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In New York state prisons today, 12 percent of female prisoners and nearly 6 percent of male prisoners are known to be HIV-positive, according to the Department of Correctional Services. That’s magnitudes more than the number, statewide and nationwide, of people with HIV in the general population: Among both men and women, it’s well under one percent.
Prisoners’ advocates and former inmates have been trying for years to implement practices to help stem the epidemic of HIV in prison where sex among inmates, tattooing, injection drug use, and sex between inmates and guards are known infection-spreading occurrences. Earlier this month, the State Assembly’s Corrections Committee approved a bill sponsored by Assemblyman Richard Gottfried, a Manhattan Democrat, which would require the state corrections and health chiefs to develop and implement practices and policies in all correctional facilities to prevent the spread of sexually transmitted diseases and Hepatitis C, a blood-borne disease. In New York state prisons, 22 percent of women and 13 percent of men are infected with Hepatitis C, compared with just under 4 percent of the state’s general population and 1.3 percent of the U.S. population.
The bill, A5312, had been rejected by the Corrections Committee for the last five years, and still has to go before the Ways and Means committee before it can move to the Senate. Though it’s still far from becoming law, it represents a glimmer of hope for a population whose health needs are often overlooked and for a politician who has championed this cause for many years.
“We are neglecting our constitutional obligation to take care of our inmates,” said Gottfried. “There is just no political plus to improving healthcare for inmates, especially in the Republican-controlled State Senate. The prison population is just not one of their constituencies.”
Rusti Miller-Hill, a Harlem resident and former inmate now living with H.I.V., supports the legislation. “One of the things I promised myself was that when I got out I would be a voice for women who are incarcerated and living with HIV and AIDS. I saw women die unnecessarily,” says Miller-Hill. “And a lot of it was because of a lack of education.”
The bill would require prisons to provide condoms and dental dams to prisoners as well as introducing a peer-education program. Supporters see effective HIV education programs in prisons as crucial to stemming the epidemic.
Department of Correctional Services spokesman Erik Kriss says prisons already address the issue, and infection rates now are lower than in recent years. “We require our medical providers to get at least four hours of training per year on HIV education,” Kriss said. “And when inmates leave, they get an information pack with HIV education as well as condoms.”
Advocates say more and different help is needed, however. “Most corrections officers have this ‘inmate’ mentality, they degrade prisoners. Why would they be the ones giving counseling?” asked Shirlene Cooper, co-director of the New York City Aids Housing Network (NYCAHN) and also a former inmate living with HIV.
Miller-Hill agreed: “The majority of women in Albion, where I was, are people of color from New York City, The majority of prison guards are white men from upstate. … There is no real passion or understanding.” She now works as an advocate on prison issues for organizations including the Correctional Association and Women’s Initiative to Stop HIV (W.I.S.H.).
Fifty-one percent of state prisoners are African-American and 26 percent are Latino, according to the Correctional Association, an independent state prison reform group. Of the 64,000 total prisoners, almost 65 percent are from New York City and the surrounding suburbs. Without accurate health information inmates will return to their communities—communities that are witnessing increasingly high rates of HIV—with inadequate knowledge about behaviors that will foster the transmission of HIV.
“We really need an effective peer-education program to convince people who are at risk to get tested,” says Jack Beck, director of the Correctional Association’s Prison Visiting Program, who estimated that 50 percent of inmates who are HIV-positive are not known to the prison staff. (Beck stressed that he does not advocate mandatory testing, however: “Testing has to be voluntary as it requires a commitment.”)
In addition to encouraging inmates to get tested, peer education should provide HIV-positive inmates with treatment literacy needed to understand the virus. “There’s so much to know, and you won’t get that education in prison,” said Cooper, who added that it wasn’t until she got seriously ill after getting out of prison that she received the education she needed to understand the virus.
The other component of Gottfried’s bill is the distribution of prophylactics in New York state prisons, where condoms are now considered contraband. The New York City jail system as well as jail systems in Philadelphia, San Francisco, and Washington, and two prison systems, in Vermont and Mississippi, make condoms available to their inmates.
While advocates see the bill’s progress as a step in the right direction, they mention other issues to be addressed, too. Not least among these is that New York State prisons are exempt from oversight by the state Department of Health. “The wardens are in charge of oversight, and wardens are not doctors,” said an aide to Gottfried, who is also the author of Assembly Bill A3787 to require state DOH oversight of prison health facilities.
That bill has made it to the State Senate, but Gottfried does not expect a vote on either piece of legislation by the end of the year. “It probably won’t happen until after the elections in November,” he said.
The sooner the better, says Beck of the Correctional Association. “There’s a real opportunity to identify and get people into a treatment program.”