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The Social Impact of Aids in the United States
a "death row." Some prisons designate units for openly gay or effeminate inmates, and transvestites to protect them from predatory behavior. For 15 years a central Florida jail segregated homosexuals and forced them to wear pink arm bands (Associated Press, 1989).
Since the AIDS epidemic began, many jurisdictions have been faced with decisions about the advisability of segregating asymptomatic HIV-positive prisoners or those with AIDS. Segregation decisions have been justified on the grounds of inmate security, the possible risk of transmission of HIV, or availability of specialized health services. In some aspects the prison debate mirrors concerns of health care providers about the creation of AIDS-dedicated hospital wards or medical facilities (see Chapter 3). Is the creation of an AIDS-dedicated prison unit a way of delivering health care more efficiently by those with specialized training, a way of protecting the health of inmates whose immune systems are compromised, or merely an administrative convenience, which will exacerbate the stigma that attaches to AIDS?
A number of potential harms are inherent in blanket segregation of HIV-infected inmates. Isolating HIV-positive prisoners labels them in the eyes of all other inmates and staff and may put them at greater risk of assault and discrimination.8 Segregation often limits prisoners' access to a wide range of prison activities, such as religious services, visitation, and drug treatment programs (e.g., Alcoholics Anonymous or Narcotics Anonymous). It also limits access to libraries, educational and recreational facilities, and work: many jurisdictions exclude known HIV-positive prisoners from food service positions, despite the lack of evidence of any danger in this regard.9 In some prisons, segregation of inmates with HIV disease has resulted in harrowing conditions, some of which have been the subject of journalistic exposés and court challenges.10 Furthermore, the segregation of HIV-positive prisoners may give a false sense of security about the risk of HIV transmission, however. Because of the window period for seroconversion, even widespread screening programs are unlikely to identify all HIV-positive entrants, and this HIV transmission may still be a possibility within the general prison population. As one official reported (Maisonet, 1990:96-97):
[with segregation of HIV-positive inmates] the inmates themselves believe that they are now safe. My greatest problem now is having putatively heterosexual men continually solicit sexual favors from our effeminate male homosexuals. … Segregated housing has created a myth that we don't have to worry about HIV in the general [prison] population. … Most inmates who are HIV positive have not been identified and are still involving themselves in high risk behavior.
HIV status can overwhelm a wide range of relevant considerations in decisions about where to house prisoners. According to Catherine A. Hanssens,