Overcrowded Prisons: The Unknown Public Health Crisis

In California, about one inmate dies every eight days because he or she lacks access to basic medical care (Conery 1). Overpopulated prisons reduce prisoners’ access to healthcare while prevailing attitudes about drug usage limit the treatments available to the inmates. The crowded living conditions and reduced access to health care create higher instances of diseases such as tuberculosis, human immunodeficiency virus (HIV) transmission, and suicide (Michel et al. 8). Harsher sentencing for drug crimes drastically increased the number of people serving jail time, which led to an influx of prisoners sent to prisons not equipped to handle large volumes of inmates and a view of drug addicts as immoral as opposed to people who could be rehabilitated. Health concerns and the spread of infectious diseases such as HIV can be managed within prisons with basic sanitation and access to bleach and condoms. However, the crowded prison conditions and negative views that stem from drug laws make reducing the prison population difficult. As a result, overcrowded prisons create unsanitary and unsafe conditions for inmates and workers alike. Decriminalizing marijuana and other drugs can improve the quality of the inmates’ lives by reducing the population of the prisons and changing the perception of drug usage in America.

The war on drugs began in 1968 when then President Nixon increased efforts countering illegal drug consumption, transport, and sales. His stance and the resulting media coverage created a “moral panic” which portrayed drug users as immoral criminals, and increased incarceration due to tougher laws and more policing (Moore and Elkavich 1). However, these tough-on-crime stances and ensuing laws caused the prison population to increase 500% in the last forty years without a corresponding decrease in drug usage (Moore and Elkavich). The tough- on-crime laws also portray drug addicts as dangerous criminals even though many of the drug offenders are serving time for nonviolent offenses (Moore and Elkavich 1). The war on drugs and a tough-on-crime mentality has not reduced drug usage in the general population, but has instead created a public health issue in which large amounts of people are forced into an institution that is not equipped to handle the growing population. Thirty three of California’s prisons are at almost double the capacity; Donald Specter, the lawyer arguing for prisoner’s rights at the Supreme Court, refers to this situation as “life and death and serious injury” (qtd in Conery 1).

Overpopulation leads to higher transmissions of disease due to a lack of basic medical treatment. The transmission of disease is higher in prison than in the general population. By some estimates, 50% of inmates suffer from a mental illness; Up to 75% suffer from alcohol or substance abuse and often do not have access to treatment (“HIV in Prison and Jails”). HIV, hepatitis and tuberculosis are spread not only between prisoners, but also to their visitors and the prison guards (Michel et al. 1). After completing their sentences, prisoners who have been infected but not treated are released into the general public, and are likely to infect others outside of prison. People in prison desperately need adequate medical care, but do not always receive it.

The prevailing attitude towards drug usage is detrimental to the quality of care received by prisoners who use drugs in prison. According to a European study “overpopulation also reflects the orientation of the global penal policy of a specific country, perhaps more focused on repression than on access to care and prevention for offenders, in particular those who use drugs” (Michel et al. 8). Most laws are aimed at punishing drug users, which leads to overpopulated prisons. These policies would rather “repress” or punish, people who use drugs by sending them to jail for drug usage than provide them with access to adequate treatment for addiction or prevention.

Compromised care due to overpopulation intersects with negative attitudes concerning drug usage in HIV transmission and treatment. According to the Centers for Disease Control and Prevention, the prevalence of HIV among inmates is almost five times higher than the disease’s prevalence in the general population (“HIV transmission among male inmates in a state prison system–Georgia, 1992-2005”). HIV can be transmitted through unprotected intercourse or using unclean needles for tattooing or drug use. Additionally, a study claims that the criminalization of drugs, especially injected drugs, creates a culture where drug use in prison is not talked about or acknowledged, even though it is a high risk behavior (Michel et al.  10). Ignoring or refusing to treat drug addiction because it is seen as a moral failing does not reduce drug usage; in fact, it exacerbates the problem because addicts cannot seek help for fear of punishment. There are no studies regarding intravenous drug usage in American prisons, and injecting drugs is common throughout the rest of the world. According to a French survey, 12% of prisoners use intravenous drugs while in jail (Michel et al. 7). In Iran, 10% of prisoners inject drugs, and 95% of them share needles (Jurgens, Nowak, and Day). A study done in the United Kingdom found that HIV positive inmates were more likely to inject drugs and share needles than those who were unsure of their status or HIV negative (Dolan et al). Switzerland, in 1992, introduced the first needle and syringe program, which provides inmates with sterile needles (Jergens, Nowak, and Day). Needle and syringe programs reduce needle sharing among prisoners without a noted increase in drug use (Jergens, Nowak, and Day). Sexual intercourse between same-sex inmates is illegal in America despite being common in prisons. Only Vermont and California require condoms in male prisons (Lavender 1), and there is no bleach available in any prison to clean needles (Bick).

