The Criminal Justice System and HIV/AIDS

POLICY BRIEF

AIDS Action • 1730 M Street, NW, Suite 611 • Washington, DC 20036 • www.aidsaction.org

The Criminal Justice System and HIV/AIDS Octoberȱ2007 Introductionȱ

Theȱ Unitedȱ Statesȱ hasȱ theȱ highestȱ incarcerationȱ rateȱ inȱ theȱ world.ȱ Atȱ theȱ endȱ ofȱ 2005,ȱ overȱ sevenȱ millionȱ people—oneȱ inȱ everyȱ 32ȱ Americans—wereȱ inȱ jail,ȱ prison,ȱ orȱ onȱ paroleȱ orȱ probation. ¹ ȱ HIVȱ isȱ aȱ significantȱ concernȱ inȱ U.S.ȱ jailsȱ andȱ prisonsȱ consideringȱ thatȱ oneȱ quarterȱ ofȱ peopleȱ livingȱ withȱ HIVȱ spendȱ timeȱ inȱ theȱ correctionalȱsystem. ² ȱPrevalenceȱratesȱinȱfacilitiesȱacrossȱ theȱ countryȱ rangeȱ asȱ highȱ asȱ sevenȱ percent, ³ ȱ andȱ theȱ prevalenceȱ rateȱ ofȱ confirmedȱ AIDSȱ casesȱ isȱ moreȱ thanȱ twoȱandȱaȱhalfȱtimesȱtheȱrateȱinȱtheȱgeneralȱpopulation. ⁴ ȱȱ

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Toȱ changeȱ theȱ courseȱ ofȱ theȱ HIVȱ epidemicȱ inȱ ourȱ countryȱ weȱ mustȱ understandȱ theȱ trueȱ extentȱ ofȱ HIVȱ infectionȱ amongȱ incarceratedȱ populations,ȱ mostȱ ofȱ whomȱeventuallyȱreturnȱbackȱtoȱtheirȱcommunities.ȱWeȱ mustȱ alsoȱ commitȱ toȱ implementingȱ prevention,ȱ care,ȱ treatment,ȱandȱpostȬreleaseȱstrategiesȱthatȱareȱeffective,ȱ ofȱhighȱqualityȱandȱrespectfulȱofȱhumanȱrights.ȱ

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HIVȱPrevention,ȱEducation,ȱandȱTestingȱ

Condomsȱ areȱ distributedȱ inȱ onlyȱ aȱ fewȱ stateȱ andȱ localȱ correctionalȱ facilities.ȱ Inȱ aȱ recentȱ report,ȱ however,ȱ theȱ Centersȱ forȱ Diseaseȱ Controlȱ andȱ Preventionȱ urgedȱ correctionsȱ departmentsȱ toȱ evaluateȱ theȱ feasibilityȱ ofȱ implementingȱ condomȱ distributionȱ programsȱ inȱ theirȱ facilities. ⁵ ȱ Providingȱ condomsȱ toȱ prisonersȱ mayȱ yieldȱ additionalȱpublicȱ healthȱ advantagesȱ beyondȱ theȱ prisonȱ wallsȱ ifȱ exposureȱ toȱ andȱ experienceȱ withȱ condomsȱ inȱ thisȱ settingȱ translateȱ intoȱ increasedȱ useȱ afterȱ release. ⁶ ȱ Additionally,ȱ sterileȱ syringesȱ andȱ bleachȱ kitsȱ areȱ alsoȱ availableȱonlyȱtoȱaȱhandfulȱofȱinmatesȱevenȱthoughȱtheȱ sharingȱofȱequipmentȱforȱinjectingȱdrugs,ȱtattooingȱandȱ bodyȱpiercingȱareȱwellȱdocumentedȱriskȬfactorsȱforȱHIVȱ transmissionȱregularlyȱoccurringȱinȱprisonsȱandȱjails. ⁷ ȱ ȱ

Evidenceȱ suggestsȱ thatȱ HIVȱ educationȱ programs,ȱ particularlyȱpeerȬledȱprograms,ȱareȱeffectiveȱinȱengagingȱ incarceratedȱ populations.ȱ Throughȱ peerȬledȱ programs,ȱ inmatesȱ canȱ receiveȱ informationȱ aboutȱ HIVȱ transmission,ȱ availableȱ careȱ options,ȱ andȱ saferȱ sexualȱ andȱ drugȱ usingȱ practicesȱ fromȱ respectedȱ membersȱ ofȱ theirȱcommunity. ⁸ ȱ

