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The appearance of new “super-strain” of AIDS has dramatically refocused public attention on the importance of HIV prevention. Needle exchange, condom distribution, and high-profile awareness campaigns have been part of the battle for years.
Unless you happen to be one the state’s 65,000 prisoners, who still lack access to even the most basic safeguards.
According to a National Commission on Correctional Health Care report published in 2002, 20 percent of all HIV infected individuals pass through the prison system in a year, and rates of infection are five to ten times higher in prisons than in the general population.
Assemblymember Dick Gottfried has spent years trying to lower those numbers. Earlier this month, he reintroduced a package of bills that would improve prison oversight and create HIV-prevention programs such as needle exchanges and condom distribution. While the bills still need a Republican sponsor, Gottfried hopes that this year, public pressure and the support of more than 40 community groups will finally spark action. “We don’t think the bills are particularly radical,” he said.
The first of the three would require annual review by the Department of Health (DOH) on policies and practices concerning HIV, AIDS and Hepatitis C at state prisons and local jails. As it stands, monitoring of prison health care is not only internal to the Department of Correctional Services (DOCS), but often remains within each facility.
The second would place health care facilities operated or supervised by the Department of Correctional Services under the definition of ‘hospital’, thus bringing them under the same DOH standards of care required of hospitals on the outside.
The final bill (known as ‘the condom bill’) authorizes the Corrections commissioner to develop and implement programs in prisons to prevent the spread of sexually transmitted diseases. Currently, condoms are available to inmates in jails, but not in prisons.
A DOCS spokesperson said the agency does not comment on pending legislation.
Meanwhile, advocates have found that care varies widely from prison to prison. Handy Rayam was diagnosed with HIV at Rikers Island in 1995. In 1996 he was transferred to Franklin Correctional Facility upstate, where he would spend the next four years. In November 2003, Rayam testified before the Committee on Health and Corrections at the New York State Assembly that, during his time at Franklin, he met with a doctor only twice. The standard practice for monitoring HIV/AIDS includes a doctor’s visit and blood testing every three months.
John Damars, deputy superintendent for programs at Franklin, said he would have “no way of knowing” how often an inmate had seen a doctor. “If they request to see a doctor they would see one,” he said.
In 2000, Rayam was transferred to Woodbourne Correctional Facility, where “my health care went from what had been completely inadequate to exceptional,” he said. Upon arrival, he met with a doctor who referred him to an infectious disease specialist. With a new drug regimen and monthly check-ups, he soon had an undetectable viral load.
Rayam considers his visits with the infectious disease specialist (IDS) crucial. “It’s very important, if you had a chronic disease you would want to see a specialist, you would have a right to see a specialist,” said Rayam.
Access to an IDS is a key indicator used to monitor prison health care. Research conducted by the Prisoners’ Rights Project of the Legal Aid Society, showed that in 2001, 54 percent of the state’s all known HIV positive inmates did not see an IDS on any occasion.
However, between individual prisons, the number of HIV positive prisoners who saw a specialist in 2001 (the most recent data available), varied from as much as 88 percent (at the Bedford Hills Correctional Center) to as few as 9 percent (in the Watertown Hub complex).
“Prisons are like fiefdoms. What happens in prison A doesn’t necessarily happen in prison B,” said Jack Beck, director of the Correctional Association’s Prison Visiting Project. “This is a public health opportunity that is not being adequately exploited…prison health care is good public health.”