Prisons are breeding grounds for HIV
but officials ignore problem
By Stacey Singer and C. Ron Allen
WEST PALM BEACH -- Pointing to a jagged scar on his forehead, Charles Johnson explains how he tried to fight off his cellmate during his most recent stay in the Palm Beach County jail.
Night after night, when the lights went out, the inmate was on him, demanding sex.
“After a while, I gave in, because it’s a never-ending fight, and I knew I couldn’t win it,” said Johnson, 36, a convicted drug dealer with a rap sheet dating back to 1987.
Despite repeated attacks, Johnson, of Lake Worth, has never taken a test for HIV, the virus that causes AIDS.
If he’s positive, Johnson said, “I don’t want to know.”
The former prisoner’s attitude may be short-sighted. But it’s shared by many jailers.
Although health-care workers say jails and prisons are a known transfer point for HIV, Florida prison officials are reluctant to screen because of the high cost of HIV-fighting drugs. Even so, they don’t distribute the condoms that might prevent HIV’s spread.
Because inmates so frequently return to the outside world, health workers say, a major opportunity to slow the epidemic is being wasted.
Left undetected, sick inmates are likely to pass disease to each other and in turn carry AIDS, hepatitis, chlamydia and syphilis back into their communities. One in three hepatitis C cases in the United States occur in people who spent time in prisons and jails, said Dr. Anne DeGroot, a physician who runs the HIV Prison Project at Brown University.
The implications are “huge,” DeGroot said. “If you don’t provide care to those people, if you don’t provide education, it really is a problem. People do not stay in corrections forever.”
In Florida, prisons and jails test for HIV only if an inmate falls ill or asks for a test. Even so, a recently released survey showed that one in 10 inmates at the Palm Beach County Jail — 274 prisoners — were HIV positive or showing symptoms of AIDS. Meanwhile, 80 inmates were sick with full-blown AIDS in the Broward County jail system, and 130 were sick with it in the Miami-Dade County jail system. Broward and Miami-Dade counties declined to provide the number of HIV-positive inmates, listing only those inmates so sick that they had full-blown AIDS.
The survey, released last month by the U.S. Bureau of Justice Statistics, counted prisoners on a single day — June 30, 1999. The figures were reported by jail officials based on known HIV and AIDS cases.
The reported figures are “absolutely the tip of the iceberg,” said Dr. Frederick L. Altice, director of the HIV in Prisons Project at Yale University.
“If you have 10 percent who are known to be positive, you can count on it being more like 16 to 20 percent.”
Nationally, scientists know that about 17 percent of people who have HIV were in a correctional facility in the previous year, said Hugh Potter, a researcher at the U.S. Centers for Disease Control and Prevention.
As HIV increases in jails, so do budgets for inmate health care. The Broward County Jail system expects its health budget to rise to $14.2 million next year, up from $13.4 million. In Palm Beach County, HIV medications alone will cost $500,000 next year, a cost expected to reach $1 million in 2002.
HIV tests cost between $8 and $30 each, and if inmates are HIV positive, their medication can cost $1,500 to $4,000 a month.
The cost issue keeps the Broward County jail system from conducting widespread testing, said Cheryl Stopnick, spokeswoman for the sheriff.
“Because it’s a funding issue for us, you have to be symptomatic or you have to request it,” she said.
One obvious way of preventing transmission would be to distribute condoms. At least six jails nationwide do, including those in Vermont, in San Francisco, and at Rikers Island in New York City, DeGroot said.
But in Florida, condoms are considered contraband.
Inside the jail
At the Palm Beach County jail on Gun Club Road, most inmates live in enormous rooms of up to 64 beds each, where clandestine sex and crude tattoos are sometimes shared beneath blankets or under cover of night.
Johnson said inmates know about the risk of AIDS, so they make do with any protection they can find.
Often when inmates go to the dining hall, they are served food wrapped in plastic wrap, said Johnson, who goes by several aliases, including Charles Jacobs.
After meals, inmates save the plastic and use it for protection during sex, he said.
“They use latex gloves, plastic bags or Saran Wrap,” he said.
Jail officials insist that sex among inmates is unusual in Palm Beach County’s institutions, where the average length of stay is 43 to 48 days. They say most dormitories and cells are under deputies’ scrutiny 24 hours a day.
“It’s not a common occurrence because of transitory nature
of this population,” said Capt. Chris Kneisley. “We advise inmates not to engage in that type of behavior.”
