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On prisons, blacks, HIV
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By Derrick Z. Jackson | August 19, 2006
http://www.boston.com
SEVENTEEN YEARS ago, time enough for a new generation to start the next generation, Robert Fullilove tried to warn the nation about the rising impact of AIDS on black people. He and his wife Mindy were researchers in San Francisco at the nation's largest research center of color that is working on AIDS.
``We have a series of epidemics that work against dealing with AIDS," he told me in 1989. ``Homicide is caught up in drug abuse. Drug abuse is caught up in AIDS. AIDS is caught up in crack use. Crack use is caught up in STDs [sexually transmitted diseases] . STDs are caught up in AIDS. Now, AIDS is threatening to make tuberculosis common again to many people who don't have AIDS. It could start looking like 200, 300 years ago."
This week, Fullilove spoke at the 16th International Conference on AIDS in Toronto to warn participants that the series of epidemics continues to grow. ``The whole issue of black men in prison is one we also have to talk about if we're serious about this," he said over the phone. ``There is growing evidence that this is the major contributing factor that we have not paid enough attention to to connect the dots as to why infection rates are so disproportionate (in the United States) among black people."
Fullilove, 62, now at Columbia University, cited a study of HIV transmission in Georgia's prisons from 1992 to 2005, published in April in the Centers for Disease Control's Morbidity and Mortality Weekly Report. The study found that the prevalence of HIV infection among inmates is nearly 5 times the rate of the general population. While black inmates make up 63 percent of the Georgia prison population, they accounted for 86 percent of inmates who were infected with HIV before entering jail.
The older the prisoners and the longer their sentences, the more likely it was that they would transmit or contract HIV behind bars, primarily through male-to-male sex or tattooing. With no differences in risk behaviors among racial groups, the percentage of black inmates who contracted HIV in prison, 67 percent, roughly mirrored their share of the prison population. According to the CDC study, only 15 percent of inmates reported using ``improvised barrier protection methods" during sex. An editor's note to the study said, ``Departments of corrections without condom distribution programs should assess relevant state laws, policies, and circumstances to determine the feasibility and benefits and risks of implementing such programs." The CDC only cites state prisons in Mississippi and Vermont and city jails in New York, Los Angeles, San Francisco, Philadelphia, and Washington, D.C., as having condom distribution programs.
Massachusetts, despite years of urging from AIDS prevention activists, does not distribute condoms in state prisons.
With 1 out of every 3 black males facing the chance of prison in their lifetimes, according to The Sentencing Project, a nonprofit group that promotes sentencing alternatives, Fullilove said that if prisons do not make changes soon, the loaded dice will explode in many more transmissions. ``There is . . . reason to assume that this is probably similar all across the country," he said. ``These young men go in because they lost hope, and when they come out, in many states, their prison record means they can't vote, they find it difficult to get a job or loans for education and qualify for housing subsidies. We're creating an underclass."
It is one being created as a bipartisan failure. Former President Bill Clinton addressed the AIDS conference this week in his current incarnation as a planetary savior against the disease. Indeed, his two terms in office were marked by a significant increase in support for AIDS education and research. But his efforts were marred by his refusal to fight congressional Republicans to overturn grossly disparate drug sentencing laws that were far more harsh for crack cocaine than for powdered cocaine. Even though illegal drug use by racial groups roughly mirrors their actual percentage of the population, those laws and enforcement of those laws have resulted in the vastly disproportionate incarceration of black people. President George W. Bush made a splash by pledging $15 billion to fight AIDS in Africa, more than any other president. But he undercut his promises by reducing general research in the sciences, while overstressing abstinence and understressing condoms.
Just as Fullilove warned 17 years ago, the world and black people in particular have a series of epidemics that work against dealing with AIDS. With all that we know now, Fullilove said, any inaction on the crisis ``is as close as you can get to being criminal." Given his latest concern, that pun is intended.
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