From My Archives: Critique of Article Advocating for Segregation of HIV-Positive Inmates

Robinette, P., Long, B. (1999). Is the segregation of HIB-Positive inmates ethical?:Yes, Prison
       Journal, 79(1), 101-118.

 

 

Is the Segregation of HIV-Positive Inmates Ethical? : Yes

                The article from Prison Journal, speaks to an issue that is still prevalent in the U.S. Prison system. Although written in 1999, the issues discussed here still warrant attention and consideration. Penny Robinette makes the case that segregation of inmates who are living with HIV/AIDS is acceptable from an ethical point of view. I’ll begin with a short synopsis and comment on her point of view and then offer my own critique as a doctoral student who specializes in HIV and minority populations.

                Inmates are at risk for acquiring HIV infection due to a number of risk factors. These include the association of injection drug use, anal intercourse (consensual and coerced), tattooing, having multiple sexual partners and having a history of multiple sexually transmitted infections.  Not only are these behaviors risky in terms of HIV infection, but also to other diseases such as hepatitis B and hepatitis C. Due to America’s “war on drugs” prison populations have grown dramatically as this is the means by which America solves its drug related problems.  The sharing of dirty syringe needles is commonplace amongst the general public and for those inmates who continue their drug habit inside the prison system.  Contaminated needles are the source for many HIV infections.

                She posits that in regards to HIV/AIDS that prison systems have adopted a variety of strategies to combat HIV/AIDS infections here in the USA: mandatory testing of all inmates, segregation of HIV/AIDS prison populations, and educational outreach for all inmates (notice she did not specify prison staff). She then presents a series of questions related to the complexity of this issue: who is tested, who knows the results, should they be quarantined, is HIV such as risk that the rights of the individual are limited, care and safety issues for prison staff, and what are the responsibilities of the prison to families of those with HIV?

                She advocates that it makes sense for prison officials to screen all prisoners upon entry to the prison system and that those testing positive for HIV/AIDS should be segregated. She states that this will allow closer monitoring of inmates for health treatment concerns. She further states that this will allow for a more concerted effort in education and counseling outreach.  Isolation will also prevent inmates from spreading the disease to the rest of the prison population and to prison staff.

                I’m happy to report that the majority of states (48) have not followed this line of thought. I’m hoping that Ms. Robinette has not continued to advocate for this stigmatizing style of treatment.  I did a little follow up work on this and as of earlier this year (2010) only the states of Alabama and South Carolina have continued to segregate their HIV-positive inmates. Earlier in the year Mississippi decided to end its longstanding policy of segregation of HIV-positive inmates.

                First of all, anyone remotely associated with HIV can remember during the beginnings of the epidemic that one of the “solutions” offered to contain the spread of HIV was to quarantine all people infected with HIV from the rest of the general population. I myself even recall that one of the reasons to do this was so that those infected and those suspected of having the disease could reinfect one another and get sick and die.  Ms. Robinette’s suggestion that segregation from the rest of the prison population is too similar to this early fearmongering rhetoric for my comfort. It parallels a course of action that could have been.

                Mandatory testing is problematic here as I don’t recall any situation where we would force someone to take a test to determine their status. We don’t require this of our citizens so what makes this any different? Do inmates lose all rights when entering the prison system?  How is compulsory testing of prisoners ethical? This flies in the face of informed consent.  Better to screen prisoners for HIV with voluntary testing. In this sense, their right to be treated with humanity and with respect to their inherent dignity worthy of a person is encouraged. Also, could mandatory testing not be construed a degrading treatment as this is forcible and without consent.  My thoughts are that inmates can be encouraged to be tested voluntarily. If there is a situation that might warrant testing (that is, exposure to body fluids) then mandatory testing could be initiated. It is in this sense that only that I see compulsory testing as being ethical. In this situation, the inmate has either willingly or unwillingly put himself and others in harm’s way and the needs of others involved outweigh his right to consent.

                How does segregation of HIVers help the general population?  The act, of housing those with the disease from others, does nothing more than announce to the rest of the prison population that these people have HIV. This would also announce, without permission of the infected, to his family and friends of his illness. Segregating of prisoners with HIV indicates to others and discloses to others regarding their HIV status. I know that segregation is supposed to be good for HIVers in the sense that care to these prisoners is easier to manage, and for protection from the general population due to stigma however, an unintended consequence of this action is the promotion of the very thing they (prison officials) say they want; stigmatized inmates. I would say that this promotes myths and misunderstandings about the nature of HIV and transmission among prison staff, fellow prisoners and the community in general. These misconceptions are going to undermine ANY educational outreach used to combat stigma.

                Where are segregated inmates housed? I asked around and was told that often times they are housed in a harsher more locked down units. Isn’t this where the more dangerous inmates are held?  What if the inmate (HIV-positive) is a low level offender, does this mean that the unit they serve in is more restrictive in nature in regards to any personal freedoms, outreach opportunities, educational benefits, activities, work related training and etc. Not because of his / her crime but a medical condition?  How is this not differential treatment?

                I understand that prisoners are required to wear clothing that identifies them as HIV-positive.  In Alabama, the HIVers are required to wear a white armband and this is generally understood by the rest of the prison as being the poz unit. In South Carolina the HIVers have a blue dot on their identification badges.  This is disclosure of their confidential medical information!  In my mind’s eye I visualize the pink triangles that the Nazi’s issued for homosexuals in the prison camps.  It’s the scarlet letter of Hawthorne’s classic brought into real life. Since HIV is a chronic lifelong condition, why not just take this one step further and brand those with HIV? (Sarcasm intended here).  

Since the writing of this journal article all but two states in the USA have rescinded the practice of segregated housing for HIV-positive inmates.  I feel that this article was a product of the time it was written, one where heightened anxiety and fear was rampant in the general population. I feel this article did nothing more than promote the public’s sentiment and encouraged the identification, segregation and isolation of inmates in our prison system.