Truly Understanding the Connection between HIV and Incarceration

By Laura McTighe

From PHN Issue 24, Spring 2015

   We know that HIV and incarceration overlap. One in seven people with HIV will pass through our prisons and jails this year. But knowing that HIV and incarceration overlap doesn’t tell us why. Understanding why is critical if we are to end AIDS.

Two Crises, Same Communities

   If we look at statistics on HIV and incarceration, we see that they are both affecting exactly the same communities. The Black community has been hit very hard by both.

   Why is that the case? There are a lot of myths that surround HIV in prisons—that prisons are hotbeds for HIV transmission, that folks are contracting HIV in prison and bringing it home to their partners… These myths are simply not true. As many as 90% of HIV-positive people in prison already had HIV at the point of their arrest. That means that most people are not getting HIV in prison.

   To understand how HIV and incarceration are tied together in the Black community, we have to look beyond the prison walls.  

Making a Health Crisis

   The mass imprisonment affecting the Black community is a result of racism. Black Americans are much more likely to be arrested for drug possession or sales than white Americans, even though they use drugs at the same rate. White youth are actually more likely to sell drugs than Black youth, according to several studies written about in the Washington Post last year.

   Under the “War on Drugs,” politicians in the late 1970s began pushing imprisonment over drug treatment. Laws were designed to restrict people’s rights once they are released. These policies exclude people from jobs, housing, and participation in society.

   Just as the War on Drugs was gaining speed, the AIDS epidemic broke. AIDS is linked to behaviors that can transmit HIV. But people are more likely to get HIV because of the ways that government policies and institutions like prisons work. Prisons disrupt family and social networks and weaken emotional, financial and political support systems in communities outside prison.

Imprisoning Entire Communities

   The War on Drugs has been a war on relationships. It’s a war on people’s parents, their spouses, their partners and their caretakers. These are the relationships that hold together strong and vibrant communities. These are the relationships people depend on for support in times of need. In the wake of a partner’s imprisonment, a mother may suddenly be saddled with the impossible burden of making ends meet to keep a roof over her children’s heads and food in their bellies. If sex work is her only source of income, she is going to do what she has to do to care for her children. Sex work will put her at risk for HIV. But long-term health consequences like HIV might not even register in her mind, because she’s dealing with a pressing crisis.

   More and more people have been put in the position of making such impossible decisions. And because of the racism of the War on Drugs, HIV has most impacted communities of color, particularly Black communities. That’s why mass imprisonment is a major reason for the disproportionate impact of HIV on Black communities.

Decarceration is HIV Prevention

   Right now, HIV treatment is thought of as our first line of prevention. People who are HIV negative take pills to prevent contracting HIV. People who are HIV positive take pills to prevent passing HIV on to others. But what does this model of HIV prevention miss? I would argue that the single most important strategy for controlling HIV in prison is reducing incarceration itself.

   Let’s imagine a world where prisons fade into the background, where the 2.3 million people currently incarcerated return to their loved ones, where families can begin to heal, where barriers to employment are removed, where people have access to the supportive services they need… What would we see then?

   We can end AIDS. But only if we end prisons.