HIV Rates Higher Around TDCJ Prisons
By Stephen Green
Areas surrounding Texas Department of Criminal Justice prison facilities have higher HIV rates than those that do not, according to a study released last spring.
Walker County was among those listed with high HIV rates in a study published in “The Professional Geographer” academic journal in May 2013. The study titled “Vulnerable places: prison locations, socioeconomic status, and HIV infection in Texas” found that in ZIP codes with TDCJ prisons, HIV rates were significantly higher than those farther from the prisons.
“This is an important finding and suggests that prison facility locations might be considered a risk marker for places that are vulnerable to HIV infection and spread,” the study reads. “Prioritizing them for HIV surveillance and intervention will reduce the rate of new infections and help to accomplish the goals of (the National HIV/AIDS Strategy).”
The area in and around Walker County has the highest number of prison facilities in the state — a total of seven and also elevated HIV rates — according to the Texas Department of State Health Services.
The TDSHS report from 2012 lists the HIV rate (cumulative number of people diagnosed) in Walker County as 150 per 100,000. The national rate sits at about 16 while the rate in Texas is slightly higher at 16.4, they say using data from the U.S. Census.
“The results ... indicate that areas in close proximity to TDCJ units have lower socioeconomic status and rates of HIV,” the study reads. “With increasing distance from TDCJ prison units, the HIV infection rate of the general public decreases.”
Huntsville was also listed in the top 25 cities (tied for 20th highest) in Texas in HIV infection and AIDS diagnoses, according to the TDSHS.
The researchers explain in the article that there isn’t a definite cause for this finding — likening it to a chicken-and-egg scenario.
“Do TDCJ facilities create high HIV rates by releasing prisoners (known to have high HIV rates) into the community or do TDCJ facilities locate in areas with high HIV rates?” the researchers ask. “There might not be an answer to this question.”
In other words, the study merely presents a correlation between HIV rates in communities near TDCJ prisons. However, they lean more likely to the latter.
Jason Clark, director of TDCJ public information, said it is not likely that TDCJ is causing high HIV rates, especially in Walker County, due to prisoner release because of state law.
“The vast majority of offenders released from the Huntsville Unit do not stay in Walker County,” he said. “Texas law requires that offenders return to their legal county of residence. Offenders are either picked up by family members or are issued a bus ticket to their legal county of residence and leave Walker County the same day they’re released.”
The researchers addressed that concern in the study but because of a lack of information, they did not know where released prisoners returned. This made it difficult to determine whether prisoners were from areas with TDCJ prisons or in other counties without.
Where prisons are built could be one explanation. Originally state prisons were built on farms in rural areas, they say, like Brazoria, Fort Bend, Polk and Walker counties where 19 of the 117 prison units alone are located. These areas were comparably impoverished.
“In the 1980s, when Texas began to establish prison facilities outside of the cotton belt, impoverished communities saw the prisons as a boon as they provided jobs,” the study read. “The prospect of a prison siting led financially strapped communities to engage in bidding wars, offering economic incentives including tax breaks, infrastructure subsidies such as roads and sewers, and free land.”
The communities that host TDCJ facilities also include high density counties with cities like Houston, Dallas and Beaumont. According to the Center for Disease Control, both high density and rural areas have characteristics that HIV researchers label with high risk of HIV spread: high populations of gay and bisexual men, low-income families, intravenous drug users, blacks, and Latinos.
Both TDCJ and state HIV totals have risen in the last 15 years. In 1996, TDCJ accounted for 1,377 inmates that were positive for the disease. In 2009, (the most recent data on TDCJ’s website) 2,453 inmates were positive for the virus.
“When an offender is newly identified as having HIV infection, the patient receives an extensive evaluation to assess the severity of the infection,” Clark said. “This evaluation includes baseline lab testing, a complete medical and sexual history, physical examination and referrals for counseling and support (i.e., mental health, chaplaincy, nutritional, etc.) as indicated. In addition, all HIV infected offenders are enrolled in Chronic Care Clinic and seen by a provider at a minimum of every six months.”
During visits to the clinic the patient’s labs and symptoms are evaluated to determine the need to initiate or change antiretroviral — the main combatant of the HIV and AIDS virus — therapies and, in the case of a patient with the diagnosis of AIDS, the need for prophylactic therapy to prevent opportunistic infection.
Moreover, inmates are tested prior to discharge to help set up HIV care while the inmate is transitioning from correctional care to the general public.
“The (discharge planning) team provides the patient with follow-up medical appointments, enough medications to prevent interruption of treatment, information about prescription drug programs and referrals to community based organizations to assist with housing, job placement, transportation, etc.,” Clark said.
