Prisons are considered “hotbeds” for HIV. Some prisons in the world have HIV rates up to 65 percent, and the HIV rate of prisoners is often significantly higher than that of the outside community—Zambian prisoners have a prevalence of 27 percent, while the national HIV rate is 15 percent.
This is in part due to widely documented human rights abuses and unsanitary conditions in prisons. Most prisons do not provide condoms or harm reduction supplies to prisoners, as most prisons do not account for sex (consensual and coerced) and drug use that nonetheless regularly occur. Tattooing in prisons is another common activity that increases risk of transmission when prisoners share needles.
Yet it is not only the actions occuring within the prison walls that lead to the high prevalence rate. A high proportion of prisoners are already infected when they enter the system. This is a manifestation of the criminalization of HIV—both explicit and implicit—exacerbating the epidemic in the world today.
I am currently attending the 2010 International AIDS conference in Vienna. The conference theme is “Rights Here, Right Now” and the “Vienna Declaration” is a statement of intent and focus for the conference. It calls for an end to the war on drugs and a reformation of HIV policies based on evidence rather than morality.
It has been repeatedly shown that decriminalizing drug use and allowing injecting drug users to access clean needles decreases the spread of HIV. Yet many countries continue to prohibit syringe exchange and criminalize drug users, pushing the epidemic underground. This makes it more difficult for people to make healthy decisions about their drug use, and floods the prisons.
The drug war is one aspect of the problem; sex work, homosexuality, and HIV transmission are also criminalized in parts of the world. These groups often have the highest prevalence of HIV in their societies, due both to broader incidents of “risky behavior” but also largely due to their isolation from society. Where sex workers have access to safer sex supplies, are not harassed or attacked by the police, and can be open about their work—exceedingly rare circumstances—they have improved access to social services, and can take more authority over their choices.
As it stands, criminalized populations with high risks of HIV are confined together in unsafe prisons where the epidemic can easily spread, enhancing the chance of transmission to other inmates and by extension to society outside the prison walls, due to transience in and out of prisons.
The stigma of these populations piles on top of each other. It can be difficult to live with the transgender label in some societies, worse if he or she is a sex worker, worse still if he or she is imprisoned, and worse again if he or she has HIV. In a criminalized system someone living all of these taboos has significant difficulty getting regulated employment, and may find it necessary to return to sex work or other criminalized activities, where they are again vulnerable to incarceration.
Global leaders are finally talking about the benefits of harm reduction, and UNDP and UNAIDS are launching a new global commission on HIV and the law. With the focus on decriminalization, stigma reduction, and evidence (rather than morality) based HIV policies at the conference, activists are hopeful that more countries will implement effective policies to manage the epidemic.
