|
PRISONS HOST AN EPIDEMIC OF INFECTIOUS DISEASES
http:mondediplo.com.2003/08/10comfort
United States: sentenced to sickness
The US policy of mass incarceration with access to inept
medical care but
without access to information, prophylactics or disinfectants)
has led to a
steep increase in the number of prisoners with communicable
diseases. By MEGAN
COMFORT
PEOPLE walking out of jail in the United States usually have
up to $200 "gate
money" to get them started in their new lives, to buy
some clothes and pay
the Greyhound bus fare to reach the city in which they must
live. But they might
also come out with something less helpful and more perman ent:
1.3 million of
the 9 million released in 2002 were infected with hepatitis C,
137,000 with
HIV, and 12,000 had tuberculosis. These figures represent 29%,
13-17%, and 35%
respectively of the total number of Americans who have these
diseases (1).
As public health researchers have warned for years, the mass
incarceration
that has been happening across the country since the early
1980s has been
accompanied by the mass incubation of infectious diseases in
correctional facilities
across the US (2).
The figures are dramatic but not really surprising. Much of
the behaviour for
which people are sent to jail - such as injecting drugs, sex
work, and
violence - leads to infection with blood-borne or sexually
transmitted diseases. So
any police sweep of law-breakers means a round-up of the
currently or
soon-to-be ill. Once behind bars, the practices continue, but
without the protection
that people might have had on the streets: since homosexual
sex, drugs and
violence are illegal in correctional facilities, syringes,
needles, bleach,
condoms or latex barriers are considered contraband (and even
clean water for
rinsing things is hard to come by).
The result is a make-do policy that results in scarce
injection equipment and
a few coveted needles (perhaps actual needles, but what is
used are more
likely to be ingeniously transformed ink cartridges, straws,
or guitar strings)
that are widely shared. Unprotected sex is routine without
access to condoms.
And even activities such as tattooing or skin piercing that
are relatively safe
against infection from HIV or hepatitis C when performed in
the outside world
become high-risk activities in prison. They are prohibited by
law, and their
equipment banned; therefore everything connected with them is
concealed and, of
course, shared.
Body decoration is an important and highly ritualised activity
among
convicts, for whom "tattooing creates permanent
representations of identity that
cannot be taken away by authorities; they represent positive
affirmations of self
in an environment full of negatives" as well as a visual
means of identifying
gang or group affiliation in a world full of strangers (3).
While all
needle-related activities are illegal in prison and therefore
go unreported or
underreported, researchers suspect that tattooing involves
greater numbers of inmates
than does injection-drug use and could perhaps be the primary
means of HIV and
hepatitis C transmission in correctional facilities.
This information surprises many inmates, since untold numbers
of them do not
know the crucial facts about the transmission, prevention, or
treatment of
infectious diseases; before their arrest they probably did not
have access to
medical care. In the US medical care is contingent upon having
an employer who
provides benefits (in the form of health insurance) at an
affordable premium, or
having personal funds to purchase private insurance, or
qualifying for public
aid, which is denied to those who are not impoverished enough
and may anyway
specifically exclude medication for drug addiction, mental
illness and other
serious conditions. This is a problem.
Paul Farmer and Barbara Rylko-Bauer have written: "The US
health system is in
fact a non-system, and what happens is the result of chance
and a patchwork
of services: it is splintered, unsystematic, fragmentary and
inefficient." So
people entering prison may not know that they are already
carrying infectious
diseases if they have not already received treatment for
symptoms, or they may
not know they are at risk of acquiring them.
Once inside prison inmates are tested for certain diseases,
such as
tuberculosis or syphilis, but institutions do not
automatically test for HIV or
hepatitis. But when procedures are not well explained (or when
a prisoner does not
speak English) and blood is taken, some inmates think that
they are being tested
for these viruses. Budget limitations often mean a
no-news-is-good-news
policy, so only those whose results show infection receive a
follow-up appointment
- and the rest assume that all is clear.
Inept or illegal medical companies compound the disorder. One
California
laboratory faked test results for thousands of prisoners for
years during the
1990s. Tipped off by concerned prison medical staff who had
noticed spelling
mistakes and other errors in reports, officials from the
California State
Department of Health raided the laboratory building in 1996
and "found a jumble of idle
equipment - a laboratory in disarray, with testing equipment
that didn't
work, was out-of- calibration or lacked proper reagents for
conducting tests of
blood and urine" (4).
By 2000, when the San Francisco Chronicle investigated this
affair, there was little evidence that the California
Department of Corrections
had made any efforts to contact or retest inmates who had
received wrong
information about their HIV or hepatitis C status, their
cervical cancer exams or
any other life-threatening conditions. But in the meantime the
manager of the
phoney lab had obtained a state licence to operate a new
clinical testing
outfit.
In another case a Michigan prisoner was accidentally shown
medical records
from his previous incarceration and was stunned to learn that
he had tested
positive for hepatitis C two years earlier and had never been
told. His
girlfriend, with whom he had lived between his arrests,
discovered that she too had the
disease (probably acquired between her partner's detentions).