To help combat the spread of the virus inside prison walls, Clark said TDCJ allows inmates to request tests if they feel in danger of contracting the virus and worked to set up a program to educate inmates.
“TDCJ, in cooperation with the Texas Department of State Health Services and partnership with AIDS foundation Houston, AIDS Arms of Dallas, and other community based organizations, has implemented an offender peer education program called Wall Talk to teach offenders about prevention of HIV and other communicable diseases,” he said. “This program is currently available on 100 units and most offenders participate in this program upon entering TDCJ.”
The research team suggests future research target HIV service provider distribution and HIV rates. The team was made up of two University of North Texas professors, Dr. Joseph R. Oppong and Chetan Tiwari; Libbey Kutch, a doctoral student at Michigan State University and Sam Houston State University alumnus; and Sonia Arbona, a medical geographer and epidemiologist for TDSHS who studies spatial analysis of HIV and STD rates.
- Read more at: www.itemonline.com
HIV and Condoms in Texas Prisons
By Craig Malisow
When asked how many times he stabbed the old man, Daniel Harris says, "Once. To start with."
Fourteen years ago, Harris had a girlfriend who had an uncle, and she wanted the uncle dead. So, Harris says, he and the girlfriend went to the 78-year-old' s Virginia home, where Harris stabbed him 37 times.
He took a .22 from the man's pocket, a .357 from his chair, and a . 45, .38 and Glock stashed around the house. They spent the next few months driving from state to state, buying and selling antiques for cash.
Then came Dallas.
An antiques dealer there thought they were acting funny, so the dealer called the cops. When the cops arrived, Harris and his girl hauled ass. A 60-mile chase followed, with the girlfriend flooring it and Harris shooting like a lunatic out the window. He hit about a dozen vehicles, including a cop car, but no one was killed. Harris got a bullet in the wrist and 35 years.
Harris says that sentence was shifted to life, when he contracted HIV in prison.
Speaking from behind glass in a closet-sized visiting booth in the Ellis Unit, Harris is nonchalant about his illness. He says his HIV meds are working; for the past five years, he's had a normal CD-4 count.
Harris, who considers himself bisexual, is convinced he was infected in prison. In 1994, Harris says, he got into a disagreement with an Aryan Nation leader out to recruit him. Harris didn't want to be a part of the gang. At six feet, 200 pounds, Harris can handle a disagreement. Afterward, the bloody pulps wound up in the hospital, where routine tests showed Harris was HIV-negative.
He says that, in 2000, after another of many skirmishes, he was diagnosed with HIV. Was it the consensual sex, the coerced sex or one of the bloody fights? Harris doesn't know. But he got it from someone and, by his count, gave it to ten other someones.
"The numbers are a lot higher than they're telling you," Harris says in a warm, soft Alabama drawl. "They're not testing, and if you don't ask to be tested, you don't get tested. So you've got a lot of people that have this and they don't know. They don't want to know." As for the ones who do know, there are 2,676 of them out of a total Texas prison population of 152,158. Nationally, the prevalence of HIV among prisoners is five times that of the general public.
As of August, 808 HIV-positive offenders were released from Texas prisons. Forty percent of all HIV-positive offenders released this year will wind up in Houston. Hopefully, they'll practice safe sex in the outside world. Behind bars, they aren't allowed to have sex, but they do. And, for the most part, it isn't safe.
What makes it even riskier, condoms aren't allowed in Texas prisons. Nothing out of the ordinary there; most prisons around the country don't allow rubbers. Even if they would protect against all manner of infection and death. Even if they cost mere pennies apiece. In Texas, a pioneering peer-education class called Wall Talk tells incoming inmates about HIV prevention.
The program, designed in part by AIDS Foundation Houston, aims to tell prisoners how to protect themselves on both the inside and outside. There is, for example, a demonstration of how to put on a condom. But the models for this procedure are a tube sock and an arm. The presence of condoms, Texas Department of Criminal Justice officials explain, would violate the department's zero-tolerance stance on sex behind bars.
This policy won them an award from ACT UP Austin, an advocacy group that wants TDCJ to make condoms available. In August, members of the group showed up outside the department's administrative offices in Huntsville with a three-foot World Cup-type trophy acknowledging the department's "Commitment to Ensuring the Spread of HIV."
"They never actually came down to accept the award, so we'll have to find a way to get it to them later," says ACT UP member Heather Mitchell from Austin.
For Mitchell, it's a no-brainer: "Prisoners are engaging in sex and condoms are a proven HIV-prevention tool, so it just makes sense that providing condoms is going to decrease the number of infections. And from a public health standpoint, anything that decreases HIV infection is a good idea."
