Patrick Forcier

Honors 230 – Podcast script

A lot of things are deemed to be “silent killers” such as HIV, high blood pressure, or diabetes.
These conditions are termed the “silent killers” because so many people can live with them and never
even know it’s there until it is too late. They are conditions that without regular follow up, or careful
examination, will never be caught or taken care of. Yet one thing, which has a massive presence in the
United States, more than any other country, seems to be ignored when talking about such things. If you
want, pause this right now and see if you can figure out what it is on your own, I’ll even give you a hint, it
has to do with prisons… Are you ready?... It’s the federal prison healthcare system. The healthcare
present in the federal prison system is something that is flawed, much like high blood pressure or diabetes
is a flaw in the human body’s functionality. And just like these conditions, it is something that goes so
unnoticed to the vast majority of individuals because most do not undergo a careful examination to find
its flaws. However, what I seek to do today, is to bring these flaws into the light.
So good morning to all of my listeners out there right now, and welcome back to another episode
of what I hope is your favorite podcast, Medicine Today, where we cover all things related to the medical
field and explore the extent to which this amazing field may impact society. I am your host, Patrick
Forcier, and today, we have a very interesting and somber topic to be discussing. Today I want to do what
few are willing to do by themselves, examine flaws in the federal government. I want to carefully
examine HIV and AIDS in the federal prison system and highlight how the healthcare systems in place in
prisons facilitates the disparities and disadvantages of the already less fortunate. Specifically, I want to
show how the African American population is not only disproportionately targeted by policing and makes
up a significant portion of the incarcerated population, but is also disproportionately affected by HIV in
prison and how the healthcare systems present are inadequate in solving this deadly disparity.
Before we really get started today, it is important to outline what the HIV epidemic looks like
outside of prisons. In terms of the general population, there are a predicted 1.2 million individuals who
are currently living with HIV (HIV.gov). About 14% of individuals within the United States are currently
living with HIV and have no idea that they are positive for this deadly virus until they require immediate
care (HIV.gov). This percentage just goes to reinforce the idea of this being a ‘silent killer’ as the virus is
often not detected until action absolutely needs to be taken. Of the 1.2 million individuals living with
HIV, we can see that African American males make up 40.2% of new infections of men with HIV and
African American women make up 61.6% of the new infections found in women (McDougle 2017). This
goes to illustrate just how significant the current HIV epidemic is, and how much it affects people of
color.
Now that we have taken a look at the general statistics of the U.S population, let’s take a brief
look at some of the history and general ideas behind what I am going to be talking about. To begin, we
need to jump back all the way to just after the end of the Civil War, where we see the white populace of
the country desperately creating new methods through which they are able to ‘re-enslave’ recently freed
African Americans. Highlighting this aspect of history, is Chained in Silence by Talitha Leflouria, in
which she highlights the racist views which ran rampant in society, especially in regards to criminality. In
this book, she makes note of the common view of African Americans from a white perspective of having
an, ““inherent” predisposition towards delinquency” (Leflouria 22). This demonstrates the prejudiced
views that led to a natural assumption that all African Americans are criminals, and it serves to facilitate
bringing them back into prisons where they are able to be controlled once more. From here, we can see
that the mass imprisonment of African Americans during this time period was used in a manner which
was designed to help the white populace turn a profit off of prisons. Focusing on this aspect of history,
Ida B. Wells writes about the convict leasing system and how not only did individuals leasing these
convicts make a profit off of their cheap labor, but so did the states from which the convicts were leased
(Wells chapter III). An important distinction to make in this aspect is the fact that because a vast majority
of prisoners were African American, it meant that African Americans were the ones who were being
forced to return to working large plantations, railways, and for other companies while the states made a
handsome profit off of their labor (Wells). The work done by Wells is excellent in highlighting the profit-
making aspect of incarceration of African Americans, which is something that we will be seeing
throughout today’s discussion. While none of this holds a lot of relevance in today’s society, we will still
be able to see the perpetuation of these flaws in the carceral system when we discuss more recent data,
they simply take different forms.
Now, we need to take a look at the history of the federal prison healthcare system as it works in
combination with these aforementioned concepts to provide a complete background for how the HIV
epidemic has disproportionately affected people of color in prisons. In terms of the historical basis of the
healthcare system in U.S. federal prisons, there really is not much of a history in the sense that it is such a
recent development when considering the entirety of imprisonment in the U.S. As reported by the
National Commission on Correctional Health Care (NCCHC), It was not until 1970 that inadequate health
services in prisons was even identified as being a major problem. As we continue down this timeline
presented by the NCCHC, we can see that even after this problem was identified, it took seven years for
even just sixteen jails to meet the American Health Association’s guidelines for providing adequate
healthcare for those incarcerated in these locations (NCCHC). What makes this lack of prisons even
