Death sentence

Widespread HIV infection means that sex in prison can be fatal -- not just for inmates, but for their future partners on the outside. Condoms could save lives, but state prison officials won't allow them.

by Sarah McNaught

"I don't care how cool you think you are, how dangerous your crime may have been, or what bad-ass reputation you have in your neighborhood. In jail, guys are going to have sex with you or you're going to have sex with them."

"John" knows. He served six years at MCI-Cedar Junction for assault and battery; he beat a man so badly that when passersby found the victim lying in a gutter outside an empty warehouse, he wasn't breathing. John, a Dorchester resident who is now a bricklayer, will not say whether he was sexually active in jail, but he attests to seeing people involved in some kind of sexual activity nearly every day.

If what John saw reflects widespread prison reality -- and many public-health experts believe that it does -- then inmates are endangering their lives and the lives of their partners. The rate of AIDS in prison is six times the rate seen in the general population, according to the US Department of Justice. The 1998 annual report of the Department of Corrections states that 5.5 percent of the nearly 11,400 men incarcerated in DOC-run facilities are known to be HIV-positive when they enter prison, and -- as in the case of incarcerated women -- the real number may be much higher (see "Hard Time," News and Features, July 2). And prisoners in Massachusetts are not allowed access to condoms.

Corrections officials say they have good reasons for denying condoms to inmates. Condoms can be used to smuggle drugs or money, officials argue, and they can even be used to strangle someone. Besides, the prison establishment insists that there's no need for safe-sex measures in jail. The number of AIDS-related deaths in prison has declined in recent years -- and, as DOC spokesman Anthony Carnevale puts it, "They aren't having sex anyway. It's against regulations."

Yet health-care providers and civil libertarians say that although fewer inmates are dying of AIDS in jail, they are contracting the disease there and bringing it back to the streets with them when they're released. (Besides, critics counter, there's little point worrying about prisoners' using condoms as weapons when so many other potentially lethal items are available: just last week, the superintendent of the Baranowski Correctional Facility in Shirley was stabbed by an inmate, apparently with a shank, or homemade knife.) Given these realities, advocates argue, condoms save lives. "This is a public-health crisis," says Jackie Walker, the AIDS information coordinator at the American Civil Liberties Union's National Prison Project. "And it's ludicrous for prison officials to pretend that sex is not happening."

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Outside the US, some governments permit prisoners to use condoms. Canada allows condoms in most of its prisons, and a British judge ruled Monday that gay prisoners who would otherwise have unsafe sex should be offered protection. But there is no national movement toward widespread condom distribution among inmates in this country, although prison systems in Mississippi, Vermont, New York City, Philadelphia, San Francisco, and Washington, DC, do give prisoners access to condoms to help prevent the spread of AIDS.

Forty percent of male Massachusetts prison inmates who have AIDS were exposed to the disease through sex with other men, according to the Massachusetts Department of Public Health's April 1999 AIDS Surveillance Summary. Figures like that help illustrate why, in December 1996, state public-health specialists urged prison officials to permit condom distribution. But the notion was shot down by the DOC and has not been raised since. Prison officials insisted that allowing condoms would mean condoning an activity that is prohibited to begin with.

But in showers, in locked cells after lights out, during kitchen duty, and even in the common areas of prisons, inmates are having sex, both consensual and coerced. And even those prisoners who force sex on others may worry about contracting a deadly disease in the process. Dr. Anne De Groot, head of the TB/HIV research laboratory at Brown University School of Medicine's International Health Institute, says she has heard of inmates' using rubber gloves, plastic wrap, and other makeshift forms of protection. "Inmates want condoms so much that there is a black market for them," says the ACLU's Walker. "Sometimes they go for as much as $10 apiece in a system where money can better be spent on things like food, toiletries, and such."

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"I need money," says "Tim," who's serving a short sentence for cocaine possession at the Dedham House of Corrections. He was nabbed by undercover officers coming out of a known drug house on Talbot Avenue, in the Ashmont area of Dorchester. "Even the fuckin' rubbers are going for $7 in this place. I can't even afford a candy bar or a pack of smokes."

Tim says he isn't having sex and hasn't seen it taking place, but he knows it's going on: "Why are they buying rubbers if they aren't having sex?" When he arrived in prison, Tim adds, his first goal was to prove that he wouldn't be victimized. "You know, hit the biggest guy and then no one fucks with you." But now, he says, he's worried that he could be forced to have sex -- and that if he does, he'll have no chance of protecting himself from disease. "They're nuts," he says of some of his fellow prisoners. "They throw their shit at the guards and they cut themselves to flick their blood at their enemies. It's fuckin' scary."

What's really scary, Tim says, is that he just doesn't know anything about the health status of his fellow inmates -- and, quite possibly, neither do they. Massachusetts prisons are allowed to require testing only for tuberculosis and syphilis -- not for HIV.

Massachusetts prisons do offer voluntary HIV testing, but many inmates don't want to be tested for fear of others' learning the results. "We also conduct blind testing on inmates coming into the system," says Carnevale, referring to a system in which samples of bodily fluids retained for syphilis and tuberculosis screening are tested for HIV on a random, anonymous basis. Those results, according to Carnevale, show that the HIV infection rate is declining: "There is no epidemic here," he says. But blind testing may undercount the number of prisoners with HIV, and it does not allow prison or health officials to identify, treat, and monitor the behavior of those who are infected.

To some public-health advocates, including Anne De Groot, mandatory testing could play a crucial role in protecting HIV-positive inmates and those around them. In Rhode Island, mandatory testing has been used for several years. Not only has it given researchers solid disease statistics to gauge the rate and spread of AIDS, but it also enables prison health officials to treat those who might otherwise spend their prison time unaware of any health problems.

The Department of Public Health, however, argues that mandatory testing violates the privacy of inmates. "Mandatory testing sends the wrong message," explains Tim Gagnon, head of the DPH's AIDS Bureau. "If the first step of treatment is strapping a person down and forcing them to participate in a test they don't want, they may refuse treatment.

"We do offer voluntary testing, and we believe that many of the inmates know what their HIV status is," says Gagnon. "The reason we can mandate testing for the other diseases is because they are curable. AIDS isn't."

Which is precisely why inmates must be tested, says Michael Dallaire, who was a nurse in Massachusetts prisons for more than 11 years before leaving the system in 1995 to start his own health-care organization. Of the no-condom policy, "it's like the argument against distributing condoms in high school," he says. "If you distribute condoms, you are condoning the activity -- something the prison system simply can't admit to."

Yet by refusing to admit that condoms are necessary, the Massachusetts prison system may be condemning many of its prisoners to a fate as deadly as lethal injection or the electric chair.

"It's sick," says John, the former Cedar Junction inmate. "If someone gave me a choice, I'd feel safer protecting myself against some psycho in prison with a shank than I would against an inmate with AIDS. At least I can see the shank coming."

Sarah McNaught can be reached at smcnaught[a]phx.com.