Alabama: Ending Segregation of Inmates with HIV

wikipedia.org

Here is a nice New York Times article about the recent Alabama court ruling against the state's policy of segregating inmates with HIV from other inmates. This practice is associated with social isolation, stigmatization, lack of access to certain educational programs and an inability to transfer to prisons closer to families. Inmates are forced to wear arm bands identifying them as being HIV positive, eat alone and are not allowed to work around food; another nice New York Times article about this can be found here.

My friend and colleague Dr. Gonzalo Bearman wrote a very nice blog piece about segregating inmates with HIV back in November that is also worth taking a look at.

wikipedia.org

The New York Times article notes that Alabama inmates are not isolated based on having the hepatitis B or C viruses, both of which are more infectious than HIV. All three viruses are transmitted through blood and body fluids. Activities such as having unprotected sex and tattooing (if needles or ink are reused) can lead to acquisition of any of these viruses.

Per the CDC, people who are incarcerated are at increased risk for both acquiring and transmitting HIV. The CDC does not recommend isolating inmates with HIV, however. Rather, the CDC recommends testing inmates for HIV at the time of facility entry and exit, providing educational and treatment programs to inmates who test positive and linking inmates with HIV to care when they are released.

The Alabama court ruling is a definite victory for inmates living with HIV in Alabama. More work needs to be done, however, as this practice of segregation is still in place in South Carolina. Beyond this, prisons and jails should consider adopting practices that will limit infectious disease spread across the board, such as making condoms available.

HIV: Learning From Stigmatization

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Here is a thoughtful piece from over at PLoS on the stigma associated with various infectious diseases, especially HIV. Despite decades of research and education, discrimination still exists for people living with HIV; Gorman cites examples of people denied employment, of HIV positive inmates being isolated from other inmates and the ban on people with HIV entering the United States that was only lifted in 2009.

She poignantly notes that discrimination leads to false beliefs about disease transmission that in turn drive the stigma associated with disease. She also notes that stigmatization is a not a phenomenon isolated to HIV, but rather has been associated with many infectious diseases throughout history. Stigmas alienate people and undermine disease detection, prevention and treatment efforts.

Gorman calls for research into what drives stigmatization, with a special focus on what we can learn from history. As the emergence of new infectious diseases is a reality of human existence, learning from the stigma associated with HIV and other infectious diseases is critical.