Furthermore, most prisons are not equipped to provide adequate medical care to the prisoners. Depending on the state in which the prison is located, HIV testing may be required or not even offered. Alternatively, some prisons punish HIV positive inmates by housing them separately from other prisoners, denying them certain work details, and providing them with no privacy concerning their status (“HIV in Prisons and Jails”). While the transmission of HIV is preventable, a study notes that growing prison populations “have not been counterbalanced by the adequate implementation of preventive measures to control the increased risk of infection…or by an increase in health care funds” (Michel et al. 7). Prisons are not equipped to prevent the spread of infectious disease or provide proper treatment once HIV is diagnosed. The overpopulation of prisons and prevailing attitudes about drug usage endanger inmates’ health.

The prison population needs to be reduced so that officials can provide adequate health care to the remaining prisoners. Decriminalizing marijuana and the nonviolent possession of other narcotics would keep people who do not deserve to be in prison out of prison while ensuring those caught committing a violent crime go to prison. In 2014, California enacted Proposition 47, which reclassified many minor nonviolent or drug offenses from felonies to misdemeanors. During the following year, the prison population was reduced by 3,000 inmates and the resulting savings will be used to provide substance abuse treatment and drug prevention programs (“How California is Reducing its Prison Population”). This solution not only reduces the prison population, thereby ensuring the remaining prisoners have better access to health care, but also provides inmates with treatment for their addictions. Providing treatment for drug addictions reduces the number of people using drugs and allows them a second chance at life, unfettered by a criminal record and unharmed by the dangers of prisons. Legislation similar to Proposition 47 should be introduced across the country, but in the interim, action must be taken immediately to ensure inmates in overpopulated prisons have access to healthcare.

Changing the drug laws should spark changes in prison medical care related to drugs. To combat the most pressing health concerns, condoms need to be available in both men and women’s prisons in all fifty states, in addition to either sterilized needles or bleach to clean needles for drug usage and tattooing to reduce the transmission of HIV. European prisons face many of the same problems as American prisons and are taking steps to improve the health of their inmates. In France, 95% of male prisons and 21% of female prisons provide condoms or other protection to the inmates (Michel et al. 3). Generally, condoms are supplied by a medical unit, but 20% of prisons have them available in an anonymous area, such as a library (Michel et al. 3). Additionally, 90% of French prisons provide HIV, hepatitis, and sexuality classes to the inmates to educate people in prison about disease transmission (Michel et al., 4). Prisons in Austria and Denmark provide bleach packets in medical units (Michel et al. 6), and prisons in Spain and other countries are introducing needle and syringe programs (Jurgens, Nowak, and Day). America needs to enact similar policies to improve the quality of their health care. Additionally, decriminalizing marijuana and other nonviolent drug offenses, while providing people in prison with condoms and sterile needles, will both decrease the prison population and improve the health of the prisoners.

Works Cited

Bick, Joessph A. “Infection Control in Jails and Prisons.” Clinical Infectious Diseases. Oxford Journal, 2016. Web. 14 April 2016.

Conery, Ben “High court debates overpopulation in California prisons; Safety, inmates’ rights at issue.” Washington Times [Washington, DC] 1 Dec. 2010: A04. Business Insights: Essentials. Web. 07 Apr. 2016.

Dolan, Kate, et al. “People who inject drugs in prison: HIV prevalence, transmission and prevention.” International Journal of Drug Policy 26 (2015): S12-S15.

“HIV in Prisons and Jails.” HIV in Prisons and Jails. AIDS InfoNet, 24 February 2014. Web. 07 Apr. 2016.

“HIV Transmission Among Male Inmates in a State Prison System — Georgia, 1992–2005.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 21 Apr. 2006. Web. 07 Apr. 2016.

“How California Is Reducing Its Prison Population.” US Official News 25 Mar. 2015. Infotrac Newsstand. Web. 07 Apr. 2016.

Jürgens, Ralf, Manfred Nowak, and Marcus Day. “HIV and incarceration: prisons and detention.” Journal of the International AIDS Society 14.1 (2011): 26.

Lavender, George. “California Prisons Aim To Keep Sex Between Inmates Safe, If Illegal.” NPR. NPR, 21 Jan. 2015. Web. 07 Apr. 2016.

Michel, Laurent, Caroline Lions, Sara Van Malderen, Julie Schilt , Wouter Vanderplasschen, Karina Holm , Torsten Kolind , Felice Nava, Nadja Weltzien, Andrea Moser, Marie Jauffret-Roustide, Olivier Maguet, Patrizia M Carrieri, Cinzia Brentari and Heino Stöver. “Insufficient Access to Harm Reduction Measures in Prisons in 5 Countries (PRIDE Europe): A Shared European Public Health Concern.” BMC Public Health. BMC Public Health,2015. Web. 07 Apr. 2016.

Michel et al.: Limited access to HIV prevention in French prisons (ANRS PRI2 DE): implications for public health and drug policy. BMC Public Health 2011 11:400.

Moore, Lisa D., and Amy Elkavich. “Who’s Using and Who’s Doing Time: Incarceration, the War on Drugs, and Public Health.” American Journal of Public Health. American Public Health Association, May 2008. Web. 01 Apr. 2016.