Just a little more than a decade ago, HIV/AIDS was the leading cause of death for young black women. While their rates of diagnoses have dropped drastically since then, they are still higher than women of other races, and black people are the most affected by HIV of any race or ethnicity in the U.S. The tipping point started 30 years ago, five years into the AIDS crisis, when African American and Latinx populations began to be affected at disproportionately high rates.
While prevention programs and access to affordable healthcare are important to reducing the spread of HIV among black women, part of protecting black women from contracting HIV goes back to reducing incarceration rates among black men. But the specter of President-elect Donald Trump, who has expressed a pretty draconian approach to “restoring law and order” in U.S. cities, could mean a rollback of the significant gains made by prevention efforts in the last decade.
It might sound peculiar that incarceration rates have such an impact on the health of black women. But according to the Center for Disease Control, the rate of inmates diagnosed with HIV in state and federal prisons is more than five times greater than that of people who aren’t incarcerated. Then factor in that black Americans make up nearly 1 million of the total 2.3 million incarcerated population, and that one in three black men can expect to find himself behind bars at some point in his life. Studies have also pointed to mass incarceration as an important factor behind the high rates of HIV among black women–a hidden side effect of America’s criminal justice system.
Laurie Shrage, a professor of philosophy at Florida International University who also studies HIV and AIDS rates among women, points to the high rate of sexual violence, lack of condom and needle distribution, and tattooing as factors that contribute to the virus spreading more easily in prisons. Despite HIV being a well-documented and significant health issue among incarcerated populations, not all prisoners are offered testing so it’s impossible to know what transmission rates are in prisons. And while most inmates contract HIV before they enter the criminal justice system, detention exacerbates the problem. “Even if we have prevention programs in black communities, there are very few in prisons,” Shrage says.
Without testing or prevention, black men go home, back to their girlfriends and wives, and the virus spreads. On top of that, cycling through the prison system can also mean interruptions in treatments and greater chances of infecting sexual partners.
But the high rates of HIV in underserved black communities are not the fault of black men and women. It’s their “social vulnerability,” Shrage says.
“The relationship [between] mass incarceration and HIV is so complex,” says Naina Khanna, Executive Director at the Positive Women’s Network, an organization that works with women living with HIV. “Blacks are at high risk even when their individual behaviors are not,” she says. Beyond time in prison, less access to affordable and good health care, housing, safety, and education are all factors that make black Americans more vulnerable to HIV. Prevention programs are aimed at what individuals can do to reduce the risk of contracting the virus, but, Shrage explains, those programs don’t address systemic issues. It’s up to policy makers, she says.
While Hillary Clinton pledged to reform the criminal justice system–including strict laws passed by her husband’s administration that had a large hand in increasing the prison population–Trump made his plans for policing America’s black communities crystal clear at the first presidential debate in September.
“These are felons. These are people that are bad people,” he said about Chicagoans with guns. His answer for “curing” America’s inner cities, he’s said time and time again, is to restore law and order. The president-elect wants to ramp up stop-and-frisk, a controversial program that was already dismantled in New York for profiling black and Latinx residents.
If police departments become more emboldened by Trump’s insistence at using stop-and-frisk policies, black men and women will surely end up in jails and prisons even more. If Obama’s policy agenda to move away from criminalizing nonviolent drug offenses ends when his presidency does, drug users who are at high risk for HIV will continue to go to prison and spread the virus.
And “we definitely need to be concerned about what happens if healthcare is dismantled,” says Khanna. If Republicans replace the Affordable Care Act with a healthcare system that reduces coverage for less advantaged Americans, access to HIV medications could be harder to come by.
We don’t yet know what sorts of policies Trump will enact to address the criminal justice system. What we do know now is that black women contract HIV at about 20 times their white counterparts, and black men are six times more likely to contract HIV than white men. And if there aren’t policy changes made to the criminal justice system, then those disparities are unlikely to get smaller.
Correction: A previous version of this article stated that HIV testing is not offered in prisons. It has since been updated to reflect that not all prisoners are offered testing.