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Currently,ȱHIVȱtestingȱpoliciesȱvaryȱfromȱstateȱtoȱstate.ȱ Inmatesȱ mayȱ receiveȱ anȱ HIVȱ testȱ ifȱ theyȱ haveȱ HIVȬ relatedȱ symptoms,ȱ requestȱ aȱ test,ȱ belongȱ toȱ aȱ specificȱ

“highȬrisk”ȱgroup,ȱorȱifȱtheyȱareȱinvolvedȱinȱanȱincidentȱ inȱ whichȱ anȱ inmateȱ isȱ exposedȱ toȱ possibleȱ HIVȱ transmission.ȱ Nineteenȱ jurisdictionsȱ testȱ allȱ incomingȱ inmatesȱandȱfiveȱtestȱallȱinmatesȱuponȱrelease,ȱmostȱonȱaȱ mandatoryȱbasis. ⁹ ȱMandatoryȱtestingȱofȱallȱinmatesȱhasȱ notȱ beenȱ shownȱ toȱ beȱ anȱ effectiveȱ publicȱ healthȱ measure.ȱ Mandatory—asȱ opposedȱ toȱ optȬoutȱ testing—

leavesȱ inmatesȱ withȱ fewerȱ opportunitiesȱ toȱ receiveȱ counseling,ȱremovesȱtheȱrightȱofȱchoice,ȱandȱmayȱleadȱtoȱ discriminationȱ orȱ segregationȱ withinȱ theȱ prisonȱ orȱ jail.ȱ Additionally,ȱ itȱ isȱ viewedȱ byȱ someȱ asȱ unethical,ȱ ineffective,ȱ andȱ anȱ invasionȱ ofȱ privacy. ¹⁰ ȱ Aȱ strong,ȱ rightsȬbasedȱtestingȱprogram,ȱonȱtheȱotherȱhand,ȱhasȱtheȱ abilityȱ toȱ successfullyȱ identifyȱ newȱ HIVȱ casesȱ andȱ ensureȱaȱbetterȱpublicȱhealthȱresponse.ȱȱ

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PopulationsȱAtȬRiskȱ

HIVȱcontinuesȱtoȱdisproportionatelyȱaffectȱminoritiesȱatȱ theȱsameȱtimeȱthatȱtheyȱareȱalsoȱoverrepresentedȱinȱtheȱ country’sȱ jailsȱ andȱ prisons.ȱ Inȱ 2005,ȱ 60%ȱ ofȱ stateȱ andȱ federalȱinmatesȱwereȱblackȱorȱHispanic. ¹¹ ȱAȱcomparisonȱ ofȱ prisonȱ andȱ totalȱ AIDSȱ deathsȱ foundȱ thatȱ Africanȱ Americansȱcompriseȱmoreȱthanȱ66%ȱȱofȱAIDSȱdeathsȱinȱ prisonȱcomparedȱwithȱ39%ȱofȱtotalȱAIDSȱdeaths.ȱAȱ2001ȱ reportȱ ofȱ AIDSȱ casesȱ identifiedȱ inȱ Maryland’sȱ prisonsȱ notedȱthatȱ91%ȱwereȱAfricanȱAmerican,ȱcomparedȱwithȱ 75%ȱofȱAIDSȱcasesȱstatewide. ¹² Currentȱdataȱshowsȱthatȱ Hispanicȱ andȱ Latinoȱ inmatesȱ alsoȱ disproportionatelyȱ testȱpositiveȱforȱHIV. ¹³ ȱ

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Incarceratedȱ womenȱ areȱ moreȱ likelyȱ thanȱ incarceratedȱ

menȱ toȱ beȱ livingȱ withȱ HIV.ȱ Inȱ 2005,ȱ 2.3%ȱ ofȱ stateȱ andȱ

federalȱfemaleȱinmatesȱwereȱHIVȱpositiveȱcomparedȱtoȱ

1.8%ȱ ofȱ men.ȱ Inȱ someȱ states,ȱ overȱ tenȱ percentȱ ofȱ allȱ

femaleȱinmatesȱareȱknownȱtoȱbeȱHIVȱpositive. ¹⁴ ȱWomenȱ

areȱ alsoȱ moreȱ likelyȱ thanȱ menȱ toȱ beȱ incarceratedȱ forȱ

drugȬrelatedȱoffensesȱandȱtoȱbeȱexposedȱtoȱHIVȱthroughȱ

injectingȱdrugȱuse ¹⁵ ȱorȱsexȱwithȱdrugȱusers.ȱ

AIDS ACTION POLICY BRIEF

AIDS Action • 1730 M Street, NW, Suite 611 • Washington, DC 20036 • www.aidsaction.org Withȱ aȱ heavyȱ nationalȱ focusȱ onȱ arresting,ȱ prosecutingȱ

