Debt To Society: The Real Price Of Prisons, Part 2 of 8

INCUBATING DISEASE

Prisons Are Rife With Infectious Illnesses -- And Threaten To Spread Them
To The Public

After the first few times he was raped, Michael Blucker got up the
courage to get an HIV test. Fortunately for the married 24-year-old,
he tested negative. But the assaults didn't stop. Locked inside Menard
Correctional Center, the maximum-security prison in Illinois where he
had been sent for car theft in 1993, Blucker says he was turned into a
sex slave, traded by gang members for cigarettes and drugs.

According to a lawsuit he filed later, he was raped by 10 men in the
showers, by his cellmate while in "protective custody," and on dozens
of other occasions.

In March 1994, he was again tested for HIV. This time, he was
positive.

Michael Blucker, sentenced to seven years, had contracted a death
sentence.

Blucker's story is unusual not because of what happened to him, but
because we know about it. Unlike most victims of prison rape, he took
the state to court, contending that prison staff helped gang members
rape him. Juries ultimately found the staff members not liable; but no
one disputes the damage done to Blucker.

Blucker is just one of many, many inmates who, through forced or
voluntary sex, intravenous drug use, or exposure to ailing fellow
cons, have contracted deadly diseases inside America's overflowing
prisons -- diseases they bring with them when they return to their
communities. Yet despite the danger to inmates and citizens alike,
little has been done to track the spread of illnesses like HIV,
hepatitis C, and tuberculosis behind bars, let alone prevent it.
Wardens discourage serious epidemiological studies, and prisoner
advocates and public health officials admit privately that they are
reluctant to press the issue, fearing that they will be denied access
to facilities if they speak out.

As a result, no one knows the exact extent of the problem; but
virtually all the evidence indicates that the US penal system has
become a prime breeding ground for some of the world's deadliest
diseases, ultimately hastening their spread beyond prison walls.

"Blucker is definitely not an anomaly," says Joanne Mariner, author of
a recent report on prison rape for Human Rights Watch, a nonprofit
research and advocacy group based in New York City. "The prison
context is very fertile ground for the spread of HIV."

That prisoners can infect the public at large is not in
question.

Russia's overcrowded prisons have bred new drug-resistant strains of
tuberculosis that have proliferated virulently among the general public.

An outbreak of meningitis in Los Angeles' city jail spread into nearby
neighborhoods in the early 1990s.

The federal Centers for Disease Control and Prevention even has an
office devoted to the issue.

Last March in Atlanta, its director, John Miles, told a hotel ballroom
full of prison doctors and nurses that nearly 600,000 inmates are
released every year -- many of them riddled with disease. According to
the most recent numbers from the Bureau of Justice Statistics, 24,000
inmates nationwide were HIV positive in 1996; a more recent study by
the nonprofit National Commission on Correctional Health Care put the
number with HIV as high as 47,000 -- 10 times the rate in the general
population. Tuberculosis, a potentially lethal lung disease that
spreads rapidly through the air in enclosed spaces, infects 1 in 4
people in some prisons, compared to fewer than 1 in 10,000 in the
general population. Hepatitis C, an often-lethal liver disease spread
by blood exchange, infects an estimated 41 percent of inmates just in
California prisons, compared to less than 2 percent of the population
at large.

What's less clear is precisely how many inmates become infected in
prison. Miles calls prisons "the nation's reservoir of disease," but
like many officials, he insists that most prisoners bring their
illnesses with them from the outside -- a side effect of the drug use
and risky sexual practices many of them indulged in before being
locked up. "Sure, sex and drug use take place behind bars," Miles
says. But the rate of new infections, he maintains, is "very, very
low."

But Miles and other health officials don't really know that for sure,
for a very simple reason: The Centers for Disease Control has failed
to conduct studies that might show how prison life spreads disease.
"The CDC does not want to know the truth," says Cal Skinner, a former
state representative in Illinois. Skinner, who describes himself as a
"right-wing conservative," was infuriated when he learned of Blucker's
case. He wanted to know if prisons are "handing down unadjudicated
death sentences" by breeding AIDS and then spreading the disease among
the citizens of his state.

Federal officials didn't answer his question -- so Skinner filed a
request for documents under the Freedom of Information Act. To his
surprise, he unearthed a 1990 study by the CDC, which had spent
$483,000 to track the rate of new infections in Illinois jails.