reaching adequate healthcare measures even more startling, is the fact that a 1986 supreme court case,
Estelle v Gamble, established that medical neglect violates the 8th Amendment, and that is based off of
research performed by Dr. Carolyn Sufrin, reported in her book, Jailcare (Sufrin 41). It is important to
keep in mind that this case reached its verdict a full year before these few prisons ever reached medical
standards. In keeping with the idea of a lack of history regarding prison healthcare, it was not until 2001
that the NCCHC issued its first set of clinical guidelines for correctional healthcare (NCCHC). Since this
time, the National Commission on Correctional Health Care has been closely following the development
of prison healthcare and continually issuing reviews regarding the status of these systems in attempts to
keep the growing field on the right track towards providing adequate care for inmates. Fortunately, the
burden of ensuring that prisoners are receiving adequate medical care is not only placed on the NCCHC.
As Sufrin highlights in her work, lawyers, judges, advocacy groups, correctional healthcare workers, and
more have all been working towards improving the quality of care in the prison setting (Sufrin 42). As is
evident with this history, there are a great number of flaws that have not yet been solved within the
healthcare system, which are only exacerbated further by the complexities involved with the HIV
epidemic.
Taking it back to 1968, as Ruth Wilson Gilmore highlights, Richard Nixon is running on a “law
and order” platform that quickly instills a “moral panic over crime and criminality” (Gilmore 171). This
panic, fueled by racism and potential for profit-making off of prisons, is what feeds directly into the years
and years of mass incarceration that we see beginning in the 1970’s and continuing into today’s society
(Gilmore). While the growth of mass incarceration is often attributed to things such as the war on drugs,
Michelle Alexander illustrates support for the idea that it is fueled by racism and a desire for profit in her
novel, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, when she states “The War
on Drugs is the vehicle through which extraordinary numbers of black men are forced into the cage…Vast
numbers of people are swept into the criminal justice system by the police, who conduct drug operations
primarily in poor communities of color. They are rewarded in cash…” (Alexander 180). This shows us
that money and making a profit off of the imprisonment of others, especially poor people of color is
certainly a large part of the carceral system, so we can take a look at how this drive for profit is something
that leads to the inadequate HIV health services for people of color who are incarcerated. As Lauren
Brinkley-Rubinstein and William Turner highlight in their 2013 study, federal prisons have an increased
rate of HIV, which is four to six times that of the general population of the United States (Brinkley-
Rubinstein et al. 2013). Later in their study, they illustrate the point that these groups who are more likely
to be incarcerated, African Americans, are thus placed at a much larger risk of HIV infection in prison
and are more likely to suffer from the inadequate resources present (Brinkley-Rubinstein et al. 2013).
Continuing with the idea of profit-making being a significant factor for poor HIV care, the federal bureau
of prisons states that one of its primary goals in health services is to maximize cost effectiveness of the
treatments offered to inmates (BOP). This demonstrates one initial flaw with the healthcare system
present in federal prisons. It shows that these prisons are attempting to limit their own expenses, which
includes expenses directed towards the care of the prisoners. This directly relates to those with HIV in
prisons in the sense that while care may be deemed to be “adequate”, Bisola Ojikutu and others published
a study in 2018 which noted that a significant number of federal prisons have failed to make investments
in HIV testing, prevention, or even proper treatment services for inmates (Ojikutu et al. 2018). This
illustrates the idea that the desire to reduce costs in order to increase the profitability of the federal
prisons, presents a real harm to the inmates afflicted by HIV. There is a lack of desire for monetary
investment in their current state of health, prevention, or even for testing which can only lead to increased
transmission of the virus. Compiling on to the desire to not invest money into improving the quality of
health services that these individuals have access to, is the fact that they must also pay additional fees to
access HIV care that can save their lives (Brinkley-Rubinstein et al. 2013). This demonstrates the fact that
not only are these federal prisons focused on cutting their costs, to the detriment of people living with
HIV, but they are also seeking to make money directly from these people who are already disadvantaged
due to the racist systems that put them in prison in the first place.
While the financial aspect of HIV treatment in prisons is certainly a driving factor for the
inequalities that are seen in the prison healthcare system, there is more that can be seen to be contributing
to the HIV epidemic in prisons when considering behavioral risks that prisoners are faced with. Initially
concerning is the presence of rape in prisons. The Human Rights Watch (HRW) reports that while exact
numbers are hard to come by, rape or other forms of unwanted sexual attention is a significant problem
present in prisons and contributes largely to the rate of HIV spread amongst prisoners (Human Rights
Watch). The unfortunate presence of rape can once again be attributed to the practices of prisons. As
further highlighted by the Human Rights Watch, these prisons often fail to provide preventative measures
such as condoms or simply educating inmates about the risks of their behavior in regards to the spread of
HIV (HRW). Continuing with this, Avert, a non-profit organization seeking to highlight the persistence of
the HIV epidemic, makes note that federal law in the US states that condoms should be supplied to
