After the first few times he was raped, Michael Blucker got up the courage to get an HIV test. Fortunately for the married 24-year-old, he tested negative. But the assaults didn't stop. Locked inside Menard Correctional Center, the maximum-security prison in Illinois where he had been sent for car theft in 1993, Blucker says he was turned into a sex slave, traded by gang members for cigarettes and drugs. According to a lawsuit he filed later, he was raped by 10 men in the showers, by his cellmate while in "protective custody," and on dozens of other occasions. In March 1994, he was again tested for HIV. This time, he was positive. Michael Blucker, sentenced to seven years, had contracted a death sentence.
Blucker's story is unusual not because of what happened to him, but because we know about it. Unlike most victims of prison rape, he took the state to court, contending that prison staff helped gang members rape him. Juries ultimately found the staff members not liable; but no one disputes the damage done to Blucker.
Blucker is just one of many, many inmates who, through forced or voluntary sex, intravenous drug use, or exposure to ailing fellow cons, have contracted deadly diseases inside America's overflowing prisons -- diseases they bring with them when they return to their communities. Yet despite the danger to inmates and citizens alike, little has been done to track the spread of illnesses like HIV, hepatitis C, and tuberculosis behind bars, let alone prevent it. Wardens discourage serious epidemiological studies, and prisoner advocates and public health officials admit privately that they are reluctant to press the issue, fearing that they will be denied access to facilities if they speak out.
As a result, no one knows the exact extent of the problem; but virtually all the evidence indicates that the US penal system has become a prime breeding ground for some of the world's deadliest diseases, ultimately hastening their spread beyond prison walls.
"Blucker is definitely not an anomaly," says Joanne Mariner, author of a recent report on prison rape for Human Rights Watch, a nonprofit research and advocacy group based in New York City. "The prison context is very fertile ground for the spread of HIV."
That prisoners can infect the public at large is not in question. Russia's overcrowded prisons have bred new drug-resistant strains of tuberculosis that have proliferated virulently among the general public. An outbreak of meningitis in Los Angeles' city jail spread into nearby neighborhoods in the early 1990s.
The federal Centers for Disease Control and Prevention even has an office devoted to the issue. Last March in Atlanta, its director, John Miles, told a hotel ballroom full of prison doctors and nurses that nearly 600,000 inmates are released every year -- many of them riddled with disease. According to the most recent numbers from the Bureau of Justice Statistics, 24,000 inmates nationwide were HIV positive in 1996; a more recent study by the nonprofit National Commission on Correctional Health Care put the number with HIV as high as 47,000 -- 10 times the rate in the general population. Tuberculosis, a potentially lethal lung disease that spreads rapidly through the air in enclosed spaces, infects 1 in 4 people in some prisons, compared to fewer than 1 in 10,000 in the general population. Hepatitis C, an often-lethal liver disease spread by blood exchange, infects an estimated 41 percent of inmates just in California prisons, compared to less than 2 percent of the population at large.
What's less clear is precisely how many inmates become infected in prison. Miles calls prisons "the nation's reservoir of disease," but like many officials, he insists that most prisoners bring their illnesses with them from the outside -- a side effect of the drug use and risky sexual practices many of them indulged in before being locked up. "Sure, sex and drug use take place behind bars," Miles says. But the rate of new infections, he maintains, is "very, very low."
But Miles and other health officials don't really know that for sure, for a very simple reason: The Centers for Disease Control has failed to conduct studies that might show how prison life spreads disease. "The CDC does not want to know the truth," says Cal Skinner, a former state representative in Illinois. Skinner, who describes himself as a "right-wing conservative," was infuriated when he learned of Blucker's case. He wanted to know if prisons are "handing down unadjudicated death sentences" by breeding AIDS and then spreading the disease among the citizens of his state. Federal officials didn't answer his question -- so Skinner filed a request for documents under the Freedom of Information Act. To his surprise, he unearthed a 1990 study by the CDC, which had spent $483,000 to track the rate of new infections in Illinois jails. The study found that 3 out of every 1,000 inmates catch HIV in jail each year -- more than 10 times the statewide rate.
