How Does Incarceration Impact the Spread of HIV?

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Baltimore has one of the higher HIV rates among U.S. cities. It’s also the city that one-third of the people in Maryland’s state prisons call home.

What do the two have to do with each other? A lot, according to “The Global Burden of HIV, Viral Hepatitis, and Tuberculosis in Prisoners and Detainees”, a recent study on HIV and incarceration worldwide. Though the authors don’t examine individual cities, or even countries, they note that mass incarceration, particularly the cycling of people in and out of jails and prisons, has contributed to the spread of not only HIV, but also viral hepatitis and tuberculosis.

But it’s not just Baltimore, or even Maryland. The authors estimate that, of the approximately 10.2 million people incarcerated on any given day, 3.8 percent (or 389,000 people) are living with HIV. In the United States, prisons in Florida, Maryland and New York have higher rates of HIV prevalence than any country outside sub-Saharan Africa. At the same time, incarceration in the United States disproportionately impacts people of color, particularly African Americans.

Andrea Wirtz, Ph.D., one of the study’s co-authors and an assistant scientist at Johns Hopkins Bloomberg School of Public Health, is quick to clarify that it’s not that HIV transmission is rampant within U.S. jails and prisons. The availability of antiretroviral therapy in prison actually keeps the risk of transmission low behind bars, she told The risk arises once people are released and have difficulties continuing their medications. These interruptions mean they are no longer virally suppressed and thus are more at risk of transmission. “It’s right after release that there’s an increased risk of overdose and HIV transmission,” she explained.

Release Can Be Risky for HIV
Across the globe, over 30 million people are released from prison and return to their home communities each year. It’s the time just after release when the risk of HIV transmission increases. Even a short time behind bars means disruptions in treatment, causing viral loads to increase. Once people are released, their sexual partners or those with whom they inject drugs are at risk for HIV.

The racial disparities of arrest and incarceration — and the accompanying disruption in antiretroviral treatment — put black women in the U.S. at particular risk. Chris Beyrer, M.D., another of the study’s co-authors and a professor at Johns Hopkins University, noted that, despite having lower levels of individual sexual risk, African-American women are five times more likely to become HIV positive than Latina or white women. “So how do we understand that?” he asked a media delegation from Black AIDS Institute at the 2016 International AIDS Conference, as reported by Emerge Media Online. One underlying driver is the mass incarceration of African-American men and the interruptions in treatment upon release, he said. “People are sometimes released with three days’ worth of antivirals [and told,] ‘Be sure to follow up and get your appointment’. How likely is that to happen?”

Higher Rates in Women
But not just post-prison sex increases women’s risk. Women in jails and prisons face a higher risk of infection than both their male counterparts and non-criminalized women. In most regions of the world, HIV prevalence is higher for women behind bars than their male counterparts. Closer to home, the New York City Department of Health found that women incarcerated at Rikers Island, the second largest jail in the country, have a prevalence rate 14 times higher than the city’s general female population.

On the state level, nearly 12 percent of women in New York State prisons were living with HIV in 2010, a rate that is more than double that of their imprisoned male counterparts and far above the rate of the general public. The Correctional Association of New York, an organization that monitors New York State prison conditions, noted that “experiences that lead women to be criminalized and incarcerated, including addiction, being prostituted, engaging in sex work, and experiencing domestic violence and trauma, put women at greater risk for contracting the virus.”

Read the entire article by Vikki Law here.