Mitchell points out that condoms would be a cheap way of combating the spread of HIV. Her group cites a 2001 report from the state comptroller' s office that states that "drug therapy for the 2,500 Texas prisoners who are HIV-positive costs the state about $1 million a month -- about 40 percent of TDCJ's total medical cost -- and that does not include hospital or practitioner fees."
According to a 2003 report from the state Senate Finance Subcommittee, an "alteration in drug therapies" contributed to skyrocketing costs. In 1996, the year before the change in therapies, it cost TDCJ $1.23 million to treat 1,876 prisoners. In 1998, the number of HIV-positive prisoners increased by about 500, but the overall cost jumped to $7.54 million. In the last seven years, the yearly cost has not dipped below $12 million.
Meanwhile, ACT UP estimates that it would cost TDCJ less than $300,000 a year to make condoms available. But, the group says, it's likely that "federal, state and local HIV prevention streams" would cover much of the cost. (The numbers are based on a bill pending before the California governor that would allow condoms in the state's prisons. At a wholesale cost of 15 cents per condom, ACT UP's figure allows for 2 million condoms a year.)
Outside the United States, condom distribution has been a mainstay in many European prisons. In Canada, some provincial systems provide bleach (for sanitizing needles) in addition to condoms.
But the prison system of only one American state, Vermont, makes condoms available for nonconjugal visits. However, county jails in New York, Los Angeles, Philadelphia and Washington, D.C. have provided condoms for years, while maintaining a no-sex policy.
"It was considered a public health issue," says Bob Eskind, spokesman for Philadelphia' s county jail system. Eskind says condoms have been available in the county's jails since 1988. "[Our] inmates should have access to the same level of protection as...citizens on the street."
Beverly Young of the D.C. Department of Corrections had a similar explanation. In an e-mail to the Houston Press, Young wrote: "While sexual activity among inmates is strictly prohibited.. .the prison HIV/AIDS issue may present [greater consequences] than the consequences resulting from the infraction inmates commit as a result of sexual behavior."
And while many in the medical community have backed condom distribution for years, politicians have largely avoided the subject.
So far, Senator Rodney Ellis says he has avoided the subject for strategic reasons.
Last year, the Houston Democrat successfully pushed legislation for Texas prisoners to be tested for HIV before they are released. (While there is no mandatory HIV testing upon entry, TDCJ officials say about 80 percent agree to be tested.)
Ellis says he considered adding condom distribution to his proposal. "But I was afraid it would kill the bill," he says from his Houston office. He's clear in saying he doesn't want TDCJ to encourage or condone sex among inmates. "But I think that, in the year of our Lord 2006, they ought to be willing to accept reality."
Department spokeswoman Michelle Lyons says TDCJ is not ignoring the issue, but is addressing HIV in ways that don't violate the no-sex policy, chiefly via the Wall Talk program. She also cites concerns shared by other prison authorities: Condoms can be used to smuggle contraband like drugs, and can also be used in the popular prisoner pastime of "chunking" -- throwing urine and feces on guards.
But for Kelly McCann, head of AIDS Foundation Houston, the public health threat is just too great.
"We have to acknowledge that it is not a good public health practice to prohibit condoms and bleach," she says. "Now, on the other hand, we have to realize that the prison system is not in the business of public health as much as they are in the business of security...But I have to say, with this particular disease, if we're ever going to make a dent in it -- whether we're talking free world or prison -- we've got to address safer sex."
If Daniel Harris did indeed contract HIV in prison, he's the exception to the rule.
There are probably harder things to measure than the transmission of HIV behind bars, like, say, proving the existence of God.
For all the years that researchers have studied HIV-positive prisoners, the research is largely considered to be flawed, outdated or both.
But a Centers for Disease Control and Prevention study released in April has come the closest to achieving consensus in the field. The study, which tracked HIV transmission among male prisoners in the Georgia prison system from 1992 to 2005, concluded that 91 percent of the inmates studied had HIV before they went to prison.
The HIV-positive inmates were 13 times as likely to have been tattooed in prison and ten times as likely to have had sex with another inmate.
Other findings included:
¥ 72 percent of prisoners reporting sexual encounters said the sex was consensual
¥ 30 percent of those inmates reported using makeshift condoms (rubber gloves or plastic wrap)
The study also looked for characteristics associated with HIV- positive inmates, as follows: inmates who engaged in homosexual activity; inmates who were tattooed in prison; a body-mass index of 25.4 or lower; and black inmates.
The CDC recommended implementing an educational program but stopped short of endorsing condom distribution.
