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The Easy Way the Government can Reduce AIDS and Hep C

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We all know that AIDS has become a scourge among black and Latina women.  64% of American women with AIDS come from the 13% who are African-American.  AIDS is the leading cause of death for black women age 24 – 34 years.


It is generally assumed that this is something only those individuals can change, by changing their behavior.


However, some of this differential infection is actually due to government behavior.  And, it is something the government could fix immediately and cheaply with one policy change.


This change would be the segregation of prison populations by infectious disease status, that is, based on seropositivity for HIV, Hepatitis B (HVB) and C (HVC) and TB.  Separate facilities or cellblocks would be reserved for the virus-free, for those with the blood-borne diseases HIV, HVB and HVC and for those with TB, which can be airborne. 


Prisons have become breeding grounds for disease.  Ex-cons become vectors that carry diseases of incarceration out to their families and lovers, many of whom are innocent, faithfully waiting wives.  HIV passes an estimated 10 times more easily from a man to a woman than vice versa, so women who have never been in prison are at high risk from men who have been.


It is estimated that the prevalence of HIV seropositivity behind bars, compared to in the general population, is 3 to 5 times higher, Hep C (or HCV) 9 to 10 times higher, and TB 4 to 17 times higher.  The highest rates of known HIV seropositivity are in New York’s prisons: 7.5% for men and 14.2% for women.  These rates are far higher than the estimated prevalence among the general US population of 0.6% and even the pandemic rate of 8.8% in sub-Saharan Africa.


12% of African-American men in their 20s and 30s are in prison.  28% to 32% of African-American men become prisoners at some point in their lives.  65% of prisoners are non-white and 44% are African-American, despite the fact that only 13% of the general population is. 


Meanwhile, prisons have become breeding grounds for infectious disease. 


These factors must explain some of the differential rates of infection of African-American women, as compared to white women, whose likely partners, white men, comprise only 35% of incarcerated men.


The rate of infection at intake is far higher than in the general population, and then the uninfected readily contract infections in the crowded conditions of incarceration, where clean syringes and condoms are largely unavailable.  One-quarter of inmates have injected drugs in prison, and nearly half of prisoners who use illegal drugs have shared needles. A Federal Bureau of Prisons study reported that 30 percent of federal inmates engaged in consensual homosexual activity while incarcerated. The same study found that 9 to 20 percent of federal inmates were victims of rape.  In addition, when many infected individuals are forced into crowded conditions dangerous blood-borne diseases can be passed via accidents, handmade tattooing tools, fights, shared razors and deliberate infection.


In the case of Hep C (HCV), another slow-developing, frequently fatal and very expensive-to-treat viral disease which infects 17% of inmates but only 1.5% of the general population, some 15% of transmission is due to unknown or little-understood factors, among them “household transmission.”  While HCV transmission usually requires blood-to-blood contact, some strains apparently pass between household members.  It is probably those strains which infect those American prisons in which 100% of prisoners are known to be infected with HCV.  Hep C is a serious disease, which costs millions to treat, eventually leads to a slow, painful death by liver failure or a costly liver transplant.


An Op Ed in the New York Times on 18 July, 2007 called for condom distribution in prisons; however, this addresses only a fraction of the problem.  Segregation is less controversial and would address all vectors by which disease spreads.


The negligence of prison officials in the face of these epidemics is tantamount to pronouncing death sentences for even minor offenses on many of those inmates unlucky enough to be placed in highly infectious institutions. 


Until prison populations are segregated by disease status, thousands of inmates will be exposed behind bars, then released from prison each year to carry home serious diseases which will infect their wives, husbands and lovers. 


Given the highly segregated nature of housing blocks inside prison, the separation of prison populations by disease status should be practical.  Many prison inmates are already tested, as in most prisons it is already policy that infected men cannot work in the kitchen.  Eighteen states already test all new inmates.


In addition, the fact that prisons have become hotbeds propagating dangerous, expensive-to-treat infectious disease is yet another argument for a major re-think of the “war on drugs.”  Individuals with addiction problems, or minor recreational drug use issues, are being sentenced to a substantial probability of rape by a population well known to be frequently infected with dangerous diseases or to being exposed through “household transmission" of potentially fatal Hep C.

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Jan VanDenBerg earned a Master's Degree from the Economics Department of Stanford University in 1987.  She served as head Japan economist for Merrill Lynch Tokyo 1987-1993, and worked for the US Treasury Department Office of (more...)

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