Disproportionate Drug Imprisonment Perpetuates the HIV/AIDS Epidemic in African American Communities

  • Juarlyn L. Gaiter
  • Ann O’Leary


The U.S. inmate population increased by 700% between 1970 and 2005 (Austin, Naro, & Fabelo, 2007), mainly because correctional policies criminalize drug addiction. Almost one half of all prisoners are drug abusers (Karberg & James, 2002) despite evidence from molecular and imaging studies that addiction is a brain disorder with a strong genetic component (Chandler, Fletcher, & Volkow, 2009). The composition of prison admissions has shifted away from perpetrators of violent crimes towards less serious offenses such as parole violations and drug offenses (Clear, 2007). These offenses are largely responsible for the steep increases in the number of people who are incarcerated. Mauer (2006) notes that since there are no direct victims in drug selling and possession police rarely receive reports of these activities. Also, drug law enforcement is far more discretionary than for other offenses. The police decide when and where they will seek out people to arrest and most importantly what priority they will place on enforcing drug laws. Nearly six in ten persons in state prisons for a drug offense have no history of violence or significant selling activity. In 2005 four out of five drug arrests were for possession and only one out of five were for drug sales (Webb, 2007). States that have high numbers of drug arrests usually have higher incarceration rates (Mauer) and counties with burgeoning unemployment, persistent poverty and large percentages of African Americans have the highest incarceration rates for drug offenses (Beatty, Petteruti, & Ziedenberg, 2007).


African American Woman Methadone Maintenance Treatment African American Community Injection Drug User Drug Offense 
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  1. Adimora, A. A., Schoenbach, V. J., Martinson, F., Donaldson, K. H., Staneil, T. R, & Fullilove, R. E. (2004). Concurrent partnerships among African Americans in the Rural South. Annals of Epidemiology, 3, 155–160.CrossRefGoogle Scholar
  2. Adimora, A. A., Schoenbach, V. J., & Doherty, I. A. (2007). Concurrent sexual partnerships among men in the United States. American Journal of Public Health, 97, 2230–2237.PubMedCrossRefGoogle Scholar
  3. Altice, F. L., Mostashari, F., & Friedland, G. H. (2001). Trust and the acceptance of and adherence to antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 28, 47–58.PubMedGoogle Scholar
  4. Aral, S. O. (1999). Sexual network patterns as determinants of STD rates: Paradigm shift in the behavioral epidemiology of STDs made visible. Sexually Transmitted Disease, 26, 262–264.CrossRefGoogle Scholar
  5. Austin, J. Naro, W., & Fabelo, T. (2007). Public safety, public spending: Forecasting America’s Prison Population 2007–2011, A project of the Pew Charitable Trust, JFA Institute, 1-52.
  6. Baillargeon, J., Giordano, T. P., Rich, J. D., Wu, Z. H., Wells, K., Pollock, B. H., et al. (2009). Accessing antiretroviral therapy following release from prison. Journal of the American Medical Association, 301, 848–857.PubMedCrossRefGoogle Scholar
  7. Beatty, P., Petteruti, A., & Ziedenberg, J. (2007). The vortex: The concentrated racial impact of drug imprisonment and the characteristics of punitive counties (pp. 1–32). Washington, DC: Justice Policy Institute Report.Google Scholar
  8. Carvell, A. L. M., & Hart, G. J. (1990). Risk behaviors for HIV infection among drug users in prison. British Medical Journal, 300, 1383–1384.PubMedCrossRefGoogle Scholar
  9. Center for Addiction and Substance Abuse (CASA). (1998). Crossing the bridge: An evaluation of the Drug Treatment Alternative to Prison (DTAP) Program, the National Center on Addiction and Substance Abuse at Columbia University, National Institute on Drug Abuse, 1–30.Google Scholar
  10. Centers for Disease Control and Prevention. (1998). HIV Prevention through early detection and treatment of other sexually transmitted diseases: United States recommendations of the Advisory Committee for HIV and STD prevention. MMWR Recommendations and Reports, 47 (rr12), 1–24.Google Scholar
