Inter Press Service - August 26, 2002
Katherine Stapp

These problems are magnified behind prison walls, where the proportion of woman inmates with HIV is as high as 21 percent in some states like New York - compared to just nine percent of male inmates.

"In most states, only a very small number of HIV-positive inmates are even identified," said Judy Greenspan, a long-time advocate for prisoners living with HIV/AIDS. "People are reluctant to come forward. You have to take a lot of grief, a lot of discrimination and stigmatisation," she said.

"There's also some degree of internalised AIDS phobia. It's the one disease you're blamed for - you did something wrong in your life and it's your fault."

Women of colour comprise just over half of the female U.S. prison population. Many are mothers. The Atlanta-based Centers for Disease Control and Prevention (CDC) says that Latina and African-American women of childbearing age now constitute 75 percent of female AIDS cases.

Behind bars and on the street, complaints of breaches of confidentiality, lack of support services and insensitivity crop up again and again, advocates say.

"Some of the case managers (at federally-funded support agencies) are just there for the paycheque," said Precious Jackson, a caseworker with an HIV/AIDS support group called Women Alive, in Los Angeles. "They're too busy to give these women the proper help - getting them connected to housing, transportation, food, the things that they need to live."

Also, "many of the case workers are not HIV-positive, so they don't understand what the women are going through, the side effects of the drugs they're taking, things like that," she said.

Greenspan believes the biggest problem in treating incarcerated women is prison itself. Most female inmates - about 80 percent - are in jail for non-violent offences, usually drug-related.

"It's very difficult, even in the most enlightened correctional setting," she said. "You just don't have the standard of care that you would get on the street. (Black and Latina) women, of course, bear the extra burden of facing the racism of the corrections guards, other prisoners and the system itself."

Obstacles to getting the proper medicine, on time, include lockdowns - when prisoners are confined to their cells for hours or days - doctors who lack expertise in infectious diseases, and vindictive guards, Greenspan said.

"It's the whole nature of prison. Prison medicine is adversarial medicine - doctors are suspicions toward the inmates, (wondering) 'are they lying', 'are they malingering'?"

One prisoner in California writes in Women Alive's newsletter: "We have a so- called 'specialist' who comes into the prison to examine us and offer advice. In reality, a doctor checks our reflexes. He listens to our complaints about our pain and our symptoms. Then he writes in our medical records that it's all in our heads."

"We are all perceived as dope fiends, who only want drugs," she writes. "HIV is not in our heads, and we need medicine for it. Neuropathy is not in our heads, it's in our hands, our feet and our legs. And we need medicine for that."

Women in jail are three times as likely as male prisoners to be living with AIDS. In the general population, these rates are reversed: men are four times as likely as women to be living with the disease.

Jackson says that most of the women she deals with contract HIV through heterosexual sex, often because their partner is bisexual and in denial.

In the community, they're called "down-low brothers", she said - men who have sex with men and then go home to their wives and girlfriends. "That's how I contracted the virus," Jackson said, adding that some women face violence or abuse if they ask their partner to use a condom.

Prisoners in the United States have a constitutional right to health care, including to the life-saving antiretroviral drugs most effective in keeping AIDS at bay. But prevention and emotional support are also critical, experts say, and can often be lacking.

To fill this need, non-governmental organisations (NGOs) and prisoners themselves have formed alliances like New York's AIDS Counselling and Education Project, Chicago's Live Hard, Stay Safe programme, and Kentucky's Survive Outside.

The projects use so-called peer education, in which inmates are recruited to talk to other inmates, to spread the word about testing and treatment options, and to provide a friendly face to women who just need to talk.

At a broader level, the Chicago-based National Commission on Correctional Health Care works to improve overall standards of healthcare in prisons around the country by conducting voluntary accreditation of correctional facilities and publishing guidelines on best practices for doctors working with inmates.

Quality of care tends to be best in facilities where there are a large number of HIV-positive inmates, says Judith Stanley, NCCHC's director of accreditation. Ultimately, "prison health care should be viewed as just one part of the public health system," she said, noting that besides simple treatment, it was critical that prisoners be treated with the same respect as other patients. (END/IPS/NA/HE/HD/KS/AN/ML/02) .

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