This raises a little-known issue: a sizeable percentage of the
9 million
people released from jail each year in the US carry infectious
diseases back into
their communities and risk transmitting them to their sexual
and
needle-sharing partners - and anyone else who comes into
contact with their bodily fluids.
People do not see prisons as particularly risky to their
health and so do not
avoid unprotected sex or needle-sharing with someone who has
recently
rejoined society (5). In fact, since the correctional
facilities do provide regular
meals, sheltered housing and some degree of health care
(however inadequate),
the poor and homeless in the outside world may view prisons as
quite healthy
environments, especially when they see someone return to the
streets well
rested, nourished and even buffed up from long hours of
exercise in the gym. The
decline in the US welfare state to the point where the penal
institution "has
increasingly become America's social agency of first
resort" (6) means that, for
the most marginalised, the harsh grip of the punitive state
also functions as
the steadying hand that keeps their heads above water.
Even so, errors, neglect and incompetence can prevent adequate
medical care
for detainees and prisoners. Doctors and other medical
personnel who have been
sanctioned for poor standards of practice may have their
general licences
revoked but can continue to be allowed to work in correctional
facilities. Inmates
who require medication for HIV or hepatitis C may receive
out-dated
treatments that are modified according to correctional
policies (for instance, inmates
may be required to prove compliance with single-drug regimens
before being
allowed to receive more advanced multi-drug therapies) or
improperly
administered, as in the case of a Florida prisoner who was
routinely given his pills with
his meals, despite the interdiction on eating two hours before
and one hour
after taking his HIV medication. Such blunders endanger lives
and well- being,
and they also help create drug-resistant strains of viruses.
But whatever health care someone receives in a correctional
facility may be
better than that which he or she can scrounge when not behind
bars. The US
Census Bureau reports that, in a nation that still rejects
implementing a system
of universal coverage for its citizens, 41 million people
found themselves
uninsured in 2001, meaning that they were responsible for
paying in full any
medical costs they incur. Meanwhile the price of malpractice
insurance for doctors
and hospitals translates into bills that are three to five
times higher than
in Europe; prices for prescription drugs are prohibitive; and
bills for
prolonged stays in hospital can cost hundreds of thousands of
dollars.
Those who cannot afford these costs must rely on unpredictable
and
bureaucratic state aid, underfunded and often shoddy public
services (free or low-cost),
or the hospital emergency room - which the poor often use for
primary
health-care since hospitals are required to treat people if
they arrive in bad enough
shape. Ironic ally, prisoners are the only group in the US who
are entitled
to medical treatment, for as long as they remain under state
supervision. No
wonder some people "deliberately return to incarceration
because they feel that
they can obtain better care there than in the community"
(7).
The alarming prevalence of infectious diseases among the
incarcerated
ratchets up the costs: sky-high rates of illness and infection
translate into equally
high prison medical costs, which is a difficult issue to pitch
to taxpayers
who already have seen engorged correctional budgets dwarf
allotments for
education and social welfare spending during the past decade.
The combined policies
of hypertrophic incarceration for the poor and commercially
based
laissez-faire medical coverage for citizens are causing a
public health nightmare in the
US.
* Megan Comfort is a sociologist at the London School of
Economics
(1) The Health Status of Soon-to-Be Released Inmates, National
Commission on Correctional Health Care, 2002.
(2) This situation is not confined to the US: for information
about
healthcare in French prisons, see Claude Veil et Dominique
Lhuilier, La
prison en changement, Editions Eres, Ramonville Saint-Agne,
2002. For Spanish
prisons, see "Sida y Carcel" in PANPTICO, N° 1,
Nueva Čpoca,
2001, Virus Publications. For Russian prisons, see Paul
Farmer,
Pathologies of Power, University of California Press, 2003.
(3) Susan A Phillips, "Gallo's body: decoration and
damnation in the life of
a Chicano gang member", ???I class=spip>Ethnography
2:357-388, 2001.
(4) Farmer Sabin Russell, "State Fumbles Prison Lab
Testing: Company's Fake
Results May Never Have Been Corrected," San Francisco
Chronicle,
6 July 2000.
(5) See Megan Comfort, Olga Grinstead, Bonnie Faigeles, and
Barry Zack,
"Reducing HIV Risk Among Women Visiting Their
Incarcerated Male Partners", class=spip>Criminal
Justice and Behaviour, Thousand Oaks, California, 2000.
(6) Elliott Currie, Crime and Punishment in America, Henry
Holt
and Company, New York, 1998.
(7) Theodore M Hammett, "Health-Related Issues in
Prisoner Reentry to the
Community", in Reentry Roundtable, The Urban Institute,
Justice
Policy Centre, Washington, 2000.
DISCLAIMER: Information sent out on this list may not
necessarily reflect the
opinion of HCVPRISONNEWS, but sent out as information only.
Thank you.
|
