Unprotected: HIV Prison Policy and the Deadly Politics of Denial

ABSTRACT HIV/AIDS is reaching epidemic proportions in U.S. prisons and in prison populations worldwide. The United States trails Canada, Australia, and much of Europe in responding to the crisis. What is more disturbing is that the United States does not respond to the prevalence of HIV/AIDS in prisons because policy makers refuse to acknowledge the crisis as worthy of intervention. Across the United States, policy conversations about HIV/AIDS are riddled with judgments about what prisoners do not deserve. However, while these conversations and excuses take place, people are becoming infected and dying in prison and outside of prison. Our refusal to address this issue wholeheartedly and aggressively has effects that stretch farther than prison walls--they reach into poor communities across the country. In July 2004, at the 25th International AIDS Conference in Bangkok, Thailand, a worldwide panel of experts openly discussed the HIV/AIDS epidemic in prisons across the globe. It appears that everywhere in the world, prisons present a higher rate of infection than in the general population, with rates ranging from 10 percent to 25 percent (Jurgens 2004). What was particularly disturbing about the discussions and outcomes of this conference was the extent to which the United States trails other developed countries on this issue. Wardens, legislators, and prison administrators in the United States do not seem to care about HIV in prison and have been overwhelmingly opposed to the distribution of condoms or clean needles to prevent sexually transmitted diseases. In 1999, under much fire from the Bush administration, only a handful of penal systems participated in condom distribution programs, including New York City, Philadelphia, San Francisco, Washington, D.C., and state prisons in Vermont and Mississippi (Hammett, Harmon, and Maruschak, 49). The root of the problem lies in the fallacy that denying the existence of sex or drug use in prisons will mean that prisons are, in fact, drug- and sex-free. Nothing could be farther from the truth. Some wardens have spoken against condoning undesirable or illegal behavior in prisons while others have been concerned about security risks. But whatever the proffered excuse, it appears that the United States has, to its great detriment, sat idly by while many other countries have taken steps to address the rampant spread of AIDS in prisons. Findings presented in Bangkok included the following: in 1991, almost half of the European prison systems surveyed distributed condoms to prisoners. Many prisons in Australia, most in Canada, and a small but growing number in the United States have also adopted this policy. When evaluated, this policy exhibits no negative consequences, and systems that have adopted the policy have not had to reverse it (Harding and Schaller 1992). In the same report, 16 out of 52 prison systems surveyed in Europe made bleach available to prisoners to clean their needles. Again, bleach is also available in most Canadian prisons and in many prisons in Australia. And again, no system that has adopted this policy has reversed it. A major recommendation of this conference was the adoption of needle exchange programs in prisons, which have been demonstrated to be quite effective in other areas outside of prisons. Switzerland, Germany, Spain, and several countries in Eastern Europe have already adopted this policy. And all evaluations of needle exchange programs in prisons have shown positive health effects and no negative consequences (Harding and Schaller 1992). Yet both problem and solutions seem to escape the attention of our policy makers. On October 5, during the 2004 vice presidential debate at Case Western Reserve, Vice President Dick Cheney was asked about the HIV/AIDS epidemic among African American women in the United States. His response speaks legions about the continued invisibility of the problem in America: I have not heard those numbers . …

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