"Providing condoms to sexually active persons is an integral part of HIV prevention.. .outside prisons," the study stated. "A recent survey in [a Washington, D.C. jail] reported that condom distribution was acceptable to most inmates and correctional officers...Departments of corrections without condom distribution programs should assess relevant state laws, policies and circumstances to determine the feasibility and benefits and risks of implementing such programs."
Regardless of how many offenders contract HIV while in prison, researcher Theodore Hammett says prisons need to provide all preventive measures possible.
As part of Abt Associates, a Massachusetts- based consulting firm, Hammett has conducted HIV research for the National Institute of Justice and the CDC. In 1997, he was part of a panel commissioned to review TDCJ's HIV policies and recommend improvements.
"Certainly there is nonconsensual sex going on in prison," Hammett says from Cambridge, "but there's also a lot of consensual sex that goes on in prison. And in those instances, [inmates] may well be more likely to use a condom."
Hammett says political pressure is one of the main obstacles. Prison officials don't want anyone thinking they can't enforce a zero- tolerance policy; distributing condoms would admit defeat.
But with such a disproportionate number of HIV-positive people passing through prison, Hammett says, "these are natural and really critical places to have the best interventions you can possibly have. That's it in a nutshell, I think."
Kelly McCann of AIDS Foundation Houston agrees with Hammett that wardens are nervous about the condom issue.
"It's still such a conservative atmosphere and homosexuality still has such a stigma attached to it," she says. "I think wardens privately will acknowledge that sex is going on...But publicly, I think they hesitate to talk about it because, as one warden said to me, 'If we admit that sex is going on, then we're admitting failure in our security role.'"
But McCann is proud of the Wall Talk program, as well as the foundation's ability to link released HIV-positive offenders with medical programs in their hometowns.
Hammett also has given Wall Talk good marks; in 2004, he was part of a team that evaluated it for the Journal of Correctional Health Care.
"All of the wardens indicated a desire to continue the program due to the positive changes observed in both peer educators and the general prison population," the evaluation states. "Some examples of the changes were less violent behavior, increased awareness of HIV risks, and greater concern and less fear demonstrated toward those with HIV."
Also, "one of the most important reported benefits of the program was the diffusion of HIV-related knowledge to those outside the prison. Not only did offenders share information among themselves, but they also wrote to family members...about HIV prevention."
So far, Wall Talk looks like a success. This year, TDCJ and AIDS Foundation Houston launched another program -- one that doesn't target HIV directly but aims to change entire aspects of prison culture.
To be aware is to be alive.
It's written in marker on white butcher paper taped to a chalkboard here in this prison classroom. The paper matches the rumpled white two-piece outfits worn by the 30 or so new guests of the Texas Department of Criminal Justice. Most are sitting in one-piece chair- desktop combos, listening to a stout bald man with a mustache talk about prison rape.
It's a little before 7 p.m. in TDCJ's Holliday Unit in Huntsville, where incoming inmates take part in TDCJ's brand-new Safe Prisons Program. It's a typical classroom: tiled floor, colorful educational posters tacked to clean white walls. The man with the mustache, wearing a blue TDCJ polo shirt with jeans, is Holliday's safety officer. He asked that his name not be used.
In a heavy twang, he asks how many in the room are first-timers. About seven raise their hands. These are the New Boots, the ones who are going to have to learn that things in state are different than in county. They will learn that prison doesn't have to be about getting sold or getting punked, if you retrain your brain.
Launched in 2006, Safe Prisons is another program pioneered by TDCJ and AIDS Foundation Houston. It was designed in response to the 2003 Prison Rape Elimination Act and, like Wall Talk, allows incoming prisoners to learn from long-timers.
Before the safety officer hands it over to these long-timers, he's got a few things to say by way of introduction.
"When you come to prison, you got this preconceived notion that" -- and here he rips into auctioneer speed -- "I-don't-know- nothin'- don' t-hear-nothin' -don't-see- nothin'-it- ain't-my- business- I- ain't-gettin' - involved-in- it, right? Well... that's a good concept -- if you're trying to stay in prison or you want to spend the rest of your life in prison."
He continues: "You've got an opportunity right now to do something that's going to help the people that's going to be in prison tomorrow and the next day and the next day and the next day, 20 years from now."
And then he tells a story. It's about a mountain of an inmate; six foot five, 295. Had to walk through the crash gate sideways.
"I sat out there on the rec yard, watched this man push 500 pounds off his chest," he says. "How many of y'all think you can deal with that guy?"
Above the chattering and laughter, a lean black New Boot in the back corner says, "Give me something to stick him with, I'll try."
