Lock In Model of Mass Imprisonment and HIV

1
Lock In Model of Mass Imprisonment and HIV

• Sharif Sawires
• CHAMP
• University of California David Geffen School of
  Medicine
• Program in Global Health
• Center for HIV Identification, Prevention and
  Treatment Services

2
Outline

• Discuss a framework for thinking about mass
  imprisonment, HIV, and communities of color
• Brief overview of mass detention in the U.S.
• Introduce the idea of Core Communities
• Brief overview of the Epidemiology of HIV and
  Imprisonment
• Churning and Impact
• Salient points about Impact on Communities of
  color

3
Framework

• Early Mover Advantage
• Long Wave Impact
• and
• Lock-In

4
U.S. Prison Population 2008

• The U.S. incarcerates more people than any other
  country in the world.
• 2.3 Million Adults in 2008
• 1,596,127 in state or federal prison
• another 723,131 in local jails
• 1 in every 100 Adults

5
Race/Ethnicity 2006

• Black men 41 of inmates
• About 4.8 of all Black men are in custody
• 1.9 of Latino males
• .7 of White males
• Black women were incarcerated in at nearly 4
  times the rate of white women and more than twice
  the rate of Latina women.
• Latinas were incarcerated at 1.6 times the rate
  of white women

6
HIV in U.S Prisons

• Persons at risk for incarceration are also more
  likely to be at elevated risk for HIV infection
  and this is particularly true for females as
  prisons are the only setting in the US where HIV
  Prevalence is higher in females than males - 1.6
  in males and 2.4 in Females (BJS 2006).

7
Comparison of Global Incarcerators

• U.S. 1 at 2.3 million
• 750 per 100,000 (rank 1)
• China 2 at 1.5 million
• 119 per 100,000 (rank 113)
• Russia Federation
• 633 per 100,00 (rank 2)

8
Incarceration Rate Disparities
9
Growth In U.S. Prison Population 1987-2007
10
US Comparison to 36 largest European
11
Policy Changes Drive Growth

• Changes begin in mid 1970s
• Longer sentences is a major factor
• Mandatory minimums
• Truth in Sentencing
• Increase in punitive response to drug sentencing.
• Impact of Race Neutral policies

12
Impact of Drug Sentencing On Black Communities
13
People Living with HIV/AIDS and Incarceration

• It is estimated that each year, approximately 25
  of all HIV positive persons in the United States
  spend time in prison or jail.
• 12-15 of those with chronic hepatitis B virus
  (HBV) and 39 with chronic hepatitis C virus
  (HCV) in the United States pass through or are
  released from State or Federal correctional
  facilities annually.

14
ART Effectiveness

• In the United States, HIV-positive state and
  federal prisoners often have positive HIV-related
  health outcomes while incarcerated.
• Increased CD4 counts
• Decreased viral loads
• The positive health effects are rapidly lost
  after soon after release.
• Springer SA, et al 2004

15
Core Communities

• Prisoners are disproportionately selected from
  and released to a small number of core
  communities
• These same core communities have high numbers of
  persons that repeatedly churn back and forth
  between prison and the community, frequently for
  technical parole violations.

16
Tipping Points

• The impact of nearly 700,000 people annually
  returning from prison to their communities and
  families is far reaching
• Volume of this population cycling through core
  communities dramatically changes the social and
  public health character of the population in
  these areas

17
Community Reentry the acute period of risk

• The period immediately following release from
  prison is a critical time for health and social
  service interventions

18
More Incarcerations/More ReleasesChurning

• Nearly all prisoners will be released within 5
  years of admission (Travis, 2005)
• Although the average state sentence is 4 ½ years,
  the average inmate will serve lt2 1/2 years.
• Slightly less then ½ of the population of inmates
  are released each year. ( in 2005 733,009
  admitted to State and Fed while 676,952
  released).
• Nationally over ½ of released inmates return to
  prison within 3 years for a new crime or
  violating parole.

19
Community Stability

• What is clear is that mass incarceration and high
  recidivism rates are adding to the accumulation
  of disadvantage by destabilizing communities,
  their sexual networks, and increasing infectious
  disease risks.

20
Most HIV Transmission Happens in Community
Settings?

• Georgia state prison study demonstrated although
  transmission does happen in prison, it is most
  likely that the majority of HIV positive
  individuals get infected in community settings
  (MMWR, 2006).
• Large number of studies demonstrating high HIV
  prevalence at entry to Jail or Prison for men and
  women (Macalino GE 2006, Rich JD 1999, de Ravello
  L 2205, Kassira EN 2001, Solomon L 2004, Wu ZH
  2001).
• Limitations to these assumptions.

21
Heightened Attention to Communities of Color

• Heightened attention to why HIV among men and
  women of color is increasing so rapidly
• Links between mass imprisonment and increased
  risk of HIV/STIs are complex, institutionally
  driven, and long-wave events.
• CDC 2006 HIV Incidence Numbers

22
Social and Sexual Networks

• Know a lot about individual risk behaviors in
  community settings.
• Growing body of reliable accounts and scientific
  evidence on risk while incarcerated.
• What we dont have a lot of is understanding how
  relative risk changes as folks transition between
  community/detention and understanding
  incarceration as a structural determinant of
  community health.
• As advocates and investigators we need to do a
  lot more connecting of the dots.

23
Social and Sexual Networks

• Network turnover and concurrency.
• Removing mass numbers of males from communities
  destabilizes social networks and courtship
  patterns.
• Bridging between partners from higher and lower
  HIV-risk groups.

24
Impact

• Incarceration, network stability, and HIV risk
• Diminishing stable partnerships and creating
  environments that facilitate concurrency
• Reducing womens ability to negotiate terms of
  sexual relationships and employ risk reducing
  strategies

25
A Perfect Storm and Lock-In

• Many mutually reinforcing factors that come
  together so that even post-release- in the
  absence of an individuals detention- deleterious
  population-level health effects continue.

26

• Simply put, we will never rid the United States
  of HIV and other STDs if our only weapon is
  medical treatment. And if we are unable to engage
  in a national dialogue about the sexual health of
  our youths and the social dynamics that drive
  STDs, this epidemic will go largely ignored, and
  many more lives will be lost.
• (Fullilove, Adimora, Leone 2008)