  11. Centers for Disease Control and Prevention. (2006). HIV transmission among male inmates in a state prison system – Georgia, 1992–2005. Morbidity and Mortality Weekly Report, 55, 421–426.Google Scholar
  12. Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). Treating drug abuse and addiction in the criminal justice system. Journal of the American Medical Association, 301, 183–190.PubMedCrossRefGoogle Scholar
  13. Clarke, J. G., Stein, M. D., Hanna, L., Sobota, M., & Rich, J. D. (2001). Active and former injection drug users report of HIV risk behaviors during periods of incarceration. Substance Abuse, 22, 209–216.PubMedGoogle Scholar
  14. Clear, T. R. (2007). Imprisoning communities: How mass incarceration makes disadvantaged neighborhoods worse. New York: Oxford University Press.CrossRefGoogle Scholar
  15. Clements-Nolle, K., Marx, R., Pendo, M., Loughran, E., Estes, M., & Katz, M. (2008). Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail. American Journal of Public Health, 98, 661–666.PubMedCrossRefGoogle Scholar
  16. Comfort, M., Grinstead, O., McCartney, K., Bourgois, P., & Knight, K. (2005). “You cannot do nothing in this damn place:” Sex and Intimacy among couples with an incarcerated male partner. Journal of Sex Research, 42, 3–12.PubMedCrossRefGoogle Scholar
  17. Courtwright, D. T. (2004). The Controlled Substances Act: How a “big tent” reform became a punitive drug law. Drug & Alcohol Dependency, 76, 9–15.CrossRefGoogle Scholar
  18. Cropsey, K. L., Wexler, H. K., Melnick, G., Taxman, F. S., & Young, D. W. (2007). Specialized prisons and services: Results from a national survey. Prison Journal, 87, 58–85.PubMedCrossRefGoogle Scholar
  19. Crosland, C., Poshkus, M., & Rich, J. (2002). Treating prisoners with HIV/AIDS: The importance of early identification, effective treatment and community follow-up. AIDS Clinical Care, 14, 67–76.PubMedGoogle Scholar
  20. Dembo, R., Belenko, S., Childs, K., Wareham, J., & Schmeidler, J. (2009). Individual and community risk factors and sexually transmitted diseases among arrested youth: A two level analysis. Journal of Behavioral Medicine, 32(4), 303–316.PubMedCrossRefGoogle Scholar
  21. Dufour, A., Poulin, A. M., Allard, F. N., Trottier, G., Lepine, D., & Hankins, C. (1996). Prevalence and risk behaviors for HIV infection among inmates of a provincial prison in Quebec City. AIDS, 10, 1009–1015.PubMedCrossRefGoogle Scholar
  22. Duncan Smith-Rohrberg, M., & Basu, S. (2007). HIV control efforts should directly address incarceration, reflection and reaction. The Lancet Infectious Disease, 7, 568.CrossRefGoogle Scholar
  23. Durose, M. R., & Langan, P. A. (2001). Bureau of Justice Statistics, State Court Sentencing of Convicted Felons, 1998 Statistical Tables, U.S. Department of Justice.Google Scholar
  24. Farley, T. A. (2006). Sexually transmitted diseases in the southeastern United States: Location, race and social context. Sexually Transmitted Diseases, 33(7 Suppl), S58–S64.PubMedCrossRefGoogle Scholar
  25. Gaiter, J., Potter, H., & O’Leary, A. (2006). Disproportionate rates of incarceration for people of color contribute to major health disparities in the U.S. [Letter]. American Journal of Public Health, 96, 1148–1149.PubMedCrossRefGoogle Scholar
  26. Hammett, T. M., & Drachman-Jones, A. (2006). HIV/AIDS, sexually transmitted diseases and incarceration among women: National and southern perspectives. Sexually Transmitted Diseases, 33(7 Suppl), S17–S22.PubMedCrossRefGoogle Scholar
  27. Harawa, N., & Adimora, A. (2008). Incarceration, African Americans and HIV: Advancing a research agenda. Journal of the National Medical Association, 100, 57–62.PubMedGoogle Scholar
  28. Hartney, C. (2006). U.S. rates of incarceration: A global perspective, Fact Sheet, Research from the National Council on Crime and Delinquency, November, 1–8.Google Scholar
  29. Hartney, C. & Silva, F. (2007). And justice for some: Differential treatment of youth of color in the justice system. National Council on Crime and Delinquency. Scholar
  30. Department of Health, Government of the District of Columbia HIV/AIDS Epidemiology Annual Report, Department of Health, HIV/AIDS Administration, Bureau of Surveillance and Epidemiology, November, 2007 Washington, DC.