The study found that 3 out of every 1,000 inmates catch HIV in jail
each year -- more than 10 times the statewide rate.

The results were striking -- but never published.

Cynthia Glocker Crick, a spokesperson for the CDC, says the results
were withheld because some of the blood samples had been mislabeled,
but she affirms the basic accuracy of the study's conclusions. Skinner
questions why the agency didn't follow up on its own findings. "If it
was important enough to spend a half a million dollars on it then, and
the study was faulty, why haven't we done another one?" he asks.

A pair of earlier, smaller studies also indicated that HIV infection
rates in state prisons were much higher than in the general
population. For the most part, however, the CDC and other public
health agencies have limited themselves to tracking current levels of
disease among prisoners, while avoiding studies of new infection rates.

Nevertheless, there is little doubt that rape and other behaviors that
contribute to the spread of disease are rampant inside America's
correctional facilities. A 1982 study of a medium-security prison in
California found that 14 percent of inmates had been forced into oral
or anal sex. In a 1988 survey, 87 percent of Texas prison officers
claimed that rape was a common occurrence. In 1996, Cindy
Struckman-Johnson of the University of South Dakota published a survey
of the Nebraska prison system showing that almost 1 in 4 inmates had
been "pressured or forced to have sexual contact against [their]
will." In a follow-up study of seven prisons in the Midwest last year,
Struckman-Johnson found that 1 in 10 prisoners had been forcibly raped
- -- some only once, others gang-raped repeatedly. Combining such
studies with hundreds of testimonials from inmate rape victims, a
California-based advocacy group called Stop Prison Rape estimates that
as many as 364,000 prisoners are raped every year. Struckman-Johnson
calls the estimate "within the realm of possibility."

Officials have done even less to track needle sharing.

A rare study of Tennessee prisons found that 28 percent of inmates
reported shooting up behind bars. Many former inmates say such figures
confirm their own experiences. Ruben Rodriguez, coordinator of an AIDS
hotline for inmates in New York, says he and many other men shared
needles while he was incarcerated during the 1980s. Today, he has both
HIV and hepatitis C.

Tuberculosis has received more attention, perhaps because it has on
occasion so clearly spread from prisons to the general public.

In the early 1990s, a deadly strain of TB swept through the state
prison system in New York. Thirty-nine prisoners caught the disease,
as did two corrections officers. One of them passed it on to his son;
they survived, but the other officer died of the disease.

Thirty-five prisoners also perished.

The outbreak went on to infect more than 1,000 civilians.

In 1999, a South Carolina inmate confined to a special housing unit
for prisoners with HIV started coughing incessantly. No one recognized
the problem as TB, and the disease spread easily among the roomful of
inmates with weakened immune systems. Within months, 31 prisoners and
a medical student had caught it. And in Russia, 30,000 inmates leave
prison each year with TB -- a major reason why the disease's infection
rates have tripled in the general population there in the last 10 years.

Because TB spreads quickly, simply through shared air, many prison
systems have implemented full-scale testing programs over the last
decade.

But most states do not test for AIDS, and almost none test for
hepatitis C. Few ex-cons get themselves tested after their release; in
fact, the Osborne Association, a prisoner-support organization that
sponsors the hotline where Rodriquez works, reports a drastic downturn
in inmate requests for HIV testing in the last five years.

All of which means that countless prisoners return to the streets not
knowing whether the needle sharing and sex they experienced on the
inside has left them with a deadly disease -- which they can in turn
pass on by sex and needle sharing.

Public health officials have a great incentive to focus on prisons,
but corrections departments run their own hospitals and tend to resist
efforts by outside officials to get involved -- especially those who
suggest that sex and drug use are common in their facilities. To
maintain their access to prisons, public health doctors must keep the
goodwill of corrections officials, making them reluctant to press for
controversial measures like distributing condoms and clean needles to
inmates.

Only a handful of states and cities currently allow prisoners access
to condoms.

None allows needle exchange.

Without more prevention, it is clear that the cost of treatment will
continue to mount.

State and federal prisons already spend nearly $5 billion each year to
care for sick inmates, and public health agencies spend billions more
to treat ailing prisoners after they are released.

But there is simply no way to tally the bill for second-wave
infections -- all the partners, children, and friends infected by
ex-convicts who contracted a disease while they were locked up.

"People don't want to believe it because they're scared of the
knowledge," Blucker said during his court case. "Because if they
believe this, maybe they would have to do something about it."

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