andȱimprisoningȱthoseȱwhoȱengageȱinȱdrugȱuseȱandȱtheȱ drugȱtrade,ȱtheȱcriminalȱjusticeȱsystemȱcurrentlyȱhousesȱ aȱ considerableȱ numberȱ ofȱ drugȱ usersȱ livingȱ withȱ orȱ atȱ highȱ riskȱ forȱ contractingȱ HIV.ȱ Inȱ 2005,ȱ 55%ȱ ofȱ federalȱ inmatesȱ wereȱ servingȱ sentencesȱ forȱ drugȬrelatedȱ offenses. ¹⁶ ȱAdditionally,ȱinȱ1999,ȱtheȱpercentageȱofȱmenȱ testingȱpositiveȱforȱdrugȱuseȱatȱtheȱtimeȱofȱarrestȱwasȱasȱ highȱ asȱ 77%ȱ andȱ forȱ womenȱ asȱ highȱ asȱ 81%ȱ inȱ someȱ cities. ¹⁷ ȱ Injectionȱ drugȱ useȱ isȱ aȱ wellȬdocumentedȱ riskȱ factorȱforȱHIV,ȱandȱaccordingȱtoȱaȱstudyȱofȱprisonȱAIDSȱ cases,ȱ 61%ȱ ofȱ prisonersȱ hadȱ injectedȱ drugsȱ comparedȱ withȱ27%ȱofȱtotalȱUSȱAIDSȱcases.” ¹⁸ ȱHighȱ ratesȱofȱHIVȱ canȱ alsoȱ beȱ foundȱ amongȱ theȱ sexȱ partnersȱ ofȱ injectionȱ drugȱusers,ȱ ¹⁹ ȱsoȱeffectiveȱpreventionȱinterventionsȱwithȱ thisȱ communityȱ haveȱ theȱ potentialȱ forȱ evenȱ broaderȱ impact.ȱ

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CurrentȱLegislationȱ

RepresentativeȱMaxineȱWatersȱintroducedȱHRȱ1943,ȱtheȱ StopȱAIDSȱinȱPrisonȱActȱofȱ2007ȱthatȱwouldȱrequireȱtheȱ FederalȱBureauȱofȱPrisonsȱtoȱtestȱinmatesȱuponȱenteringȱ andȱexitingȱfederalȱprison.ȱTheȱlegislationȱincludesȱanȱ optȬoutȱprovision,ȱallowsȱforȱinmatesȱtoȱrequestȱanȱHIVȱ test,ȱandȱensuresȱthatȱinmatesȱfoundȱtoȱbeȱHIVȱpositiveȱ willȱreceiveȱtreatment.ȱOnȱSeptemberȱ25,ȱ2007,ȱtheȱ HouseȱofȱRepresentativesȱpassedȱtheȱbillȱbyȱaȱ2/3ȱ majorityȱvoiceȱvote.ȱȱ

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RepresentativeȱBarbaraȱLeeȱintroducedȱHRȱ178,ȱtheȱ JusticeȱActȱofȱ2007,ȱwhichȱwouldȱallowȱcommunityȱȱ ȱ

basedȱorganizationsȱtoȱdistributeȱcondomsȱandȱengageȱ inȱSTDȱandȱHIVȱcounselingȱandȱeducationȱactivitiesȱinȱ Federalȱcorrectionalȱfacilities.ȱ

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Conclusionȱȱ

Givenȱthatȱjailsȱandȱprisonsȱcontainȱhighȱconcentrationsȱ ofȱpersonsȱlivingȱwithȱHIVȱandȱindividualsȱatȱgreatȱriskȱ forȱacquiringȱHIV,ȱinterventionȱprogramsȱimplementedȱ inȱ correctionalȱ facilitiesȱ haveȱ theȱ potentialȱ toȱ substantiallyȱ impactȱ theȱ epidemic.ȱ Soundȱ policiesȱ include:ȱ

x Implementingȱ systemȬwideȱ voluntaryȱ HIVȱ testingȱ andȱ counselingȱ andȱ surveillanceȱ inȱ orderȱ toȱ understandȱ theȱ fullȱ extentȱ ofȱ HIVȱ infectionȱ amongȱthisȱvulnerableȱpopulation;ȱȱ

x ProvidingȱcareȱandȱtreatmentȱtoȱallȱHIVȱpositiveȱ inmates;ȱ

x Providingȱ accessȱ toȱ counselingȱ andȱ languageȱ appropriateȱ materialsȱ onȱ HIVȱ preventionȱ andȱ careȱtoȱallȱinmates;ȱ

x Consideringȱ widerȱ distributionȱ ofȱ condoms,ȱ sterileȱsyringes,ȱandȱbleachȱkits;ȱ

x Workingȱ closelyȱ withȱ communityȱ basedȱ organizationsȱ andȱ medicalȱ providersȱ onȱ offeringȱ effectiveȱdischargeȱandȱtransitionalȱplanning.ȱ ȱ