The “see-no-evil” attitude among law enforcement officers is unhealthy, says Victor Jones, chair of the HIV Care Council’s community awareness committee in Palm Beach County.
“The attitude is, ‘The people who get it deserve it,’’’ Jones said.
State legislator Frederica Wilson, D-Miami, thinks she has another solution.
Two years in a row, she has introduced bills that would make HIV testing mandatory for state prisoners nearing release. The bill passed the House but died unread on the calendar in the Senate this year.
Among those opposing mandatory testing is the ACLU, which says it violates inmates’ rights.
“Requiring testing of anyone, whether a pre-trial detainee who is innocent or a citizen on the street raises serious questions of civil liberties,” said attorney Jim Green.
Still, 19 other states nationwide do test all inmates before release. Wilson thinks it’s just common sense.
“If a young man doesn’t know he is HIV positive and the community doesn’t know he is HIV positive then he presents a danger to the community,” Wilson said.
“He doesn’t know until he’s deathly ill, and in the ER. And then they ask him, ¡¥What sexual partners have you had in the last 10 years?’ Well my God, that may be a lot of people.”
Scholars such as DeGroot and Altice think the best approach is multifaceted: Educate inmates at every turn, encourage voluntary testing, make sure excellent health care is available if the inmates do test positive and ensure that care is continued after release so that drug-resistant strains of HIV do not develop.
Altice serves as a consultant to the Florida Department of Corrections, which has taken several prisons and made them centers for HIV care. The sickest inmates are sent to those specialty prisons, where health teams trained by Altice are trained in giving appropriate medications, depending on viral load and immune system changes.
“They have on-site specialists for the really complex cases at a handful of prisons, and it has been very successful,” Altice said.
The environment at specialty prisons such as the Central Florida Reception Center is supportive for sick inmates, said Samuel Perry, 36, an HIV-positive West Palm Beach man who recently was recently released after serving an eight-year sentence for robbery.
“It’s a very good program,” said Perry, who thinks he became infected 17 years ago while selling sex to finance his drug habit. “If I didn’t go to jail, I probably would have died.”
’I’ve seen skin roll off’
At South Bay Correctional Facility, a state prison run by the private Wackenhut Corp., the Palm Beach County Health Department has helped start a team of peer educators — inmates teaching inmates about prevention and treatment.
Wyndell Blue, 38, has spent 22 years behind razor wire for committing armed robbery as a teenager. He’s not HIV positive, he said, but has watched so many other inmates sicken and die that he feels he’s doing the right thing by spreading the warning.
“I’ve seen the skin of a man’s body roll off him like it was liquid, his mind go crazy, tumors push out of his head,” Blue said. “Each and every one had the sarcomas.”
Seeing how much of a difference the anti-viral drugs make, Blue said he urges people to get tested and treated.
“But a lot of guys now don’t want to hear about it, don’t want to talk about it,” said another peer counselor, Willie Smith, 41, imprisoned for murder. “And if guys do want to be tested, it can be hard.”
The difficulty comes when inmates seek a second HIV test. These require a form stating what specific high-risk activity inmates have been engaged in while they’ve been behind bars: sex, a fight, a tattoo, intravenous drug use.
Inmates said they can, and occasionally are, punished for confessing. Then they go through a grievance process.
“It’s all a bunch of red tape for the institution to give you three months to give up,” one inmate said.
“That’s just the way it is. They want you to go away.”
At the Palm Beach County jail, infection control coordinator Ann Juhaz said that in spite of the costs, the Sheriff’s Office is applying for grants to start more widespread testing. Plus, she said, the jail is beginning to work with the county’s health department to make it easier for inmates’ medical care to be continued after their release. She said the nurses and doctor have special training for treating HIV patients.
In addition, one of the jail’s facilities, the Stockade, has held yearly health fairs in which inmates can be tested on the spot if they are willing.
Last year, 230 people took tests for HIV and syphilis.
It’s a small program, but a start.
“More and more inmates are asking for help, for treatment and testing,” Juhaz said.
Johnson isn’t one of them.
Since he finished his six-month sentence in 1999, he said he has gotten his life together — but he still won’t get tested.
He has “a few” girlfriends and some of them have his children, he acknowledged.
Even so, he asserts that he practices safe sex. And he thinks he’s healthy.
“I know if anything’s wrong with my body,” Johnson said. “My body is straight. And if I have it, I don’t want to know. What you don’t know won’t hurt you.”
Stacey Singer can be reached at firstname.lastname@example.org or at 561-243-6616.