By George Curry and Tomika Anderson
BAI Contributing Writers
DURBAN, South Africa – Efforts to halt the spread of HIV among African Americans, the most impacted group in the United States—particularly African American women—will not be successful without reducing the rate of mass incarceration among people of color, according to research made public here Tuesday at the International AIDS Conference.
One of the researchers, Chris Beyrer, M.D., president of the International AIDS Society and Desmond M. Tutu Professor of Public Health and Human Rights at Johns Hopkins University in Baltimore, told a media delegation from the Black AIDS Institute:
“Black women in the U.S., if you look at their individual level of sexual risk, are less risky than Latino or even White women. And they have more than five times the infection rate. So how do we understand that? It turns out that the mass incarceration of African American men is fundamental this and it’s because of the problem of lack of access to care” once Black men are released from prison.
The United States warehouses more prisoners than any country in the world, with five percent of the world’s population and 25 percent of its prisoners. There are 2.2 million people in U.S. prisons and jails—a 500 percent increase over the past 40 years.
“Today, people of color make up 37% of the U.S. population but 67% of the prison population,” according to The Sentencing Project, a Washington, D.C.-based organization that works for a fair and effective U.S. criminal-justice system by promoting reforms in sentencing policy, addressing unjust racial disparities and practices, and advocating for alternatives to incarceration. “Overall, African Americans are more likely than White Americans to be arrested; once arrested, they are more likely to be convicted; and once convicted, they are more likely to face stiff sentences. Black men are six times as likely to be incarcerated as White men and Hispanic men are more than twice as likely to be incarcerated as non-Hispanic White men.
The disproportionate incarceration rate among Black males drives the epidemic among women once the men are released and return home.
“The problem is that people are being released without access to services and they experience treatment interruption,” causing their viral load to spike, says Dr. Beyrer. “They’re trying to reestablish family life, social life. And for many people they’re also very strongly trying to reassert their sexual identity—that is a part of what people want and need to do. People are sometimes released with three days’ worth of antivirals [and told,] ‘Be sure to follow up and get your appointment’. How likely is that to happen?”
“You release them, you do not connect them to care, and you remove any sort of structure that assures that they adhere to treatment, in an environment where they’re stigmatized because they’re Black, stigmatized because they’re ex-prisoners and they’re stigmatized because they’re HIV positive,” observes Phill Wilson, President and CEO of the Black AIDS Institute. “What sane person actually is going to disclose that they’re HIV positive?”
Research has shown that a high proportion of new HIV infections occur when a person is exposed to a partner who has recently been infected, has an acute HIV infection and/or a high viral load. “You’re basically having people perennially coming into the same small high-risk communities as though they were newly infected,” says Dr. Beyrer. “And that, I think, is essential to understanding why there’s so much more HIV infection in African Americans.”
The research released at the AIDS conference here was summarized in a special issue of the British medical journal The Lancet on HIV and related infections in prisoners. An accompanying commentary observed, “The CDC estimates that 87% of African American women with HIV become infected through heterosexual sex, and only a small percentage through injection drug use or other pathways.
“Incarceration rates have quadrupled in the USA in the past several decades, and this has reduced the number of men in black communities, and therefore the number of available partners for heterosexual black women. This fact, together with ongoing racial segregation, contributes to the formation of insular sexual networks with overlapping concurrent partners.”
That is consistent with research conducted by Adaora A. Adimora, M.D., a professor at the University of North Carolina School of Medicine who has conducted research on heterosexual HIV transmission rates escalating in the southeast, especially among Black women.
She attributed much of that growth to the prevalence of concurrent or overlapping
Dr. Adimora and two other researchers, Victor J. Schoenbach and Irene A. Doherty, wrote in the Journal of Acquired Immune Deficiency Syndromes: “Recent studies suggest that there are differences between blacks and whites in types of sexual network mixing patterns and prevalence of concurrency… African Americans with only one partner in the past year are 5 times as likely as whites to choose sexual partners from the core (persons who have had at least 4 partners in the past year).”
In an article published in The Journal of American Sexually Transmitted Diseases, the authors explained, “Once a concurrent partner acquires infection, transmission to a third person can occur without the delay involved with ending the first relationship and beginning the next. In addition, because relationships overlap in time, early partners are no more protected from infection than those acquired later. Thus, concurrency permits faster transmission of infection through a network than do sequential partnerships acquired at the same rate and has emerged as a particularly important factor in population HIV transmission.
“The prevalence of concurrent partnerships influences both the rate of the epidemic’s spread in its initial phase and the number of persons who are infected at a later time period. Concurrency particularly enhances population spread of HIV because of the virus’ long duration of infectiousness.”
In an interview, Olive Shisana, local co-chair of the International AIDS Conference, said women who are serially monogamous are also at greater risk.
“It becomes very clear as we look at the data that when you are single you are likely to have one monogamous partner for some time, then when that relationship ends, you start another relationship,” she explained. “The number of relationships that you’ve had determines the lifetime risk of you getting infected with HIV, so your probability is much higher as you change partners over time. I’m not even talking about multiple sexual partnerships, I’m just talking about serial monogamy—being single and have successive different relationships. It does put one at risk of HIV.”
There is increasing public recognition that that imprisonment of an individual impacts far more than the person serving time.
According to the Sentencing Project, in 2004, 52 percent of the people in state prisons and 63 percent of federal prisoners were parents of minor children. In 2007, 1.7 million children had a parent in prison on any given day. Black children are 7.5 times more likely and Latino children are 2.6 times more likely than White children to have a parent in prison.
Even after they are released, their prison past still punishes many former inmates. Among the impediments:
• The Adoption and Safe Families Act of 1997 (AFSA) permits the termination of parental rights when a child has been in foster care for 15 of the previous 22 months;
• The Welfare Reform Act of 1996 permanently denies welfare benefits (TANF) and food stamps to anyone convicted of felony drug crimes;
• The Housing Opportunity Program Extension Act allows local officials to deny public housing, Section 8, and other federally assisted housing to anyone convicted of a drug-related or violent crime; and
• The Violent Crime Control and Law Enforcement Act of 1994 makes prisoners ineligible for college Pell grants. They can re-gain eligibility for Pell Grants and federal financial aid upon release if they have not been convicted of a drug-related offense.
Given that daunting list of obstacles, HIV could be the proverbial final straw in the life of a Black family.
“If we’re going to have prisons,” said Kassandra Frederique, state director of the New York policy office at the Drug Policy Alliance, “they need to have a stronger health structure so we can reduce the risk associated with HIV and provide the kind of public-health interventions that will make it less likely that when someone leaves prison they will infect their unknowing partner.”