prisoners but most do not enforce this law to any degree, meaning that at a federal level, prisons fail to
provide proper preventative measures (Avert). Often times, prisoners even have to make appointments in
order to receive condoms which not only intrudes on sexual privacy and disclosure of HIV status, but
often serves to inhibit individuals from obtaining condoms (Avert). Based on this, we can see that there is
absolutely a significant lack of provision of preventative measures to inmates, so, with rape being such a
large problem, the risk of HIV transmission is only facilitated by the failure of prisons to provide proper
health services to their inmates.
One of the other most significant behavioral aspects that facilitates the risk of HIV in prisons is
the use of injection drugs. As Ralf Jürgens and others report in their 2011 study, the use of injection drugs
is one of the primary means of HIV transmission in prisons (Jürgens et al. 2011). This is due to the use of
contaminated equipment that is shared amongst inmates (Jürgens et al. 2011). However, the use of
contaminated equipment is something that could easily be eliminated with the use of needle exchange
programs present in these prisons, as has been done many countries (Avert). Unfortunately, the U.S. is not
one of these countries. As the 2017 UNAIDS report shows, the United States does not offer any needle
exchange programs not only at the federal level, but not at any level of prison (UNAIDS 2017). So, it is
once again the failures of the health services provided by the federal prison system that results in an
increased rate of transmission and infection in those who are incarcerated.
So, as we can now see based on the conversation over the last few minutes, the United States
prison system is one that disproportionately targets people of color. This is a system that is historically
engrained within the country and can be seen to be driven by racism and a desire to make a profit off of
the individuals it targets. Further, we can now see that the health services present in these prisons, are
inadequate in properly managing the current HIV epidemic. Based on both of these aspects put together,
we can finally see the entire picture. The terrible picture that results with people of color not only being
disproportionately targeted by the carceral system, but because they are targeted and imprisoned at much
higher rates, they are thus disproportionately subjected to the inadequacies of prison healthcare which will
only propagate the unequal affliction of the African American community with HIV.
While it is easy to get caught up in the inadequacies of the prison healthcare system, especially
since it is affecting the well-being of so many individuals, it is important to consider the opposition when
making a claim as large as this. Support for the opposing point of view are few and far between, however,
some sources do illustrate that there is in fact some advantage to the health services offered in federal
prisons. Initially offering some support is Josiah D Rich, MD and others in their 2014 study when they
state, “People of color are disproportionately represented in the correctional population… These
racial/ethnic communities also represent the individuals most in need of healthcare coverage but least
likely to have it” (Rich 2014). This goes to illustrate the idea that incarceration improves their access to
healthcare and allows for them to receive treatment that they would likely be unable to access otherwise.
There is the sense that because these individuals are already at a disadvantage outside of prison especially
in terms of their access to healthcare and HIV treatment, becoming incarcerated can actually improve
their access to the services that they need but are unable to afford otherwise. This idea is supported by a
2015 study by Sandra Springer and others, which illustrates that when applied properly, HIV treatment in
prisons is capable of significantly decreasing an individuals’ HIV viral load (Springer 2015). Taking both
of these sources into account, we can see that there is potential for an actual benefit to be seen in the
healthcare setting of federal prison. However, these ideas raise more questions than answers for me. For
example, what do the steps to proper application of HIV treatment in prisons look like? Or, why are these
people subjected to the need to become incarcerated in order to obtain access to life-saving HIV
treatment? Further, we have seen how the federal prison system is driven by racism and a desire for profit.
Sadly, the systems of racism do not stop at just the policing of individuals, it also stretches to the
healthcare aspect as well. As Leon McDougle demonstrates in their 2017 study, the African American
community, even outside of prison, is becoming infected with HIV at much higher rates than those of the
white population (McDoulge 2017). Continuing, McDougle then demonstrates how implicit bias is a large
concern in the medical field and leads to a significantly decreased quality of care of people of color that
extends into the prison systems present in the United States (McDougle 2017). Clearly, in order to reach
this level of proper application of HIV treatment in prisons as described by Springer, there is a lot of work
that needs to be done. So, while Springer and Rich offer some semblance of hope that the federal prison is
capable of adequately treating those living with HIV, there is a lot of work that needs to be done in order
to get there.
I hope that I have been able to paint a picture for those of you listening today. A picture of how
the engrained systems of racism present within U.S federal prisons has led to not only people of color
being disproportionately targeted by the carceral system, but how it has directly led to them being unfairly
affected by HIV during their time incarcerated. Further, we can now see how the health services offered
in prisons are not adequate in their ability to solve this deadly disparity. This inadequacy, will only serve
to propagate the unequal affliction of the African American community with HIV, especially as they are
forcibly subjected to these inadequacies because of the historically engrained systems that lead to more
and more people of color becoming incarcerated in their lifetimes.
 Works Cited