  31. Iguchi, M. Y., Bell, J., Ramchand, R. N., & Fain, T. (2005). How criminal system racial disparities may translate into health disparities. Journal of Health Care for the Poor and Underserved, 16, 48–56.PubMedGoogle Scholar
  32. Iguchi, M. Y., London, J. A., Forge, N. G., Hickman, L., Fain, T., & Reihman, K. (2002). Elements of well-being affected by criminalizing the drug user. Public Health Reports, 117(Suppl 1), 5146–5150.Google Scholar
  33. Inciardi, J. A., Martin, S. S., Butzin, C. A., Hooper, R. M., & Harrison, L. D. (1997). An effective model of prison-based treatment for drug involved offenders. Journal of Drug Issues, 27, 261–278.Google Scholar
  34. Kang, S. Y., Deren, S., Andia, J., Colon, H. M., Robles, R., & Oliver-Velez, D. (2005). HIV transmission behaviors in jail/prison among Puerto Rican drug injectors in New York and Puerto Rico. AIDS and Behavior, 9, 377–386.PubMedCrossRefGoogle Scholar
  35. Karberg, J. C., James, D. J., (2002). Substance dependence, abuse and treatment of jail inmates, Bureau of Justice Statistics, Office of Justice Programs, Washington, DC, July 2005, NCJ 209588.Google Scholar
  36. King, R. S., & Mauer, M. (2005a).The War on Marijuana: The transformation of the war on drugs in the 1990s, Report of The Sentencing Project, Washington, DC, 1–33.Google Scholar
  37. Krebs, C. P. (2006). Inmate factors associated with HIV transmission in prison. Criminology and Public Policy, 5, 113–136.CrossRefGoogle Scholar
  38. Krebs, C. P., & Simmons, M. (2002). Intra-prison HIV transmission: An assessment of whether it occurs, how it occurs and who is at risk. AIDS Education and Prevention, 14(Suppl. B), 53–64.PubMedCrossRefGoogle Scholar
  39. Lane, S. D., Rubinstein, R. A., Keefe, R. H., Webster, N., Cibula, D. A., Rosenthal, A., et al. (2004). Structural violence and racial disparity in HIV transmission. Journal of Health Care for the Poor and Underserved, 15, 319–335.PubMedCrossRefGoogle Scholar
  40. Mahon, N. (1996). New York inmate’s HIV risk behaviors: The implications for prevention policy and programs. American Journal of Public Health, 86, 1211–1215.PubMedCrossRefGoogle Scholar
  41. Marusak, L. M. (2005). HIV in prisons, 2003. Washington, DC: Bureau of Justice Statistics. NCJ publication no. 210344.Google Scholar
  42. Mauer, M. (2006). Race to incarcerate. New York, London: The New Press.Google Scholar
  43. Mauer, M., & King, R. S. (2007). Uneven justice: State rates of incarceration by race and ethnicity (pp. 1–19). Washington, DC: The Sentencing Project Report.Google Scholar
  44. May, J. P., & Williams, E. L. (2002). Acceptability of condom availability in a U.S. jail. AIDS Education and Prevention, 14(Suppl. B), 85–91.PubMedCrossRefGoogle Scholar
  45. Morris, M., & Kretschmar, M. (1995). Concurrent partnerships and transmission dynamics in networks. Social Networks, 17, 299–318.CrossRefGoogle Scholar
  46. Morris, M., & Kretschmar, M. (1997). Concurrent partnerships and the spread of HIV. AIDS, 11, 641–648.PubMedCrossRefGoogle Scholar
  47. Moseley, K., & Tewksbury, R. (2006). Prevalence and predictors of HIV risk behaviors among male prison inmates. Journal of Correctional Health Care, 12, 132–144.CrossRefGoogle Scholar
  48. Mumola, C. J., & Karberg, J. C. (2006). Drug use and dependence, state and federal prisoners, 2004. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics Special Report. NCJ 213530, 1-11.Google Scholar
  49. Okie, S. (2007). Sex, drugs, prisons and HIV. The New England Journal of Medicine, 356, 105–108. Available at: Scholar
  50. Pearson, F. S., & Lipton, D. S. (1999). A meta-analytic review of the effectiveness of corrections-based treatments for drug abuse. Prison Journal, 79, 384–410.CrossRefGoogle Scholar
  51. Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., et al. (2000). Viral load and heterosexual immunodeficiency virus type 1, Rakai Project Study Group. The New England Journal of Medicine, 30, 970–972.Google Scholar
  52. Rouse, B., Sanderson, C., & Feldmann, J. (2006). The 2005 National Survey on Drug Use and Health. Washington, DC: Table J, Division of Population Surveys, Substance Abuse and Mental Health Services Administration (SAMHSA). Available at: Scholar
  53. Sabol, W. J., Couture, H., & Harrison, P. M. (2007). Prisoners in 2006. Washington, DC: United Sates Department of Justice, Bureau of Justice Statistics Bulletin. NCJ 219416, 1-26.Google Scholar
