This piece draws on many of the themes of stigma, history of abuse, sex work, drug use, and negative mental health among HIV+ people in a carceral context. As described in the curatiorial note, incarcerated people are uniquely vulnerable to HIV, and the poverty and racial discrimination that makes them uniquely vulnerable to HIV also makes them vulnerable to the themes of stigma, abuse, sex work, drug abuse, and negative mental health discussed in this poem.

 

In Durham County Jail, the most common cause of death is medical neglect, which points to how we are failing to meet the health needs of all of our prisoners but this statistic may disproportionately target HIV+ prisoners who have additional and specialized health care needs than an average prisoner, and the overcrowding in prisons leaves HIV+ prisoners uniquely vulnerable to opportunistic infections.

 

This piece was written by Arvan Washington, who has twice been the runner up for PEN America’s prison writing program, but because of his status of living in a correctional facility, little information exists about him online. This also may be due to the stigma associated with being incarcerated and the stigma associated with living openly with HIV/AIDS. 65% of inmates on a national scale are addicted to some form of drug, and research has found that exposure to childhood sexual abuse is more common among male felons, particularly those convicted of violent crimes.

 

Between 75-95% of prostitutes are also survivors of sexual abuse in childhood, and 50% of prostitutes globally are HIV+. A prostitute is beaten, on average, 6-12 times in a year and the average prostitute has unprotected sex around 300 times per year. 21.4% of prostitutes report having been raped 10 or more times. In the United States, 6-8% of all STI cases are related to sex work. Each year, 204 out of every 100,000 prostitutes are murdered, which is a murder rate that is over 20 times the national average.

 

Both prostitutes and inmates are more likely to have diagnosable mental illnesses than the general population. This is augmented by statistics in Durham County that show that 63% of the population housed in Durham County Jail has at least one diagnosed mental illness. Increasingly, prisons and jails have been criticized for becoming de-facto mental health institutions, given that many people with mental illnesses first have their mental illness detected when they break the law and are arrested for it. Clear examples of this include addicts who are either caught using and arrested or caught stealing items to sell them for drug money, or depressed people who attempt to commit suicide by police by getting in violent confrontations with law enforcement officers.

 

This trend is additionally worsened by both the nature and nurture debates that inform current understandings of drug addiction, and how prisons and jails are often criticized for punishing addicts for breaking the law without rehabilitating them from their addictions or giving them the skills they need to cultivate to succeed in beating their addiction outside of prison, then releasing them into the same communities and situations that precipitated their drug use in the first place.

 

The nurture aspect of drug addiction says that addicts choose the drugs they are exposed to in their communities and become addicted to escape the pain of daily life, which makes this problem all the worse given that prisons often release inmates back into the same communities in which they first became exposed to the drugs they became addicted to, with the same social networks that often are based in drug abuse, and in a more stressful/painful life situation given the employment discrimination that keeps inmates from working and the painful memories associated with their stay in prison.

 

The nature debate of addiction explains this trend differently, using the common trend of comorbidity between mental illness and addiction as the basis for its argument. This nature argument says that addicts seek out the drugs that counterbalance their underlying mental illness symptoms, and take the drugs to feel normal with escalating drug use during stressful times, which results in addiction. For example, a person with the hallucinations and delusions associated with schizophrenia is unlikely to use hallucinogens that would make these symptoms worse, but may use depressants like alcohol or opiates (heroin, Vicodin) to silence these symptoms. Similarly, someone facing bipolar disorder may use depressants like alcohol or opiates to combat mania, while using stimulants like cocaine or methamphetamine during depressive episodes. Prisons and jails are often criticized for not providing adequate treatment for addicts and otherwise mentally ill inmates, despite the unique vulnerabilities of addicts and mentally ill people to become incarcerated, which sets these two populations to fail and return to the carceral system. These two theories both provide adequate justification for high rates of recidivism in the U.S. criminal justice system and operate in conjunction, a model called the stress-diathesis model: everyone has different amounts of genetic predisposition (diathesis) to mental illness and life stressors that cultivate mental illness. Some people may have such strong genetic predisposition that genetics alone cause them to develop mental illnesses, while others may have no genetic factors but extremely stressful lives that cultivate mental illnesses, but for most people, mental illness is a result of the combination and synergistic effect of these two factors. Because of all of this, both prisoners and prostitutes are disproportionately vulnerable to HIV, and are significantly more likely than members of the general population to commit suicide.

 

 

Special thanks to Inside-Outside Alliance and Threshold Clubhouse, who provided many of the statistics and information that informed this analysis that are not publicly available online

Many of the analyses from a mental health perspective is provided by former classwork, specifically Abnormal Psychology and Drugs and the Law

 

Sources and additional readings:

https://www.hhrjournal.org/2016/02/opening-the-door-to-zero-new-hiv-infections-in-closed-settings/

http://cid.oxfordjournals.org/content/45/8/1047.full

https://www.ncjrs.gov/pdffiles/fs000204.pdf

http://www.centeronaddiction.org/newsroom/press-releases/2010-behind-bars-II

https://www.prisonpolicy.org/research/mental_health/

http://www.theatlantic.com/health/archive/2015/04/more-than-half-of-prisoners-are-mentally-ill/389682/

http://sex-crimes.laws.com/prostitution/prostitution-statistics

http://www.rapeis.org/activism/prostitution/sexworkerscivilrights.htm

https://www.collegium.ethz.ch/fileadmin/autoren/pdf_papers/10_roessler_sexwork.pdf

http://www.prisonerhealth.org/news-and-events/news/incarceration-and-mental-health/

http://nicic.gov/mentalillness

http://jaapl.org/content/35/4/406

http://www.nij.gov/topics/corrections/recidivism/pages/welcome.aspx

https://www.bjs.gov/content/pub/pdf/mljsp0013st.pdf

http://www.rapeis.org/activism/prostitution/prostitutionfacts.html

http://www.npr.org/2015/07/27/426742309/the-shock-of-confinement-the-grim-reality-of-suicide-in-jail

https://books.google.com/books?id=fuaB0PIsa9wC&pg=PA91&lpg=PA91&dq=suicide+prostitutes&source=bl&ots=cWYYKUSruQ&sig=PvwjNy_2DLRyxtLqW7GnchJb-nw&hl=en&sa=X&ved=0ahUKEwjKvOT34eLQAhWBlZAKHQCyBWUQ6AEISjAI#v=onepage&q=suicide%20prostitutes&f=false