HIV/AIDS in Prisons

Everyone knows that HIV is American prisons is a huge problem, but we don't hear much about it. There are several reasons for that. For one, prisons are unpleasant places, and for the most part, we don't want to think about what goes on there. For another, many people figure that whatever happens to prisoners is their problem; some even assume that whatever happens to inmates is part of their well-deserved punishment. Perhaps homophobia is a factor, too. For some, it may be unpleasant for them to think about one of the modes of transmission of HIV/AIDS. Not that any mode is particularly nice to think about.

It is important to recognize that HIV is transmitted is different ways. Sexual activity is the most obvious, both homosexual and heterosexual. It may be tempting to assume that all sexual activity in prisons is homosexual, but that is not the case. Probably most is, but we need to be careful about making assumptions here. Intravenous or subcutaneous drug injection is another mode of transmission. Think you can't get drugs or needles in prison? Tattooing is a problem, too. Sex, drugs, and tattooing are all prohibited, but enforcement is impossible in all but the most secure facilities.

Now, The New England Journal of Medicine has published an free-access article on the subject. It is accompanied by an audio interview with Theodore Hammett, a policy expert. (I notice that NEJM finally got around to calling their recorded interviews "podcasts.") As I've mentioned before, the NEJM makes their articles open-access only if they think they contribute to public consideration of important pubic health or policy matters.

Sex, Drugs, Prisons, and HIV

Susan Okie, M.D.

NEJM 356:105-108, January 11, 2007

One recent morning at a medium-security compound at Rhode Island's state prison, Mr. M, a middle-aged black inmate, described some of the high-risk behavior he has witnessed while serving time. "I've seen it all," he said, smiling and rolling his eyes. "We have a lot of risky sexual activities. . . . Almost every second or minute, somebody's sneaking and doing something." Some participants are homosexual, he added; others are "curious, bisexual, bored, lonely, and . . . experimenting." As in all U.S. prisons, sex is illegal at the facility; as in nearly all, condoms are prohibited. Some inmates try to take precautions, fashioning makeshift condoms from latex gloves or sandwich bags. Most, however, "are so frustrated that they are not thinking of the consequences except for later," said Mr. M.

Drugs, and sometimes needles and syringes, find their way inside the walls. "I've seen the lifers that just don't care," Mr. M said. "They share needles and don't take a minute to rinse them." In the 1990s, he said, "needles were coming in by the handful," but prison officials have since stopped that traffic, and inmates who take illicit drugs usually snort or swallow them. Tattooing, although also prohibited, has been popular at times. "A lot of people I've known caught hepatitis from tattooing," Mr. M said. "They use staples, a nail . . . anything with a point."

That is a nice description of the reality. Dr. Okie goes on to point out that the prison Mr. M was in, has one of the better HIV prevention programs among American prisons. But the important point is this: According to WHO and UN AIDS standards, the American programs are substandard. The reason goes back to the controversy over harm reduction strategies. Many other countries supply prisoners with condoms and even needles.

Such strategies have proven effective in other countries. Yet very few correctional institutions provide condoms, and none has a needle exchange program. Methadone maintenance programs are rare. These substandard practices persist, even though the prison population is at a record high. That, and a high percentage of inmates have drug, alcohol, or mental health problems.

One thing the article does nicely, is to provide statistics to keep things in perspective. It turns out that the rate of HIV serocoversion (reflecting the rate of newly-acquired infections) is low in prisons: 0.63% in one study. But given the large number of persons we lock up, even that seemingly low number translates into a large absolute number of new cases.

Presumably, the current Administration is not interested in doing anything about this, since nothing has been done. Well, that's an exaggeration. Something is done: routine screening for infection. And there is some treatment. But very little for prevention. Given the cost of the treatment, one might think that prevention would be a high priority. And even among those who think that HIV infection is "just desserts" for inmates, it is important to recognize that any increase in the rate of infection presents a risk for the rest of the population.

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The prison that the author visited is considered one of the more enlightened.

But the correctional system as a whole, even here in Rhode Island is nothing but a money pit.

The problem is that the system is stretched to the limit. In the U.S. as a whole we have more people in prison than any other country. We're locking up people who don't deserve to be locked up. Most inmates are in for drug crimes, not violent or property crimes.

So we need to take a few steps back and fix the system. By the way, in the last election convicted felons who'd served their prison time and were release were given the right to vote. I wonder how many will actually exercise that right.

