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The appearance of a new “super-strain” of AIDS in February dramatically refocused public attention on the importance of HIV prevention. Needle exchange, condom distribution and high-profile awareness campaigns have been part of the arsenal 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 10 times higher in prisons than in the general population.
Assemblymember Dick Gottfried has spent years trying to lower those numbers. In February, he reintroduced a package of bills that would improve prison oversight and create HIV-prevention programs such as needle exchanges and condom distribution. Though 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 says.
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 is often left up to individual facilities.
The second would place health care facilities operated or supervised by the DOCS under the definition of “hospital,” thus bringing them under the same DOH standards of care required of hospitals on the outside.
The final legislation (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, where inmates are held before sentencing, but not in prisons.
A DOCS spokesperson says 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 and was transferred to Franklin Correctional Facility a year later. During his four years at Franklin, Rayam says, 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, says 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 says.
In 2000, Rayam was transferred to Woodbourne Correctional Facility, where he says his health care improved dramatically. Upon arrival, he met with a doctor who referred him to an infectious disease specialist (IDS). With a new drug regimen and monthly check-ups, he soon had an undetectable viral load. Rayam considers his visits with the IDS crucial. “It’s very important,” he says. “If you had a chronic disease, you would want to see a specialist.”
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 known HIV-positive inmates never saw an IDS.
“Prisons are like fiefdoms. What happens in prison A doesn’t necessarily happen in prison B,” says 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.”