South Carolina: Stronghold of (HIV) Segregation

South Carolina is the last state in the country to still segregate HIV+ inmates into separate areas, away from HIV- inmates.  The last three states in the nation to continue with this policy were South Carolina, Alabama, and Mississippi.  Alabama’s policy was deemed unconstitutional just last year, after a court battle. Mississippi changed its policy in 2010 after activists and attorneys pressured the Department of Corrections commissioner Christopher Epps to rescind the policy (which he did, very much to his credit).

Segregating HIV+ inmates is bad policy for some pretty obvious reasons.

The policy is rooted in fear, never an emotion that lends itself to rational policy-making for holistic health and well-being.  This fear makes HIV- people think they are at risk of infection by HIV+ people.  The truth is, we know that due to an often compromised immune system an HIV- person may pose more health risk to someone who is positive.  We also (or we should) know better in 2013 how HIV is spread and how it progresses both in the body and in the community.  Transmission isn’t casual.  HIV is not spread through the air, through the cough of someone who is infected, or through hugging, drinking fountains, or by sitting on a toilet seat of someone who is positive.  HIV is transmitted largely by sexual contact or contact with infected blood. Both sex and blood can be handled in a safer manner (barrier methods).  Access to condoms for consensual sex, rape and sexual assault prevention, and universal precautions would go a long way in preventing HIV transmission while in prison, if legislators were truly interested in reducing HIV transmission and taking care of HIV+ people in their states.

The policy also lends itself to separate and unequal standards of care.  HIV+ prisoners I’ve interviewed as a part of a team of attorneys and social workers contributing to this report  shared that they were treated differently by nurses who ignored their requests for care (including timely prescription refills, a crucial part of HIV treatment).  Several prisoners reported that cafeteria staff refused to civilly scoop food onto a plate (for fear of touching an HIV+ inmate) and would instead roughly shove trays at the inmates at high speeds.  Guards would ignore fights between HIV+ inmates for fear of becoming HIV infected.  When Mississippi inmates were relegated to a specific unit, their confidentiality about being HIV+ was shattered.  Everyone inside the prison knew what the unit number meant.  Desegregating HIV+ inmates doesn’t guarantee the care and support they deserve, but it’s clear that segregation makes it worse.

Less attention is paid to the effects these policies have on the communities in the Deep South.

Let’s take Mississippi as an example.

Parchman Prison, the only high-security penitentiary in the state, is located deep in the Mississippi Delta in Sunflower County.  I’m guessing it’s one of the largest employers in the area, with prison guards, food service workers, groundskeepers, and other staff reporting for duty.  These employees tell their families what happens on the job, including which unit houses HIV+ inmates.  They may even drop a few names (“did you know so-and-so has HIV?”).  In a state with few employment or social protections, this can have devastating consequences on the formerly incarcerated and the people who love and support them.

One man told us that his mother gets treated differently on her job now that folks found out her son had HIV.  Another released inmate told us he had no hope of finding a job in the surrounding area because people knew his HIV status from former inmates (who aren’t bound by confidentiality).  He even said he was refused service for a hamburger at a fast food chain.  He reported dealing with whispers by community members from his small town, and even worse he feared he would be unable to find employment.  One person we met with was kicked out of a beauty school after she disclosed to them she was HIV+.  She was fired from her job when a prison guard revealed to her employer (where she was a waitress) that she was HIV+.  The cosmetology statue at the time said that anyone with an “infectious disease” could be disqualified from obtaining a cosmetology license.  At last check (revised 2011) the law still reads the same (see page 23).  According to a letter written by the Attorney General of the United States:

“HIV-positive status in the context of barbering, cosmetology, massage therapy, home health care work, and other similar occupations is, simply, irrelevant.”

This type of ignorant policy making is bound to happen when we let idiots legislators, most of whom are not health care providers or have any expertise in the area, make public health policy.

Even more damaging, HIV+inmates who should have been eligible for parole were denied release because they were deemed ineligible for work opportunities while incarcerated.  Prison administrators felt that HIV+ individuals posed a risk to others by performing basic duties such as cafeteria work and tending to the grounds.  These risks were negligible, and were based on ignorance.  It meant that inmates who were HIV+ had longer sentences unnecessarily, and were incarcerated in conditions that did not provide them proper care.

If shaming, discrimination and fear are leveraged at HIV+ individuals, no wonder people are reticent to get an HIV test.  Perhaps it would feel better not to know one’s status.  Of course, we know that ignoring one’s status may mean the disease progresses and compromises one’s health further.

The combination of a lack of community support and a policymaking regime that is built on ignorance about the issues that are facing HIV+ people can be deadly for those who are affected. The awareness surrounding this issue has been reflective of the community that it affects: unseen and unheard, relegated to the far back of even the most supportive citizen and lawmaker’s conscience. We must change that. We must make sure that no inmate is held back from reintegration because of their HIV status. In fact, we should be providing more services to those people whose health and economic status puts them most at risk.

South Carolina, it is time to do better. It is time to ensure that all of your citizens can live with dignity and worth.