  54. Seal, D. W., Belcher, L., Morrow, K., Eldridge, G., Binson, D., Kacanek, D., et al. (2004). A qualitative study of substance use and sexual behavior among 18- to 29-year-old men while incarcerated in the United States. Health Education and Behavior, 31, 775–789.PubMedCrossRefGoogle Scholar
  55. Seal, D. W., Margolis, A. D., Morrow, K. M., Belcher, L., Sosman, J., Askew, J., et al. (2008). Substance use and sexual behavior during incarceration among 18-29-year old men: Prevalence and correlates. AIDS and Behavior, 12, 27–40.PubMedCrossRefGoogle Scholar
  56. Spaete, J. P., & Rich, J. D. (2005). HIV prevention and care in incarcerated populations. Focus, 20, 1–9.PubMedGoogle Scholar
  57. Springer, S. A., Friedland, G. H., Doros, G., Pesanti, E., & Altice, F. L. (2007). Antiretroviral treatment regimen outcomes for HIV infected prisoners. HIV Clinical Trials, 8, 205–212.PubMedCrossRefGoogle Scholar
  58. Stemen, D., Rengifo, A., & Wilson, J. (2006). Of fragmentation and ferment: The impact of state sentencing policies on incarceration rates, 1975–2002, Final Report to the U.S. Department of Justice by the Vera Institute of Justice, 1–217.Google Scholar
  59. Sylla, M. (2008). HIV treatment in U.S. jails and prisons. San Francisco AIDS Foundation, online newsletter retrieved from
  60. Taxman, F. S., Perdoni, M. L., & Harrison, L. D. (2007). Drug treatment services for adult offenders: The state of the state. Journal of Substance Abuse and Treatment, 32, 239–254.CrossRefGoogle Scholar
  61. Thomas, J. C., & Gaffield, M. E. (2003). Social structure race and gonorrhea rates in the southeastern United States. Ethnicity and Disease, 12, 362–368.Google Scholar
  62. Thomas, J. C., & Torrone, E. (2006). Incarceration as forced migration: Effects on selected community health outcomes. American Journal of Public Health, 96, 1762–1765.PubMedCrossRefGoogle Scholar
  63. Travis, J. (2005). But they all come back: Facing the challenges of prisoner reentry. Washington, DC: The Urban Institute Press.Google Scholar
  64. U.S. Department of Justice. (2003). The Federal Bureau of Investigation. Crime in the U.S. 2002 (pp. 252–259). Washington, DC: Government Printing Office.Google Scholar
  65. Volkow, N. D. (2008). Drugs, brains and behavior: The science of addiction, National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, NIH Pub. No. 07-5605, 1–30.
  66. Warren, J., Gelb, A. Horowitz, J., & Riordan, J. (2008). One in 100: Behind bars in America 2008, The Pew Public Safety Performance Project, Pew Center on the States.
  67. Webb, J. (2007). U.S. Senator (VA). Mass incarceration in the United States: At what cost? Opening statement, Joint Economic Committee Hearing, October, 4. Washington, DCGoogle Scholar
  68. Western, B., Kling, J. R., & Weiman, D. F. (2001). The labor market consequences of incarceration. Crime and Delinquency, 47, 410–427.CrossRefGoogle Scholar
  69. Wilson, P., Wright, K., & Isbell, M. T. (2008). Left behind, Black America: A neglected priority in the global AIDS epidemic. Los Angeles, CA: Black AIDS Institute. Available at: Scholar
  70. Wohl, A. R., Johnson, D., Jordan, W., Lu, S., Beall, G., Currier, J., et al. (2000). High-risk behaviors during incarceration in African American men treated for HIV at three Los Angeles public medical centers. Journal of Acquired Immune Deficiency Syndromes, 24, 386–392.PubMedGoogle Scholar
  71. Wood, E., Li, K., Small, W., Montaner, J. S., Schechter, M. T., & Kerr, T. (2005). Recent incarceration independently associated with syringe sharing by injection drug users. Public Health Reports, 120, 150–156.PubMedGoogle Scholar
  72. World Health Organization, UNAIDS. (2007). AIDS epidemic update, Joint United Nations Programme on HIV/AIDS, 1–50,
  73. World Health Organization/UNAIDS. (2006). HIV/AIDS prevention, care, treatment and support in prison settings: A framework for an effective national response (pp. 1–36). Vienna, NY: United Nations Office of Drugs and Crime, United Nations. Available at: Scholar
  74. Zaller, N., Thurmond, P., & Rich, J. D. (2007). Limited spending: An analysis of correctional expenditures on anti-retrovirals for HIV infected prisoners. Public Health Reports, 122, 49–54.PubMedGoogle Scholar
  75. Zierler, S., & Krieger, N. (1997). Reframing women’s risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA

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