The Social Impact of AIDS in the United States (1993) / Chapter Skim
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7 Correctional Systems
7 Correctional Systems
Pages 176-200
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From page 176... ...
And the stigma and fear associated with HIV pose special challenges for correctional officials charged with the day-to-day management of prisons and jails. In seeking to gauge the impact of AIDS in a society, correctional facilities are convenient units of social analysis.
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From page 177... ...
Litigation concerning HIV in prisons has continued unabated throughout the epidemic, and judicial opinions and court records tell much of the story of AIDS in prisons (see Greenspan, 1989; Gostin, 1990; Gostin, Porter, and Sandomire, 1990~. Prisoners have challenged specific practices related to attempts to control the spread of HIV.i Prisoners with HIV disease have sued to protest their segregation from the general prison population (Branham, 1990)
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From page 178... ...
, the population in federal prisons and in prisons in the District of Columbia and 18 states has doubled; in California and New Jersey, two states particularly hard hit by the HINl/AIDS epidemic, the number of inmates tripled during the same period (National Commission on AIDS, 1991~. Most commentators have attributed the dramatic increase in the U.S.
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From page 179... ...
In New York City jails, where as many as 25 percent of the inmates are estimated to be HIV positive, about 50 percent of the inmates have completed high school, 30 percent are high school dropouts, and 16 percent have finished only elementary school or have no formal schooling (Montefiore Medical Center, 1990~. Women are also a growing proportion of the nation's prison population.
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From page 180... ...
By late 1989, 5,411 confirmed cases of AIDS had been reported by federal prisons, state prisons, and a sampling of county and city jail systems. Correctional institutions in California, Florida, New Jersey, New York, and Texas have been particularly hard hit by AIDS.
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From page 181... ...
Testing and Screening Controversies The question of whether to screen inmates for HIV antibodies has arisen with particular urgency in the prison setting, and considerable resources have been expended in legislative debate and in court challenges of testing and screening practices. Prison administrators have been under pressure from legislators, city and county officials, correctional officers, and inmates themselves to conduct mandatory screening of all inmates and to identify seropositive inmates.
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From page 182... ...
Other states (e.g., Arkansas and Texas) screen on the basis of apparent risk factors, testing intravenous drug users, prostitutes, self-identified gay men, and those with clinical symptoms of sexually transmitted diseases, tuberculosis, or HIV infection.
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From page 183... ...
The fact that inmates acquire sexually transmitted diseases with incubation periods of days or weeks is evidence that sex occurs in jails, and the sexual transmission of HIV is possible.6 Prison sex is a particularly sensitive issue, and it has received more attention since the AIDS epidemic began (A Federal Prisoner, 1991~. Both in the popular imagination and in actuality, sex in prisons includes violent, forcible raped Prison sex may also be "consensual," although consent is always suspect in the prison context (Lockwood, 1980; Propper, 1981~.
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From page 184... ...
As noted, an undeniable, if difficult to quantify, amount of sexual activity takes place within prisons (van Hoeven, Rooney, and Joseph, 1990~. Many inmates are aware of the risk of HIV and other sexually transmitted diseases, as evidenced by an illicit market for plastic wrap and similar items that can provide barrier protection when used in sexual activity.
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From page 185... ...
According to the National Commission on AIDS (1991) , however, condom distribution has not disrupted prison operations in the few systems that distribute them.
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From page 186... ...
Because of the window period for seroconversion, even widespread screening programs are unlikely to identify all HIV-positive entrants, and this HIV transmission may still be a possibility within the general prison population. As one official reported (Maisonet, 1990:96-97~: [with segregation of HIV-positive inmates]
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From page 187... ...
Visitation Policies In states with many prisoners with HIV disease, prison administrators have also had to reexamine their policies related to visitation, including conjugal visitations. Prior to the HIV/AIDS epidemic, correctional administrators advanced a number of justifications for conjugal visits: conjugal visits provide for sexual and emotional release; some believe that they reduce the level of homosexual activity in prison, although there is no definitive evidence in that regard; and conjugal visits may help provide for a smoother release back into society by helping to maintain or reestablish family ties.
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From page 188... ...
A report from the Montefiore Medical Center (1990) , which provides medical and mental health care services under contract to Rikers Island, a New York City jail, recently called for more systematic attention to gathering data on prisoners' health status.
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From page 189... ...
survey of 29 states in 1984-1985 found inmates to be three times as likely to develop tuberculosis as agematched controls who were not incarcerated. In 1989, all of the 70 cases of active tuberculosis identified in New York State prisons were among prisoners who were also HIV positive (National Commission on AIDS, 1991~.
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From page 190... ...
In New York City, the jails have access to six skilled-care nursing beds, which are always filled. According to prisoners' rights advocates, the lack of prison health facilities leads to "chaining, like dogs, sick and debilitated prisoners to their hospital beds in regular civilian wards- a practice called 'outposting' or in being shuttled between hospital and prison infirmary- a practice referred to by City officials as 'ping-ponging"' (Wiseman, 1990:8~.
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From page 191... ...
Prisoners are not eligible for conventional public entitlement health care programs, such as Medicaid or Medicare. In most instances, funds for HIV care in prisons have had to come from corrections health care budgets, and they have remained static as prison populations have skyrocketed.
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From page 192... ...
A new era in medical research began in the 1960s and 1970s with the heightened concern for the rights and welfare of patients and research subjects (National Commission on AIDS, 1991; see Chapter 4~. In 1978 federal regulations were adopted to address such issues as informed consent and voluntariness in participation, subject selection, confidentiality, and independent review related to federally funded research (45 C.F.R.
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From page 193... ...
Some prisoners' rights groups asked that inmates be allowed to continue to participate, but their arguments failed to win the day with prison officials, physicians, and regulators. One lasting impact of the AIDS epidemic on prisons may be a new attitude concerning the participation of prisoners in clinical and epidemiologic research, both on HIV and other diseases of concern in correctional settings.
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From page 194... ...
Few prison health care systems have the medical, nursing, or social services necessary to take care of dying persons (Kamerman, 1991~. Such services are better provided in hospitals, hospices, nursing homes, or in home settings with nursing care support.
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From page 195... ...
Lawsuits filed on behalf of prisoners to challenge standards of care often include particulars about denial of care for HIV disease although many prison inmates come from community circumstances where it may have been as difficult to obtain needed health care as it is in prison. One of the most significant impacts of HIV disease in correctional facilities may be a sea change in the way epidemiological and clinical research involving prisoners is viewed.
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From page 196... ...
"Inmates may perceive the presence of HIV positive inmates in food service or the hospital as a threat to their own health and well-being and might not adequately avail themselves of these services" (Farmer v. Moritsugu, DC WWisc.
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From page 197... ...
Management of HIV infection in New York State prisons. Columbia Human Rights Law Review 21:363-400.
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From page 198... ...
(1990) HIV seroprevalence and the acceptance of voluntary HIV testing among newly incarcerated male prison inmates in Wisconsin.
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From page 199... ...
National Commission on AIDS (1991) Report: HIV Disease in Correctional Facilities.
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From page 200... ...
(1990) Testimony before the National Commission on AIDS.
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