There has been a lot of good news lately in the battle against AIDS.
The United Nations declared that the number of new HIV cases worldwide has dropped by a fifth over the past decade. A new pill has been shown to slash new infections without requiring patients to take many different pills many times a day. And the pope, shifting away from decades of harmful theology, said he could approve condom use in HIV-positive men as an act of responsible sexuality.
There is, however, a deeply troubling lag in AIDS policy in the U.S. and around the globe that might well undercut all this good news. AIDS is still rampant in prisons.
Prisons are disease incubators. They are dirty and overcrowded, hygiene is poor, drugs make their way in and risky sexual contact is common. Untreated and left to spread, HIV — along with tuberculosis and other nasty infections — mutate into forms that our current drugs may not treat.
With more than 2 million Americans incarcerated, the U.S. has one of the largest prison populations in the world.
And nearly 2 percent of those in jail or prisons are HIV positive.
This is a much higher rate than in the general population, where about 1 million Americans — or about .3 percent — are estimated to have the virus.
In any given year, about 20 percent of those with HIV pass through our correctional system.
Some other countries are even worse. The World Health Organization puts HIV rates among prisoners in Argentina and Brazil at over 4 percent with some prisons running close to 20. Russia, the Ukraine and Estonia have upwards of 5 percent of their inmates infected. And in some African countries, 40 percent of those in jail are HIV-positive.
So why should you care about convicts with AIDS?
Because prisons are perfect breeding grounds for new and deadlier strains of HIV. And you don't want a nastier form of AIDS let out on parole.
Prison health care in the U.S. is lousy. And HIV treatment is no exception. Consider this recent example: The prison system in Massachusetts has decided not to let inmates with HIV keep their medicine in their cells. They must now go down to the infirmary several times a day. At the infirmary, they stand in line near other prisoners who are sick thereby making it likely that, due to their weakened immune systems, they will get sick, while they get hazed for having AIDS. A lawsuit filed last week contends that the move to require treatment at the infirmary is driven by a desire to cut costs not concern for the prisoners.
Too many Americans who are barely getting by or even swamped with medical bills think that putting the screws on prisoners with HIV is just fine. Spending money in a miserable economy to make sure rapists, robbers, murderers, molesters, and con men get medical care is not a top priority for voters or politicians. But that is incredibly short-sighted.
The best chance to do something about AIDS in prisoners is when they are incarcerated. We can make sure they get tested for HIV, take their medicine, learn about safe sexual practices, have access to condoms and learn about the risks of dirty needles they too often use in shooting-up or in getting tattoos.
In the U.S. and in a lot of other countries around the world, prison is the only place inmates have any chance at contact with a nurse, public health official or AIDS counselor. Making sure they leave prison screened and getting treatment, whether it is in Rhode Island or Romania, is the best way to keep the rest of us healthy.
You don’t have to give a damn about prisoners to make sure that money is spent to diagnose and effectively treat their HIV. You just have to care about yourself, your family and the potential for future epidemics down the road.
Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania.