May 19, 2011

HIV and Mass Incarceration: A Recipe for a Super-virus

While Camping makes predictions about an impending judgement day, Dr. Robert Fullilove, the Associate Dean for Community and Minority Affairs and a Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health of Columbia University at the Mailman School of Health is making a much more likely, and therefore much more disturbing, premonition about the future of HIV in this country. By the year 2015, he says, the HIV virus will have mutuated to the point that a supervirus that is incurable and looks startingly similar to HIV in the 1980s will have been born. What does this have to do with prisons and reentry? While at first glance, it might not be obvious, but after a half an hour talk by Dr. Fullilove, similar to the one he gave yesterday at the Community Service Society's Reentry Roundtable, you will be schooled, and you will be frightened.

How do you create the perfect conditions for the spread of disease? Dr. Fullilove tells us to look to the war on drugs and the subsequent mass incarceration of individuals in confined spaces,without condoms, without access to good medical care, and disruptions in access to HIV medications that require strict adherence.

  Here is a very brief, synopsis of the very scary story that he tells:

 In 1970, Nixon declared drugs as the public enemy of the state. In 1973, the DEA decided to wage the against drugs by incarcerating those who use them.  It is no coincidence that in 1972, 200,000 were locked up, and today, the U.S. is the leader of incarceration in the world, with 2.3 million people in jails or prisons. 1/2 of all arrests today are drug related crime.  

Although HIV hit the media in the 80's with the "gay men's health crisis," because the virus has an incubation period of 10-15 years, the disease began being spread  at the very same time that the country began criminalizing the use of needles.  Fearful of getting caught with a "spike," injection drug users stopped carrying their own needles and began to share them in places they could be left and refused, engaging in the most efficient way of spreading HIV, Hep C, and a host of other diseases. 

Now, instead of treating addiction as a public health issue, incarcerate these individuals, predominantly ethnic minorities,  for drug use and sales.  In New York, take 75% of them from the 7 neighborhoods that have among the highest rates of HIV infection in the country, as high as in areas of Sub-Saharan Africa, and put them together in prisons. Mix different strands of HIV and they will become be more resistant to medication. 40% of incarcerated individuals willl have sex in prison and a large amount will inject drugs, or share needles tatooing. Don't offer condoms and, depending on the state, offer limited HIV/AIDS treatment. No wonder, Fullilove says, that prisons have 3-5 times the rate of HIV infection as the general population. Although extremely effective when given, HIV treatment requires a strict regimen, so when those incarcerated individuals who have access to HIV treatment leave the prison they must take the drug regularly. If not, the virus will mutate and become less responsive to HIV meds.  With no immediate access to Medicaid upon release and disruptions in HIV treatment due to release machinations, a "drug holiday," can eventually become deadly. When the individual with HIV returns to his/her community, or jail, and transmits the virus, that virus will be more resistant to treatment. At some point, it will become untreatable. 

And so, warns Dr. Fullilove, by the year 2015, the HIV virus will have mutuated to the point where we will create a supervirus that is incurable and looks startingly similar to HIV in the 1980s. 

Equally startling, is that Mr. Fullilove asserts that there are many very simple public policies that could prevent the spread of the disease. To read Dr. Fullilove's work, click here.