While consensual and non-consensual sex in prison (and a lack of condoms) contributes to the spread of HIV, another key factor influences the escalating rates among African Americans: the mass incarceration of the black community. In a Stanford Law Review article titled “The Social and Moral Cost of Mass Incarceration in African-American Communities,” Dorothy E. Roberts discusses how incarceration disrupts the family structure and saddles women with crushing financial and emotional burdens. Roberts says that locking up mothers in particular disrupts family life because these mothers are often the primary caretakers of their children before entering prison. With more African-American women behind bars, more black children are placed in foster care or state institutions.
Incarcerated African-American mothers may also disempower the next generation. If so many black mothers are behind bars, who is raising the kids—let alone teaching them to negotiate sex safely during adolescence?
The mass incarceration of men creates a domino effect that further disorders women’s lives and destroys their power in sexual relationships with men. For one thing, with so many black men behind bars, the women have fewer potential male partners—and that may create a competitive environment in which women are less likely to demand the use of condoms. To further complicate things, some of those men are ex-inmates themselves—some unknowingly carry the virus or are unwilling to reveal their status.
The continued stigmatization of prisoners with HIV makes inmates less likely to get tested while inside, or, if they do, to disclose their HIV status upon release. Fear of stigma may also prevent people from seeking treatment. When people don’t seek treatment, they’re more likely to have higher viral loads and are therefore more sexually infectious.
Prison is a dehumanizing experience that erodes people’s self-esteem and taxes their resilience. When one group controls another, the unbalanced social structure makes things volatile. Add to that the perception of prisoners as “bad guys” who deserve whatever they get, and it’s easy to imagine how prisons can become a fertile breeding ground for both physical and mental abuse. One woman we spoke to recounted how, when she asked a male guard for a sanitary napkin, he replied he’d already given her one earlier; it didn’t matter that she needed another one.
A daily diet of indignities such as this, coupled with the added pressures of being HIV positive, can trigger a slew of emotional and health care issues that prisoners often carry with them when they go home to their communities.
Another critical factor that leads to the spread of HIV is the lack of sex education both inside—and outside—prison walls.
“African-American women moving through the penal system are among those at greatest risk of HIV infection because prevention efforts fail to address a number of issues when it comes to making informed sexual choices,” says Jessica Fields, an assistant professor of sociology at the University of California at San Francisco and the principal investigator of an ongoing study of sex education and HIV prevention among incarcerated women in San Francisco.
Indeed, after learning her status, Shabazz-El was handed some literature about HIV/AIDS, given brief counseling and prescribed some HIV medication—some of which made her ill. She contemplated whether she would disclose her diagnosis to her family and close friends. For a while, she chose to keep the news a closely guarded secret. She hid the handouts and pamphlets about HIV/AIDS in her Koran.
While incarcerated, Shabazz-El experienced a multitude of emotions ranging from mania and anxiety to melancholia and depression. She also wondered how she would survive living in such a controlled and nondescript environment for an extended period, battling an illness she knew very little about. “My family came to visit me a few times,” she says. “There were periods when I lost hope and thought that my life was over.”
Shabazz-El says prison nurses would dispense medications in a cumbersome and lengthy process—and in some instances, HIV-positive inmates were often the last to receive meds.
“On numerous occasions, I received my HIV medications late,” she says. “I would have to wait until the nurse went to all of the other cell blocs, before returning with my HIV meds.” Shabazz-El says she believes the delay was intentional, because HIV-positive prisoners were often isolated and stigmatized by prison staff and HIV-negative inmates. Also, Shabazz-El says her relationship with a general practitioner doctor in prison changed once the doctor discovered she was HIV positive.
“He was an older white doctor who I would see for other ailments I had besides HIV when I was incarcerated,” she says. “We would laugh and talk about books and current events during my exams.” Once the physician received her full medical charts and records that highlighted her status, however, the friendly demeanor and warm bedside manner abruptly changed. “Exams were now quick, cold and impersonal once he discovered that I was positive.”
Looking beyond these hardships, Shabazz-El anticipated the time when she’d be released and would be able to return to her family. “When I was released from jail, I went to live with my middle son, Salim, and his girlfriend at their small house in the city,” she says.
Once she settled in, Shabazz-El had to make regular visits to her physician and various clinics in order to get medication. Some of her meds had to be refrigerated—something she obviously couldn’t do without revealing her HIV status to her son.
She lived with him for 15 months in close quarters. Hiding her meds and lying about where she was going became her biggest stressors.
“My son and I were very close, and we talked all the time,” she says. “I continuously put myself at great risk by not adhering to the prescribed drug regimen. I eventually got tired of lying.” After a few months, she told her son that she was HIV positive.
“We both cried and hugged each other,” she says. “I assured him that even though I was living with the virus, I was taking care of myself.”
Shabazz-El told her son not to share the news of her illness with his siblings. She wanted to disclose the information in her own time and way to her eldest son, Fahmee, and daughter, Salwa. However, one day, while discussing details about an upcoming local fashion show, Shabazz-El says, her daughter became agitated regarding a small aspect of the show. “I was shocked at how angry and upset she became about a minor detail, and she was rambling on and on about it,” she says. “I finally just told her that I was HIV positive.” Shabazz-El says her daughter immediately stopped her tirade and told her that she already knew about it from her brother. “Her frustration about the fashion show was just a substitute for the anger and resentment she had toward me for not telling her about my status.”
Shabazz-El shared the news with her eldest son shortly after. “He began researching HIV and telling me about all of the new drugs and clinical trials that were being done. There were some tears, some anger and a lot of love and hugs,” she says. “I was relieved that I no longer had to hide my condition from the people I loved the most.”