In communities in the United States already disproportionally affected by high rates of HIV and mass incarceration, mass incarceration furthers the spread of HIV in these communities. According to some estimates, 14% (or 1 in 7) of all people living with HIV in the US, and 20% (1 in 5) of Black Americans living with HIV, will pass through a jail or prison every year. Though there is variation state to state, the prevalence of HIV in state and federal prisons in the US is nearly five times greater than that of the general population. The factors associated with disproportionate rates of incarceration— drug use, non-conforming sexual or gender identity, mental illness, poverty, or being a person of color—can also augment a person’s risk of contracting HIV. A major challenge of the relationship between HIV and incarceration is the maintenance of care once someone re-enters the community after being incarcerated – it frequently drops off by a large percentage. In order to reduce the HIV epidemic the authors find that jails and prisons need to dedicate funding and fundraising to improving the continuum of care for people living with HIV who interact with the system – from screening to community linkages to care.
Further, over 30 states have laws in place that criminalize alleged HIV exposure, non-disclosure, or transmission. Many states also apply harsher penalties to sex workers and people who inject drugs on the basis of HIV status. These laws perpetuate stigma, undercut public health, and disproportionately affect women, people of color, and other marginalized communities. While HIV criminal laws must be reformed to address the overrepresentation of PLHIV in the criminal legal system, it is also essential to consider broader drivers of incarceration for PLHIV, including the war on drugs and discrimination against people of color and LGBTQ people in housing, employment, and education. Advocacy efforts seeking to reform HIV criminal laws without attention to broader community-level factors affecting risk of incarceration for PLHIV are incomplete.