Mass Incarceration and HIV/AIDS Robert E Fullilove, EdD Mailman School of Public Health Columbia University

MOTION The most important driver of any infectious disease epidemic is the creation of new hosts Without new potential hosts moving in and out of a reservoir of infection, there can be no epidemic

Imagine…. The impact of removing one half of all men 16 or older from a community…. What would their loss mean in the lives of the women and children they left behind?

Mass incarceration and AIDS The War on Drugs ranks as the number one “social driver” of the epidemic The high rates of incarceration of drug users and dealers placed the group at greatest risk for HIV infection behind bars

Growth in the prison population 200,000 men were in state and federal prison in 1972 In 2010, that number was 2.3 million with another 5.7 on parole, probation or under the supervision of the courts

Demographics 38% of all men serving time in state or federal prison are black Black men have a 1 in 3 chance of serving time in prison at some point in their life I in 4 persons incarcerated in 2002 did time for a drug-related offense

Rates of HIV/AIDS in prison Rates vary by state, but overall, rates of infection are 2-3 times what they are in the general US population Given high rates of recidivism [70%], cycling of infected men in and out of prison and into the community impacts the epidemic significantly

Impact on community “The New Jim Crow” [Michelle Alexander] demonstrates that felons and ex-felons comprise the new “underclass” Having so many men in poor communities without the rights of citizenship destabilizes the family and community functioning

Community Losses Housing insecurity and homelessness Lack of employment opportunities Loss of political and economic clout via Census counts

Incarceration impacts The capacity of communities to respond to the epidemic is seriously compromised through: Changes in mating rituals and the marriage market Changes in child rearing practices

Incarceration Impacts Loss of social controls, particularly in the all important task of raising young people to assume adult roles in the community Loss of so many adults creates ruptures in the amount of social capital that is available to everyone, but especially the young

Resources for HIV prevention Changes in parole/probation policies Engagement of the Black Church Changes in civil status or returning prisoners Improvement of educational opportunities

Resources The men themselves…. Ex-prisoners are increasingly becoming an effective group of community organizers They constitute the next step in HIV/AIDS prevention…..

Thank you