Human immune-deficiency virus
HIV (human immuno-deficiency virus) is a virus which damages a person’s immune system and weakens the ability of a person’s body to be able to fight infections (Haas, 1993). Segregation of HIV positive prisoners was a common practice during the first discovery of the disease, due to added pressure on prison officials to reduce the growing spread of HIV in prisons. The lack of education and understanding of the disease led to segregation and stigma of prisoners with this disease. General stigma of HIV positive prisoners occurs not only in prison but also amongst the public. This could be due to the media’s portrayal of HIV, creating fear amongst the population. Also, there was no cure for the disease at the time, people believed once you were infected with the disease then it meant certain death. The ethical implications of segregation of prisoners also have to be considered as some would argue it’s a violation of human rights. Through research that was carried out into the cause, unjust punishment and treatment of prisoners with HIV, a better understanding has been developed on the issue.
Segregation
To begin with, the spread of HIV is possible in many different ways from sexual intercourse to vertical transmission. However, statistics shows that around ‘74% of HIV infections have been spread from unprotected homosexual intercourse while 17% is from sharing of contaminated needles’ (Haas, 1993). This could therefore provide the basis for why many believe that compulsory segregation of HIV positive prisoners is necessary to avoid the spread of the disease. There has also been a steady growth in the spread of HIV by use of intravenous injections, this is due to there being a scarcity of needles therefore this results in the rapid spread of the disease. HIV is a disease that a person could have without knowing they are infected therefore it also poses a threat to the general public. This is because once an infected inmate is released, they could then go on into the population and spread the disease. This provides an issue for prison officials and has led to increasing pressure for changes to be made and policies put into place leading to the introduction of mandatory HIV testing for all prisoners and the segregation of HIV positive prisoners. However, these policies have faced fierce opposition from not only inmates but also from other in the public due it’s breach of human rights and constitutional rights (Haas, 1993). Prisoners also feel that there is a lack of privacy and by immediately being forced to submit to a blood test, their rights are being violated. Although, prison officials will argue that due to the increasing cases of infections mandatory testing is required to help reduce the spread of HIV and help control the infections. This is thought to be achieved by segregating the inmates (which was the only act done before the introduction of HAART) or now also administering treatments for the inmates in the form of HAART (Highly Active Anti-Retroviral Therapy) for example. The key issues that still exist is the breach of confidentiality of prisoners, by segregating HIV positive prisoners their condition is highlighted to all other inmates and prison guards. Segregation of inmates could also create the stigma towards the disease as other occupants in the prison might not understand the disease and how it’s spread. Prison officials also considered providing condoms for prisoners in order to help promote safe sexual relationships as well as providing bleach to help sterilise needles that were used by prisoners (Robinette et al., 1999). However, after 1985 there was large reduction in the number of prisons which still used segregation as an effective method to curtail the spread of HIV. This in part was due to the decrease in stigmatisation and hysteria surrounding the disease (Robinette et al., 1999). There are also perhaps four other factors as to why segregation of inmates has fallen out of favour; ‘avoiding stigmatisation, hazards of mass screening, problems with segregated housing and small chance of transmission through casual contact.’ (Robinette et al., 1999).
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Stigmatisation
In addition, looking through the stigmatisation of seropositive inmates, it is clear that through segregated housing the inevitability of inferior health care for these inmates has occurred. This stems from the fact that healthcare professionals do not view them as adequate patients. Health care providers immediately place prisoners into two groups with there being the ‘good patients’ (patients who are HIV negative) and the so called ‘rubbish patients’(those who are HIV positive)( Robinette et al., 1999). This is because health care specialities want to deal with life threatening issues or acute illnesses which can lead to them using key skills learnt and putting it into practice. Thus, ensuring that they can improve the health of the individual and save lives. However, with a disease such as HIV death is inevitable therefore the medical professional will feel like their attributes aren’t being used efficiently as there is nothing they can do to save the life of the individual hence why HIV positive patients are seen as ‘rubbish patients’. The ‘good patients’ are those who have exhibit these acute illnesses ensuring the medical personnel can help bring the person back to full health. From this it’s clear to see that segregation of inmates can only further increase this stigmatisation from health care professionals and this is therefore detrimental to the infected prisoners as it leads to inadequate care for these prisoners. To add to this, mass segregation of inmates requires mass testing of all prisoners. The issue with this is that sometimes the test could produce a false positive or negative result which could have detrimental effects. Individuals who are deemed to be seropositive will immediately be isolated, however due to a false positive result these people may not be infected. This is the same for those who are shown to be seronegative while in fact they are infected. This leads to those infected being put into the general population creating an inaccurate and false sense of security for the prisoners who aren’t infected as they may now be more likely to partake in high HIV risk activities such as unprotected sexual intercourse and Intravenous injections. It is clear as to how hugely detrimental this can be as it can lead to the rapid spread of the HIV disease in those or are uninfected. The results of these tests are also affected by the time taken between the first exposure to HIV and the presence of antibodies as sufficient time has not been given for the specific virus to be detected (Robinette et al., 1999). There are also two other issues related to mass testing of all prisoners, these being the costs as well as underappreciation of the education of HIV to inmates and the dangers of HIV. This is because only those who are infected with HIV and have been isolated, or those who are known homosexuals or intravenous injection users are more likely to be targeted when it comes to the education on the disease. This therefore ignores the belief that all prisoners should be informed and have a good knowledge on the issue to curtail the spread of the disease. As previously stated segregation of seropositive prisoners is also spreading the false belief that HIV is a disease that can be contracted by casual contact and as we know this is not the case.
Conclusion
To conclude, in order to help tackle the issue of HIV in prisons several changes can be made. A key change being the huge importance of the education of prisoners as knowledge is power and it can help reduce stigma towards HIV whilst also helping to reduce its spread as if people know what causes the disease they can be more cautious. It is also evident that sexual intercourse will occur in prisons so therefore condoms could be provided for prisoners. This is already being used in countries such as Canada and France and there have been no negative effects. For example, in Canada prison officers were surveyed to see if the use of condoms in prisons has caused any issues. Out of these people, ‘82% of prison officers surveyed said that condom availability caused no problems at their prisons’ (Robinette et al., 1999). However, there are prison rules against sexual intercourse it is argued that this is inhumane, and prisoners are bound to break the rules so is it is a better choice to provide inmates with the tools to practice safe sexual intercourse. Correctional officers may see condoms as a way to promote sexual intercourse with inmates or a way to move contraband into prisons but the protection of people from the spread of a deadly virus should outweigh these negative aspects. In future, more can be done to not only tackle segregation of inmates but to also challenge the stigma of HIV that it creates.
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