Stop Making Matters Worse:  How Criminalization Perpetuates HIV Transmission

Over the last 40 years, largely as a result of the war on drugs, our nation has increased its prison population nearly 400% and a disproportionate number of those incarcerated are black men.  Today, approximately 2.3 million children have an incarcerated parent and 500,000 black fathers are incarcerated. Over-incarceration in the United States plays a significant role in eroding the black family structure and communities are paying the price. What has not been highlighted as much however is that over-incarceration perpetuates HIV transmission in poor communities of color- a lesson I learned many years ago.

I first realized how society’s response to drugs can perpetuate HIV while working as a public health researcher. I managed an ethnographic research project that studied how HIV was being transmitted in places where homeless drug users used drugs. I read those interviews and felt great concern. I learned how some shared dirty needles, had unprotected sex and participated in other activities that increased their chances of getting HIV.  I also learned about the role addiction plays in increasing exposure to HIV and that drug abuse treatment is an ally of HIV prevention.

Coincidentally, I learned how criminalizing drug users perpetuate HIV in the lives of drug users in our community.

Some interviewees talked about being incarcerated for drug use but having just as many drugs available to them in prison as they had on the streets. The issue with being an addict in prison is that some had to do favors to feed their addiction, putting many in compromising positions. Unfortunately, we do not know how many people catch HIV in prison each year because state prisons refuse to test for HIV before a person goes into a prison and again, after they leave for fear of litigation.

I also learned that law enforcement under serves our community when it comes to responding to drug addicts or people that are at risk of getting HIV. Many interviewees spoke about regular encounters with police but that rarely did an engagement result in treatment or social services. Law enforcement is often clear that they are not social workers, therefore treatment for the addicted, a way out for low level drug dealers, education opportunities for the smart kid that took the wrong path or job for those that truly want a way out are rarely considered. By using the one one-sized fits all strategy of incarceration, those that need us the most are neglected and warehoused. As a result, opportunities to help are often missed for the sake of tough on crime, lock’em up practices.

Another way criminalization perpetuates HIV is in the rash of laws passed by state legislatures that seek to incarcerate people for transmitting HIV. Although the intent to stop HIV transmission is admirable, the continued use of incarceration to do so is yet again, making matters worse not better.  In fact, they undermine prevention efforts by discouraging HIV testing. If knowledge of HIV status could open a person up for liability for exposing someone else to HIV, then that disincentives people from getting tested in the first place.  The result of such laws have resulted in dehumanizing, demonizing and incarcerating people that live with HIV, thus making the process of HIV testing less appealing. Unfortunately, efforts that claim to reduce HIV now play a role in reducing HIV testing. 

Take a minute to examine how you engage drug users or people at high risk of getting HIV in your community. Are you criminalizing and judging them, or are you extending a helping hand? We must advocate for less criminalization and more treatment services, social services, jobs and HIV care for those living with HIV. 

Criminalizing is not the answer for addiction and HIV prevention, a helping hand is.