Sex and Drug Use: How Incarceration Can Lead to Increased Rates of HIV/AIDS

What is HIV/AIDS?

HIV, or human immunodeficiency virus, is a virus that attacks cells in the body that would normally help fight against infection. This makes an individual more vulnerable to other diseases or infections. HIV can be spread through a variety of methods, namely the sharing of certain bodily fluids or using shared drug equipment like needles.

When left untreated, HIV can develop into AIDS, or acquired immunodeficiency syndrome. The human body is not able to get rid of HIV and there is no effective cure for the condition that exists so once one has HIV, they have it for life. Many with HIV in the United States do not end up developing AIDS due to the availability of medications that stop the progression of the disease.

When one is classified as having AIDS, it means that their number of CD4 cells have fallen below 200 cells per cubic millimeter of blood (HIV.gov, 2023). Someone with a healthy CD4 count would have between 500 to 1600 cells per cubic millimeter of blood. Once one is diagnosed with AIDS, they generally survive around 3 years. Medications and treatments can help slow this process and enhance daily living so it is imperative that all who have HIV get started on treatments, such as PrEP, as soon as possible.

HIV in prisons:

Within prisons, AIDS has become the second leading cause of death (Lane, 2004). UNAIDS and the WHO report that incarcerated prisoners can be anywhere from 5 to 15 times more likely to by HIV positive than the general public. According to the National Commission on AIDS, by choosing mass imprisonment as the federal and state governments' response to the use of drugs, we have created a de facto policy of incarcerating more and more individuals with HIV infection (Kantor, 2006). This mass imprisonment has led to the overcrowding of prisons without adequate health measures to prevent the spread of the disease. Paired with the unequal access to medications and condoms that prisoners experience, this creates a significant health problem.

With so many people being in prison for drug related problems, this can pose another risk with the sharing of needles. These needles can be catalysts for the spread of HIV if the same infected needles are used over and over again by different individuals. Since prisons as a whole do not provide access to new, clean needles, this can cause the rampant spreading of HIV and other blood-related illnesses.

As a whole, prisons tend to be high-risk environments where stress, violence, rape, etc. are very common. Also common in prison are consensual sexual encounters amongst inmates, with some estimates gauging anywhere from 1-20% of prisoners engage in some form of sexual act with another inmate. The broad range mostly indicates variation in types of prisons, differing geographical areas, and more. As opposed to consensual sexual encounters, rape is often used to exert dominance over other prisoners and show who is the strongest and most powerful. It has been found that around 25% of prisoners experience violence every year, with 4 to 5% experiencing sexual violence and 1 to 2% being raped (Tutu, 2019). Without access to condoms in prisons, those with HIV who engage in sexual acts are very likely to infect others.

In prison, needles can be used for a variety of reasons including recreational drug use and for tattoos. Of those that use drugs requiring a needle, around 70% reported that they often shared needles with others (Tutu, 2019). This is largely the case because needles are not widely available or distributed to prisoners when incarcerated. This forces individuals to utilize the same needles, potentially infecting all others who share that same needle. Tattoos are also common in prison, with many estimating that around 15% of prisoners receive a new tattoo while incarcerated. Those who perform the tattooing tend not to have new or sterilized tattooing equipment with the process involving multiple skin punctures with recycled, sharpened and altered implements including staples, paperclips and plastic ink tubes found inside ballpoint pens (Tutu, 2019). This method is not sanitary and can lead to HIV and other infections spreading throughout the prison system.  

Is access to medication available for those already infected?

Even though HIV is well-studied and medications have been created, it is oftentimes very difficult to implement them in the prison system. Many prisons offer little specialized care and few health resources outside of what is required. This can make ART treatment difficult if medical staff do not go above and beyond ensuring all who are infected receive the proper and needed medical care. Additionally, PrEP and other HIV medications can be expensive, impacting the total funding prisons have allocated for medical care.

For those who have access to medications, it can be increasingly difficult to maintain a set treatment plan. Often, prison conditions undermine the consistent dosing schedules essential to the long-term effectiveness of antiretroviral therapy where gaps in treatment occur due to transfers of inmates among correctional institutions (Kantor, 2006). All of these challenges, when paired with the hurdles of working with prisoners, can make HIV treatment very difficult to successfully implement.

Sources:

HIV.gov. (2023, July 26). What are HIV and AIDS? HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids

Kantor, Elizabeth. “HIV Transmission and Prevention in Prisons.” Comprehensive, up-to-date information on HIV/AIDS treatment and prevention from the University of California San Francisco. University of California, San Francisco, May 30, 2006. HIV Transmission and Prevention in Prisons (ucsf.edu)

Lane, Sandra D, Robert A Rubinstein, Robert H Keefe, Noah Webster, Donald A Cibula, Alan Rosenthal, and Jesse Dowdell. “Structural Violence and Racial Disparity in HIV Transmission.” Project Muse. Johns Hopkins University Press, August 3, 2004. https://doi.org/10.1353/hpu.2004.0043

Tutu, Desmond M. “Prisoners, HIV and AIDS.” Global information and education on HIV and AIDS. Avert, October 10, 2019. Prisoners, HIV and AIDS | Avert

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