV in the United States pass through correctional facilities each year. States with higher HIV prevalence levels often house inmates in separate dormitories to ensure access to direct observed HIV therapy (the health care provider watches the patient take each drug dose) and to preserve the dignity and safety of those infected. The DOJ further estimated that AIDS cases are three times higher in prisons, and the HIV infection rate is estimated to be five to 10 times higher in male and female prison settings than in the general population. (6)
The Need for Action
Oklahoma is among many states increasingly incarcerating people who use illegal injection drugs, further exacerbating the opportunity for HIV transmission among inmates. When HIV-positive inmates are released from prison, they are focused on reentry tasks such as finding a job and housing, and reconnecting with their families. Health care may not be a priority, increasing the chance of the interruption of medication and causing higher HIV viral load levels. Oklahoma's HIV/STD Service reported in 2004 that approximately 12 percent of HIV-positive people who requested additional information about prevention and treatment were serving time in prison. (7) These alarming statistics highlight the need for greater collaboration between the community, medical and psychosocial service providers, and inmates living with HIV.
In response to the relational epidemics of HIV and incarceration, the Oklahoma Department of Corrections, in concert with the Oklahoma State Health Department and community-based organizations (including local and national funders), developed the HIV Peer Education Program for Incarcerated People. …