"By the way, in the last election convicted felons who'd served their prison time and were release were given the right to vote. I wonder how many will actually exercise that right. "

It is my understanding that state law varies on the voting rights of convicted felons (which could be rape, murder, armed robbery, carrying a couple of bundles of heroin for personal use, theft of a laptop worth 2k, etc.).

There are many socio-economic reasons convicted felons who are allowed to vote might not. But the perception that convicted felons as a group are signifigantly less poltically inclined/active/aware than the (already not very inclined of course) average individual in the U.S. is in my experience false.

Globalization and AIDS

K. Mustafa Ali
New Chuburji Park,
92-42-741 44 56

AIDS has become one of the major health problems affecting people around the world. As of 2006, more than 39.5 million people are currently living with HIV, and By 2010 it is estimated that approximately 100 million people will have been infected and that there will be 25 million AIDS orphans worldwide. By 2006 an estimated 39.5 million (34.1- 47.1 million) people were living with HIV/AIDS. Sub-Saharan Africa has been the region hardest hit by the HIV/AIDS epidemic; more than two-thirds of all people with HIV/AIDS are in this region.

Asia is also grappling with the increasing feminization of the epidemic and its impact on children and families. The prevailing poverty among women and its further accentuation or ?feminization of poverty? due to adverse effects of globalization make the women in the region highly vulnerable to the epidemic. The impact of Globalization, which effect directly in some individual culture in some region, the opinion of AIDS researcher Mohammad Khairul Alam, ?the mixed effect of traditional norm and globalization has brought frustration in the man. For these two things people are forgetting traditional social norms, social values and the social structure are facing a great threat following the western and others cultures. Familitical ties are breaking; family sexual behaviour is changing, attitudes of peoples towards sex is changing very fast. Besides migration for jobs, an increasing number of women taking up jobs outside the home, a decline in the traditional joint family system, and conflict to global culture were considered to have contributed to this phenomenon.? The situation is further aggravated by the presence of all forms of violence against women including those in conflict and disaster situations.

From about 20% a decade ago, the percentage of women accounting for new infections has risen to 30 per cent indicating a constantly rising vulnerability of women and girls to HIV. Severe gender inequality in political, social, educational and economic areas and absence of informed choices in the region, render women extremely vulnerable to HIV and subject them to intense stigma and discrimination. Often, women have no control over their sexual lives and have extremely limited access to prevention information and services. However, even the best knowledge on prevention does not guarantee protection for women due to the overpowering dominance of patriarchy. It is not merely coincidental that about 14 per cent and 60 per cent of the girls over the age of 15 in South East Asia and South Asia respectively are illiterate. The Rainbow Nari O Shishu Kallyan Foundation survey focuses on the attitude, behavior and practice of commercial & non- commercial / casual sex workers (so-called sex workers), floating/ street sex workers in Dhaka city in Bangladesh, this study did point out that almost 16% of sex workers enter the profession before the age of 18 years, and 30% enter between 18 to 24 years of age. Approximately 10% of prostitutes belong to the scheduled castes minority people; about 90% floating sew workers enrolled due to poverty, and 85% are illiterate.

Meanwhile, an issue that has a far reaching socio-economic impact, but is not acknowledged and measured in economic terms, is the stigma and discrimination faced by people living with HIV. The spread of HIV/AIDS presents a challenge to all of us in the Asia region, which is threatening to offset gains in human development. It underlines the urgency of effective prevention and changes in behaviors and attitudes in order to combat HIV/AIDS and mitigate its effects.

1. WHO report, HIV/AIDS in Asia and the Pacific Region, 2003.
2. Asia Pacific?s Opportunity: Investing to avert an HIV/AIDS Crisis, July 2004. ADB/UNAIDS study series.
3. ?Oh! This one is infected!?: Women, HIV & Human Rights in the Asia Pacific Region, paper commissioned by the UN Office of the High Commissioner of Human Rights, ICW, 2004
4. ?From Involvement to Empowerment?, UNDP, 2004
5. AIDS in Asia: Face the Facts. Monitoring the AIDS Panedmic (MAP) Report, 2004, HDR, 2003
6. Rainbow Nari O Shishu Kallyan Foundation

By K. Mustafa Ali (not verified) on 27 Jan 2007 #permalink