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HIV and Hepatitis C operate like a sort of epidemiological tag team: Because they’re transmitted in the same ways (most commonly, through unprotected sex and shared needles), they tend to travel in the same circles. And in New York, those circles find their center in the state prison system. The Department of Health estimates that 12 percent of women and 6 percent of men in New York prisons are HIV-positive, and that more than 8,400 are infected with hepatitis C. That makes the incidence of HIV/AIDS in the prison population 42 times higher, and of hepatitis C six times higher, than in the general population – meaning that the prison system is the largest provider of care for these diseases in the entire state.
Viewed in a glass-half-full sort of way, inmate infection rates present a tremendous opportunity to improve the state’s public health. Working with a literally captive audience, medical providers have a chance to identify, educate and treat people who can be nearly impossible to reach on the street. Since 97 percent of those people will eventually go home – most of them to the same small number of neighborhoods – giving them the best possible healthcare while they’re locked up can boost the wellbeing of whole communities. Missing that opportunity, or failing to help connect inmates with medical care on the outside, increases the odds they’ll end up in an emergency room or a morgue (but possibly pass on the virus first).
Yet providing health care to inmates is an inherently complicated task, and one that can be difficult to reconcile with prisons’ primary mandate of maintaining security. Over the past two-and-a-half decades, as the growth of HIV, hepatitis C and the nation’s prison population have collided, advocates and corrections officials have waged an increasingly furious war over how to do it best. Last month, the advocates won a major battle: Gov. Paterson signed a law (S.3842/A.903) aimed at bringing new levels of oversight to HIV and hepatitis C care in prisons.
Activists on the inside
Mary Robinson began her prison career in 1986, five years after HIV appeared in the U.S., three years after she had been given her own AIDS diagnosis, and just as the disease was at the height of its death march through New York prisons. “There was no treatment,” recalls Robinson, now 47 and living in the Bronx. “Women just wasted away in front of you.” They fell to voracious skin cancers or came down with low-grade fevers that raged into sudden pneumonia, disappeared into prison hospital wards and never came back.
AIDS phobia was just beginning to spread across the country – Over the next two years, 13-year-old Ryan White would be banned from his Indiana school and 10-year-old Ricky Ray’s house would be burned in Florida. Inside prisons, where inmates were forced into constant, intimate contact, fear exploded into panic. “I was like a pariah,” says Robinson: “The AIDS girl.” Women on her cellblock threw cartons of sour milk at her in the cafeteria. They refused to use toilets or showers after her, banned her from sitting on furniture and spat in her face when she passed them in hallways. By the time she was being transferred out of the county jail system and into state prison, she was ready to give up. “I just couldn’t take it anymore,” she says. “I was going to kill myself.”