Providingȱinmatesȱwithȱtheȱtoolsȱnecessaryȱtoȱmaintainȱ healthyȱlivesȱduringȱandȱfollowingȱtheirȱincarcerationȱisȱ necessaryȱ inȱ combatingȱ theȱ HIVȱ epidemicȱ bothȱ inȱ theȱ correctionsȱ systemȱ andȱ ourȱ communities.

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1 U.S. Department of Justice. Office of Justice Programs. (November 30, 2006). Press Release:

One in every 32 adults was in a prison, jail, on probation, or on parole at the end of 2005 from http://www.ojp.usdoj.gov/bjs/pub/press/pripropr.htm.

2 Springer, S. & Altice F.L. (2005). Managing HIV/AIDS in correctional settings. Current HIV/AIDS Reports. Vol. 2 Number 4.

3 U.S. Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. (2007). HIV in prisons, 2005. Retrieved September 2007 from http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf.

4 U.S. Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. (2007). HIV in prisons, 2005. Retrieved September 2007 from http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf.

5 Centers for Disease Control and Prevention. (2006). HIV transmission among male inmates in a state prison system -- Georgia, 1992-2005. MMWR. 55(15), 421-426. Retrieved September 2007 from http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5515a1.htm.

6 Macher, A., Kibble, D. & Wheeler, D. (2006). HIV transmission in correctional facility.

Emerging Infectious Diseases. 12(4), 669-671. Retrieved September 2007 from http://www.medscape.com/viewarticle/529449.

7 Centers for Disease Control and Prevention. (2006). HIV transmission among male inmates in a state prison system -- Georgia, 1992-2005. MMWR. 55(15), 421-426. Retrieved September 2007 from http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5515a1.htm.

8 Centers for Disease Control and Prevention. (2006). HIV transmission among male inmates in a state prison system -- Georgia, 1992-2005. MMWR. 55(15), 421-426. Retrieved September 2007 from http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5515a1.htm. And Kantor, E. (2006).

HIV transmission and prevention in prisons. University of California San Francisco. Retrieved September 2007 from http://hivinsite.ucsf.edu/InSite?page=kb-07-04-13.

9 U.S. Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. (2007). HIV in prisons, 2005. Retrieved September 2007 from http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf.

10 Avert. HIV testing in the USA. Retrieved September 2007 from http://www.avert.org/hiv- testing-usa.htm

11 U.S. Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. (2006).

Prisoners in 2005.Retrieved September 2007 from http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf.

12 Kantor, E. (2006). HIV transmission and prevention in prisons. University of California San Francisco. Retrieved September 2007 from http://hivinsite.ucsf.edu/InSite?page=kb-07-04-13.

13 U.S. Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. (2007). HIV in prisons, 2005. Retrieved September 2007 from http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf.

14 Ibid

15 The Sentencing Project. (2006). Factsheet: Women in Prison. Retrieved September 2007 from http://www.sentencingproject.org/Admin/Documents/publications/women_factsheet_prison.pdf.

16 U.S. Department of Justice. Office of Justice Programs. Bureau of Justice Statistics. (2006).

Prisoners in 2005.Retrieved September 2007 from http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf.

17 Office of National Drug Control Policy. (2002). Drug Use Trends. Retrieved September 2007 from http://www.whitehousedrugpolicy.gov/publications/factsht/druguse/.

18 Kantor, E. (2006). HIV transmission and prevention in prisons. University of California San Francisco. Retrieved September 2007 from http://hivinsite.ucsf.edu/InSite?page=kb-07-04-13.

19 Friedman, S.R., Bolyard, M. & Zenilman, J., Mateu-Gelabert. P., & Sandoval, M. (2006). Non- injector sex partners of IDUs: Results from a sexual network study of infection. Paper presented at American Public Health Association Annual Meeting, November 4-8, Boston, Massachusetts.

Retrieved September 2007 from

http://apha.confex.com/apha/134am/techprogram/paper_128302.htm.