The results were striking -- but never published. Cynthia Glocker Crick, a spokesperson for the CDC, says the results were withheld because some of the blood samples had been mislabeled, but she affirms the basic accuracy of the study's conclusions. Skinner questions why the agency didn't follow up on its own findings. "If it was important enough to spend a half a million dollars on it then, and the study was faulty, why haven't we done another one?" he asks.
A pair of earlier, smaller studies also indicated that HIV infection rates in state prisons were much higher than in the general population. For the most part, however, the CDC and other public health agencies have limited themselves to tracking current levels of disease among prisoners, while avoiding studies of new infection rates.
Nevertheless, there is little doubt that rape and other behaviors that contribute to the spread of disease are rampant inside America's correctional facilities. A 1982 study of a medium-security prison in California found that 14 percent of inmates had been forced into oral or anal sex. In a 1988 survey, 87 percent of Texas prison officers claimed that rape was a common occurrence. In 1996, Cindy Struckman-Johnson of the University of South Dakota published a survey of the Nebraska prison system showing that almost 1 in 4 inmates had been "pressured or forced to have sexual contact against [their] will." In a follow-up study of seven prisons in the Midwest last year, Struckman-Johnson found that 1 in 10 prisoners had been forcibly raped -- some only once, others gang-raped repeatedly.
Combining such studies with hundreds of testimonials from inmate rape victims, a California-based advocacy group called Stop Prison Rape estimates that as many as 364,000 prisoners are raped every year. Struckman-Johnson calls the estimate "within the realm of possibility."
Officials have done even less to track needle sharing. A rare study of Tennessee prisons found that 28 percent of inmates reported shooting up behind bars. Many former inmates say such figures confirm their own experiences. Ruben Rodriguez, coordinator of an AIDS hotline for inmates in New York, says he and many other men shared needles while he was incarcerated during the 1980s. Today, he has both HIV and hepatitis C.
Tuberculosis has received more attention, perhaps because it has on occasion so clearly spread from prisons to the general public. In the early 1990s, a deadly strain of TB swept through the state prison system in New York. Thirty-nine prisoners caught the disease, as did two corrections officers. One of them passed it on to his son; they survived, but the other officer died of the disease. Thirty-five prisoners also perished. The outbreak went on to infect more than 1,000 civilians. In 1999, a South Carolina inmate confined to a special housing unit for prisoners with HIV started coughing incessantly. No one recognized the problem as TB, and the disease spread easily among the roomful of inmates with weakened immune systems. Within months, 31 prisoners and a medical student had caught it. And in Russia, 30,000 inmates leave prison each year with TB -- a major reason why the disease's infection rates have tripled in the general population there in the last 10 years.
Because TB spreads quickly, simply through shared air, many prison systems have implemented full-scale testing programs over the last decade. But most states do not test for AIDS, and almost none test for hepatitis C. Few ex-cons get themselves tested after their release; in fact, the Osborne Association, a prisoner-support organization that sponsors the hotline where Rodriquez works, reports a drastic downturn in inmate requests for HIV testing in the last five years. All of which means that countless prisoners return to the streets not knowing whether the needle sharing and sex they experienced on the inside has left them with a deadly disease -- which they can in turn pass on by sex and needle sharing.
Public health officials have a great incentive to focus on prisons, but corrections departments run their own hospitals and tend to resist efforts by outside officials to get involved -- especially those who suggest that sex and drug use are common in their facilities. To maintain their access to prisons, public health doctors must keep the goodwill of corrections officials, making them reluctant to press for controversial measures like distributing condoms and clean needles to inmates. Only a handful of states and cities currently allow prisoners access to condoms. None allows needle exchange.
Without more prevention, it is clear that the cost of treatment will continue to mount. State and federal prisons already spend nearly $5 billion each year to care for sick inmates, and public health agencies spend billions more to treat ailing prisoners after they are released. But there is simply no way to tally the bill for second-wave infections -- all the partners, children, and friends infected by ex-convicts who contracted a disease while they were locked up.
"People don't want to believe it because they're scared of the knowledge," Blucker said during his court case. "Because if they believe this, maybe they would have to do something about it."
William Speed Weed is a New York-based freelance writer.
Additional reporting by Emily Huber.
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