Recently, a new bill passed in the New York State Assembly and Senate that works to address a gap in current legislation pertaining to successful reentry. New York legislation A916/S5945, sponsored by Assembly Member Crystal Peoples-Stokes and Senator James Sanders Jr., plans to provide educational materials on HIV/AIDS prevention and testing to individuals immediately prior to their release from incarceration. The bill unanimously passed in the Senate and Assembly, and awaits the signature of the Governor before it is enacted. At The Fortune Society, we understand the critical difference being informed can have on a person’s life—we see it firsthand when providing Health Services every day.

Why We Need to Expand HIV/AIDS Education

People at risk of incarceration are more likely to be at high-risk for HIV infection. Factors contributing to this nexus include a history of drug use, high prevalence of sexually transmitted illnesses, mental health needs, a history of assault or abuse, and low socioeconomic status.[1] Passing New York legislation A916/S5945 is a necessary step for combating the severe disparities experienced by people caught within these parallel epidemics.

HIV/AIDS is significantly more prevalent within the incarcerated population than the general population.[2] UNAIDS estimates that people in prison are on average five times more likely to be living with HIV as compared with adults who are not incarcerated. [3] The World Health Organization estimates the increased risk to be even more drastic, suggesting people incarcerated are 15 times more likely to be HIV-positive than people who are not confined.[4] A systematic evidence review released in 2018 found that a period of recent incarceration is associated with an 81% increase in HIV risk and 62% increase in hepatitis C virus (HCV) risk.[5]

Furthermore, incarceration itself may be a driver of HIV acquisition in the community. Over 70% of people transitioning out of incarceration return to communities disproportionately affected by socioeconomic and health disparities.[6] Without adequate resources upon release, formerly incarcerated individuals who are living with HIV or AIDS often lack sufficient access to medication, medical services, and supportive care. Additionally, individuals who are not living with HIV or AIDS may not be aware of recent advances in prevention such as PrEP and PEP, or where to access such resources.

Research shows that informational material, education sessions, and communication programs for people incarcerated discussing HIV and other sexually transmitted infections are not impacting levels of new infections. Sessions that include topics beyond HIV, such as employment and housing concerns, have been shown to have high success in changing risk behaviors. Peer-based interventions have demonstrated success. Yet very few prisons implement these program models as part of their strategy.[7]

The Fortune Society urges New York State to harness the expertise of directly impacted individuals living with HIV or AIDS who have experienced incarceration to guide the implementation and design of legislation A916/S5945.

Another critical consideration is the high levels of illiteracy among people confined, making a handout upon release insufficient. Approximately, 70% of people in United States’ prisons have tested at the literacy level appropriate for a nine-year-old.[8] As a result, people confined often cannot fully comprehend the complex and overwhelming HIV prevention information provided. There must be more emphasis on the importance of tailoring materials and programs to meet the specific needs of all people.

HIV prevention, testing, and treatment in prisons is both a public health and human rights issue that must be addressed urgently.

Article by Micaela Linder, Director of Health Policy and Practice at The Fortune Society and Lymus Rivera, Substance Use Counselor at The Fortune Society

1. Harawa N, Adimora A. Incarceration, African Americans, and HIV: Advancing a Research Agenda. J Natl Med
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2. Maruschak L, Bersofsky M, Unangst J. Medical problems of state and federal prisoners and jail inmates, 2011-12.
   U.S. Department of Justice. 2015.
   See: https://www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf. Accessed February 21, 2019.
3. Beg, Monica. Update on HIV in prisons and other closed settings. UNAIDS (2017) See: https://www.unaids.org/sites/default/files/media_asset/20171213_UNAIDS_PCB41_Update-HIV-Prisons-UNODC_PPT.pdf
4. World Health Organization. People in Prisons and Other Closed Settings. Accessed May 2019.
   See: https://www.who.int/hiv/topics/prisons/about/en/
5. Stone, J et al. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. The Lancet Infectious Disease, Volume 18, Issue 12, p1397-1409. 2018.
6. Jordan, A. Linkages and Care Engagement: From NYC Jail to Community Provider. September 16, 2015. See: https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/webinar_series/cjs/linkages_and_care.pdf
   Accessed June 12, 2019.
7. Kamarulzaman A, Reid SE, Schwitters A et al. Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners. The Lancet, Volume 10, Issue 388, p1115-1126. 2016.
8. BBC. Campaign warns 11% of world illiterate. 29 September, 2015. Accessed May 2019.