Waheedah Shabazz-El, a loyal and devoted employee of the U.S. Postal Service for more than 20 years, made decent money and lived an exciting life that included a big house in the West Oak Lane section of Philadelphia. She drove a Nissan Elantra, dressed in only designer clothes, vacationed in the Bahamas and enjoyed plenty of male companionship. She also did drugs, mostly marijuana and crack cocaine—and she was no stranger to the more expensive powdered stuff.
“Back in the day, my house was the party place,” Shabazz-El says. “There were always a lot of people, music, drugs and alcohol at any time of the day or night.” One day in 2003 an army of Philadelphia police officers raided her house, rounded up everyone and took them to jail. Shabazz-El was sentenced to six months at the Cambria Correctional Center (CCC) in Philadelphia for drug possession with intent to distribute a controlled substance. She was placed on five years probation. Shabazz-El, whom POZ profiled briefly in 2004, discovered that she was HIV positive during a routine examination at the correctional facility.
“The tester blurted out that I was HIV positive in an open room with a large window and no curtains,” she recalls. “Everyone walking by could see me. I sobbed and wanted to kill myself.” Uneducated about HIV/AIDS, Shabazz-El never thought that the disease could directly affect her.
Some might have written off Shabazz-El, a 55-year-old, Muslim, HIV-positive mother of three and grandmother of four. But she did more than survive prison and HIV—she fully integrated into society after doing her time. Perhaps that’s why her story of survival resonates so deeply. But it’s an important story because it illuminates the link between incarceration and the spread of AIDS.
According to the Centers for Disease Control and Prevention (CDC), nearly one in every four Americans living with HIV passes through a state or federal correctional facility each year. A disproportionate number of those individuals are people of color. Many never recover from the trauma of prison life and its destabilizing effect on all areas of their lives.
African Americans represent 45 percent of all new HIV infections in the United States. HIV is the No. 1 killer of African-American women ages 25 to 44. And the United States incarcerates more people than any other nation on earth (more than 2.3 million)—the majority of them black. These facts translate to an escalating number of HIV-positive black Americans behind bars.
But like the mugshot number that identifies a prisoner, startling statistics tell only part of the story. The soaring incarceration rates for African-American women (they are the fastest rising group to be imprisoned; proportionally, the number of HIV-positive women in prison is higher than that for men) and an increase in HIV infection rates in general in the black community hint at a connection between the two disturbing trends. But it has been hard to explain the exact relationship between being HIV positive and being incarcerated. Too many people wrongly believe that skyrocketing HIV rates among black people result from drug-addled inmates engaging in indiscriminate sexual activity behind bars, acquiring HIV in prison or jail then taking it home and spreading it through an unsuspecting community. The fact is, most people don’t contract HIV in prison; they enter the system already positive then, like Shabazz-El, discover their status behind bars.
A 2006 CDC study noted that about 90 percent of people with HIV in the state of Georgia’s male prison population were HIV positive before they were incarcerated. The statistics were similar for women.
In fact, Shabazz-El was never tested for the virus—until she was in jail. “Discovering that I was HIV positive and being in jail at the same time was almost too much to bear,” she says.
Laura McTighe, project coordinator of Project Unshackle and author of a study titled “Confronting Overlapping Epidemics: HIV and Mass Imprisonment” commissioned by the Community HIV/AIDS Mobilization Project (CHAMP), a grassroots advocacy group based in Philadelphia, says the relationship between HIV and imprisonment is about much more than what happens while people are imprisoned. “The notion that prisons are hotbeds for HIV transmission is inaccurate,” she says. “The intertwining of HIV and imprisonment points to a deeper community level crisis.” McTighe notes that although HIV is transmitted by specific behaviors, recent research indicates that the risk of HIV and vulnerability are more closely related to socioeconomic inequities. “These injustices often make it more difficult for people to protect their health [both inside and outside of prison],” she says. Translation: If you are hungry and have nowhere to live or your kids need new clothes and you’re broke, you may get involved in something you might not do (selling drugs, stealing, prostituting yourself) if your bank account were flush.
McTighe’s study discovered that people with HIV in prison often leave sicker than when they were first locked up. This is because prisons fall short of addressing essential HIV needs. Prisoners lack meds. They lack knowledgeable docs who can prescribe effective regimens. They lack regular delivery of meds (interruptions can lead to drug resistance). When they do take their meds, prisoners often lack proper food, and that can amplify side effects. They lack drug resistance testing, which can cause them to take an ineffective HIV regimen. And they lack viral load and CD4 tests, which can show the meds are working and therefore provide incentives for patients to adhere to meds.
Another common dilemma is that coinfection with hepatitis C—a common killer of HIV-positive people behind bars—may go untreated because prisons don’t want to pay for expensive hep C meds.
In addition, inmates with HIV/AIDS are often segregated, abused and stigmatized. And, denied access to the Internet and abandoned by families who could provide info, many HIV-positive prisoners are in the dark about what HIV/AIDS is, how to treat it and how to avoid getting, or spreading, it. “The lack of knowledge, condoms, clean needles and other HIV-prevention tools can increase a person’s risk of contracting [and inadvertently spreading] HIV while imprisoned,” McTighe notes.