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AIDS Co-Chair Chris Beyrer: Mass Incarceration is Driving the HIV Epidemic Among African-American Women

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beyrer chris(TriceEdneyWire.com) – In the days before the 2016 International AIDS Conference began, International AIDS Society President and AIDS 2016 co-chair Chris Beyrer, M.D., met with the Black Media Delegation to preview some of the late-breaking news at the Conference in Durban, South Africa. Dr. Beyrer was particularly excited about the July 2016 issue of the British medical journal The Lancet, which contains an analysis of HIV, viral hepatitis and tuberculosis among prisoners worldwide. We became very disturbed about new research he shared about the relationship between mass incarceration and the HIV epidemic among African American women—especially because we now know that untreated HIV is infectious HIV and we have been sold this story that the epidemic has been driven by the “down low.” What follows is a heavily edited version of a long conversation:

Q: What are you most excited about?

A: Today we are launching a very important series of six papers and three commentaries in The Lancet on HIV and prisoners. We looked at all the data available globally including the U.S. A very important piece by an American researcher looks specifically at the impact of the mass incarceration of young Black men on HIV infections in African American women. We now really understand why this relationship exists and what the biology is.

Are Black men getting HIV in prison?

The issue is not so much that people get infected in prison—that is not what is happening. People do pretty well under treatment in federal and state penitentiary systems—viral suppression rates are very high. (Jails are different.) The problem is that people are being released without access to services and they experience treatment interruption.

So you’re saying that the amount of HIV virus in their system is very low when they’re in prison. But they’re released into the community without being carefully linked to health care, so their viral load spikes right when they go home, making them very infectious to their wife, girlfriend or partner?

That’s exactly right. They’re trying to reestablish family life, social life. And for many people they’re also very strongly trying to reassert their sexual identity—that is a part of what people want and need to do. People are sometimes released with three days’ worth of antivirals [and told,] “Be sure to follow up and get your appointment”. How likely is that to happen?

And their sexual partners may not know that they’re HIV positive, right—they may not have the ability or desire to disclose their status?

That’s right. This is something now we know about the biology of HIV: a high proportion of new infections are the outcome of acute or recent infection, or of high viral load. So you’re basically having people perennially coming into the same small high-risk communities [with high viral loads] as though they were newly infected. And that, I think, is essential to understanding why there’s so much more HIV infection in African Americans.

The linkage to care upon release—that’s where the system is broken. When Douglas Brooks was in the Office of National AIDS Policy, he convened several meetings trying to get the different federal players together to talk about, for example, how we connect criminal justice to Medicaid. The government knows precisely who the folks in the criminal justice system are, but [after they are released] they are so often lost [out of health care]. And when we look at recidivism rates, we have very good data on what proportion of people are virally suppressed when they are picked up and linked back into the prison system, and it’s tragically low.

What additional barriers do newly released people experience that can drive the epidemic?

People who have narcotics charges often are denied public housing. You can’t live in public housing, so you get into the issues [that occur when you don’t have housing]. Among people who have drug dependency, there’s a very high rate of overdose and overdose deaths in the immediate post-release period. Because if people have, for example, been on methadone or buprenorphine, upon release there’s also an interruption. Sometimes people [are given] two days of buprenorphine.

That’s extremely disturbing. How often is this happening? What is the magnitude of the problem.

In the U.S. 14 percent of people living with HIV infection cycle through the criminal justice system every year. Substance use rates do not differ by race; who goes to prison differs. So disproportionate incarceration of African American and Latino men and adolescents has this very important impact on HIV infection rates among African American women.

Because if you look at their individual level of sexual risk, Black women in the United States [engage in] less risky [sexual behavior] than Latino or White women. Yet they have more than five times the infection rate. The mass incarceration of African American men is fundamental to this and it’s because of this problem of lack of access to care.

In addition to driving HIV infection rates, mass incarceration is devastatingly destabilizing to Black families.

It has an intergenerational impact. It has an enormously harmful impact on child health and development and children’s outcomes.

It also has an important gender aspect. There are about 700,000 women worldwide in prisons; 205,000 are Americans. No one is incarcerating women more than the U.S. and they are hugely, disproportionately women of color; mostly for nonviolent, substance-abuse related crimes. …. Black women are dramatically more likely to be imprisoned than White women and Latino women. That’s a very important aspect of this.

It has been said, and I think it’s absolutely true, that the War on Drugs is a War on Black families. In this Lancet series, I think we have really unpacked a lot of the actual epidemiology behind this and understood it.

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