Jails across across the country have long since stopped putting inmates with the AIDS virus in separate housing. Here's why one state refuses to change its ways.
During the earliest and scariest years of the AIDS crisis, prisons across America commonly housed HIV-positive inmates separately from their HIV-negative counterparts. That practice has largely disappeared, however, as science and society have changed. The evolution of antiretroviral medicines has drastically reduced the likelihood of disease transmission, and in recent years, 48 states and the Federal Bureau of Prisons have sent their segregation policies packing.
Alabama and South Carolina, however, have hung on. Prisons officials from both states continue to insist that keeping HIV-positive patients separate not only prevents HIV transmission, but also makes disease treatment cheaper and easier. In South Carolina, for example, all HIV-positive inmates are housed in one maximum security prison, making it simpler to administer HIV care on the state's spaghetti-thin healthcare budget.
Prisoners with HIV have fought back, however, insisting that while conditions for inmates with the virus are certainly separate, they are far from equal.
Beverly Jacobs, 43, experienced this firsthand. While imprisoned for credit card fraud, she spent 16 months in the Julia Tutwiler Prison in Wetumpka, Alabama. She sought entrance to a religious dorm, but officials denied her a space because she is HIV positive, she said. She was also rejected from a support dorm for people recovering from substance abuse, thereby missing out on critical services. And she was turned away from a work-release program that could have helped her gain valuable skills.
Her clothing was washed separately from that of HIV-negative inmates, destined for a bin marked with thick letters: "AIDS." Her linens often came back dirty. "I still have nightmares about that prison," said Jacobs.
In 2011, the American Civil Liberties Union sued to end the practice in Alabama, and a decision is expected by Christmas. Lawyers are arguing that Jacobs' experience was the rule, not the exception, and that the policy violates the Americans with Disabilities Act by excluding inmates with HIV from a host of rehabilitative and vocational programs.
By housing HIV-positive inmates in one facility, the state says it can deliver first-rate care at a fraction of the cost.
It is also, they argue, unnecessary: Prisoners with far more contagious diseases, like hepatitis B and C, are not kept segregated. And since the advent of potent antiretrovirals, there has been no data, they say, to show that HIV-negative prisoners are more likely to contract the virus when housed with HIV-positive ones.
"These policies no longer make any sense," said Kathie Hiers, CEO of AIDS Alabama, which is able to serve about half of the state's approximately 15,000 people living with HIV. "To treat folks as lepers were treated in biblical days is ridiculous."
If the ACLU wins, one state -- South Carolina, rarely one to cower under pressure from outside entities -- will be left as the lone defender of the practice.
And it's anyone's guess what will happen next the Palmetto State.
According to Jon Ozmint, who directed the South Carolina Department of Corrections from 2003 to 2011, his state's policy has been challenged and upheld in court several times.
In 2010, the ACLU and Human Rights Watch released a report criticizing the practice in three southern states. After, Mississippi changed its policy. South Carolina did not.
That same year, the Justice Department informed South Carolina state that it was investigating the practice, and might sue to stop the policy. No action has been taken.
The state's persistence, Ozmint said, has a lot to do with guaranteeing health care for its approximately 400 HIV-positive prisoners. By housing all inmates with HIV in one place, the Broad River Correctional Institution, the state can bring in specialists and deliver first-rate care at a fraction of the cost. "There is nobody being victimized by this," he said. "They're being helped by this."
The ACLU and Human Rights Watch, however, have argued that other states have mixed prison populations without spending more money. During the Alabama trial this year, Emmitt Sparkman, the deputy commissioner of institutions for the Mississippi Department of Corrections, testified that keeping HIV prisoners separate had actually been more expensive [PDF]. "The fewer specialized populations you have, the less expensive it is to operate," he said.
"Our housing units are not made for 20 offenders," he said. "So if you continue -- if they continue to segregate, they have to staff that. Say it's a 50-bed housing, if they have to staff it for 50 beds when there's only 20 there, it's more costly."
Ozmint said that there are some downsides to the South Carolina policy. Some of Broad River's HIV-positive inmates are low-level offenders, but because the facility is a maximum-security prison, they are given less access to their families than they'd have if they were housed according to their crimes.
And the ability to participate in work programs is not universal. "These guys might not have access to everything," he said.
But during Ozmint tenure, prisoners with HIV repeatedly left and then returned to serve more time -- and explained that they could not find the same quality of health care anywhere else.
Three things could happen in the South Carolina's prison system after the Alabama decision is made. In one scenario, everything will stay the same. In another, the ACLU will sue South Carolina next. "Or," said Ozmint, "they decide maybe there's a middle ground, a better way to go, to try to modify this program so that inmates could have some of the opportunities they don't have, but we keep some of the positive parts of this program" like housing segregation.
"We think it works," said Ozmint. "It might not be medically necessary, but I say it's medically best."