1. Alexander, Michelle (2020). New Jim Crow: mass incarceration in the age of colorblindness.
NEW Press.
2. Brinkley-Rubinstein, Lauren, & Turner, William L. (2013). Health Impact of Incarceration on
HIV-Positive African American Males: A Qualitative Exploration. AIDS Patient Care and
STDs, 27(8), 45-458.

3. Content Source: HIV.govDate last updated: June 30, 2020. (2020, November 5). U.S. Statistics.
https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics.
4. Federal Bureau of Prisons. BOP. https://www.bop.gov/resources/health_care_mngmt.jsp.
5. Gilmore, R. W. (1999). Globalisation and US prison growth: from military Keynesianism to post-
Keynesian militarism. Race & Class, 40(2-3), 171–188.

6. Jürgens , R., Nowak, M., & Day, M. (2011). HIV and incarceration: prisons and detention.
https://doi.org/10.1186/1758-2652-14-26
7. LeFlouria, T. L. (2016). The Gendered Anatomy of “Negro Crime.” In Chained in silence: black
women and convict labor in the New South (pp. 21–60). essay, University of North Carolina
Press.
8. McDougle, L., Davies, S.L., & Clinchot, D.M. (2017). HIV and African Americans: Relationship
to Cultural Competence, Implicit Bias, Social Determinants, and US Jails and Prisons. Spectrum:
A Journal on Black Men 5(2), 97-111.

9. Murakawa, N. (2014). Protection From Lawless Racial Violence. In The first civil right: how
liberals built prison America (pp. 1–26). essay, Oxford Univ. Press.
10. NCCHC Historical Time Line. Historical Time Line. https://www.ncchc.org/time-line.
11. Ojikutu , B. O., Srinivasan, S., Bogart, L. M., Subramanian , S. V., & . Mayer, K. H. (2018).
Mass incarceration and the impact of prison release on HIV diagnoses in the US South. Public
Library of Science.
https://doi.org/http://dx.doi.org.offcampus.lib.washington.edu/10.1371/journal.pone.0198258
12. Prisoners, HIV and AIDS. Avert. (2019, October 10). https://www.avert.org/professionals/hiv-
social-issues/key-affected-populations/prisoners.
13. Rich, J. D., DiClemente, R., Levy, J., Lyda, K., Ruiz, M. S., Rosen, D. L., Dumont, D., Centers
for AIDS Research at the Social and Behavioral Sciences Research Network, & Centers for AIDS
Research–Collaboration on HIV in Corrections Working Group (2013). Correctional facilities as
 partners in reducing HIV disparities. Journal of acquired immune deficiency syndromes
(1999), 63 Suppl 1(0 1), S49–S53. https://doi.org/10.1097/QAI.0b013e318292fe4c

14. Sufrin, C. (2017). Jailcare: finding the safety net for women behind bars. University of California
Press.
15. THE PHYSICAL AND PSYCHOLOGICAL INJURY OF PRISON RAPE. No Escape: Male Rape
in U.S. Prisons - Body And Soul: The Physical And Psychological Injury Of Prison Rape. Human
Rights Watch. https://www.hrw.org/reports/2001/prison/report6.html.
16. Springer, S. A, Pesanti, E, Hodges, J, Macura, T, Doros, G, & Altice, F. L. (2004). Effectiveness
of Antiretroviral Therapy among HIV-Infected Prisoners: Reincarceration and the Lack of
Sustained Benefit after Release to the Community. Clinical Infectious Diseases, 38(12), 1754-
1760
17. Brinkley-Rubinstein, L., & Turner, W. L. (2013). Health Impact of Incarceration on HIV-Positive
African American Males: A Qualitative Exploration. AIDS Patient Care and STDs, 27(8).