"You're absolutely right," the safety officer says. "But if you're of the male species, you already have something to stick him with, because that's exactly what he wants."
Laughter, clapping, groans.
"Look here," he continues. "If you didn't have sex with him and him be the...passive partner and you take charge, that dude would beat you within an inch of your life."
Now he flips the script on New Boots. Now the mountain wants you to be the woman. Are you still going to stick him and buy yourself some more years?
"I ain't just gonna lay down and let him have me," New Boots says, his voice getting louder, defensive, like he's being pushed further back into his corner. "I'm a man. Ain't no man gonna lay down."
That's when a tall, bald black inmate standing beside him steps forward and says in a quiet but authoritative voice, "Brother, you'd be surprised how many would lay down."
The tall guy is a peer educator; a long-timer thought of as a leader by other inmates. He's one of several in the classroom, patiently waiting to share their stories. Well, most are patient. An educator on the opposite side of the room proceeds to tell New Boots just how wrong he is.
"See how you interjecting on everything?" the educator says. "Dude, you asking for them to come to you! You asking for this man to try you...Everybody lookin' for a challenge, baby. You throwin' down a sign!" He points to his own eyes. "As you speak, you speak with your eyes...You're saying, 'This is my conviction,' but I'm readin' your eyes!"
New Boots counters: "Are you going to lay down?"
The educator is practically hopping. "Do you see? Do you see it?...You're throwing a flag up! If I was to pick anybody in this room right now to fuck with, it would be you. 'Cause I hear you. And I'm not even lookin' at you, man...You're tellin' everything about you just by your eyes. Your words don't move me, man...it's your eyes, little brother!"
Here's what they want New Boots to learn: that just because you're not a victim today doesn't mean you won't be a victim tomorrow; that you can't just look the other way when a man's being hurt; that the rate of HIV among male Texas prisoners is five times that of free men; that no sex of any kind will be tolerated, because if you didn't come in with HIV, you sure as hell don't want to leave with it.
Daniel Harris doesn't think he'll be leaving prison, but he may have infected some who will be leaving, or already have left.
Even if he does make it out of TDCJ, he's facing a murder rap in Virginia. So he uses his time to write, to try to educate people he believes need educating.
In 2004, he won an honorable mention from the PEN American Center, a prestigious literary foundation, for an essay titled "Prison Sexuality."
"When you have people who are never getting out of prison, they may turn to homosexuality when their need for affection becomes too strong to be denied," Harris wrote. "All humanity needs someone to love and care for...Relationships of this type are long-lasting and, when one is released, can transcend prison walls."
Yet, he adds, "In the close confines of prison, it is criminal negligence on the part of Texas officials not to recognize the need and implement plans for the containment of STD's." He concludes the essay with a list of suggestions, including HIV testing of all inmates upon entry, condom distribution and conjugal visits.
Harris says he's had to choose his battles.
"The only kind of rapes that have ever happened to me are coercion," he says. "More just a choice of tired of fighting. Sometimes you just get tired and it's like, well, might as well, who cares. Doesn't matter. You just get wore down by the whole situation after a while."
He says that most of these oppressors were satisfied after one encounter. If they weren't, Harris had to draw a line. He doesn't want to be anybody's property, and for that he's been called a punk, a "renegade ho."
"I refuse to be a punk," he says. "And you wouldn't believe the fights I've had behind that refusal."
But the fights can erupt over anything, even a Scrabble game. In another essay, Harris describes a guy named D-Town who liked to mess with him when he was laying his letters on the board. Six years ago, when Harris was newly diagnosed and just waiting to die, he decided to teach D-Town a lesson.
"If you keep interfering in my games, I'm going to call you to the shower for disrespecting me," Harris told D-Town. "It'd be stupid to fight over a kids' game."
Ever eloquent, D-Town responded: "Let's go. You ain't said shit."
The essay has them landing in a shower stall out of the guards' sight. D-Town was 15 years younger. But Harris figured he had a weapon more powerful than any shiv.
"My viral load was 100,000," he wrote. "A potent brew."
Then: "On the floor, I got him in a headlock and beat on his face. He tried to claw my eyes to get free and I bit off his finger. He didn't want to fight when the blood started to spurt."
Later on, Harris claims to have gnawed off a guard's ear in a fight. So much blood sloshing around.
"Was he infected? Maybe," Harris wrote.
Back then, his fatalistic attitude really showed. Years of being called punk and wrapping your penis in a bread bag can do that to a man. Rape, lovemaking, sex for trade; it's all there, behind the bars. It can make a man just give up.
"No doubt I gave HIV to someone, but someone gave it to me," he wrote. "Who gave who what first wasn't worth discussing. We all had it."
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