Women Sexually Involved With Former Inmates Face HIV-Prevention Challenges
Fourteen years ago, 25-year-old Precious Jackson did something that many young women her age do: She fell in love. Her boyfriend at the time had a lengthy rap sheet and was in and out of prison, but "those were the types of men that I really dug," she recalls. "I liked the bad boys." Though Jackson wanted to ask him to take an HIV test, "I didn't want to insult his manhood," she says. A year and a half later, he tested positive for HIV, and so did she.
Jackson is convinced that her ex-boyfriend contracted HIV in prison, where high-risk behavior is not uncommon. Not only does consensual sex -- and rape -- occur, but injection drug use and tattooing often take place behind bars as well. According to the U.S. Department of Justice, about 1.5 percent of prisoners are HIV positive (pdf), and it's estimated that between 17 percent and 25 percent of people in the U.S. living with HIV have been in the prison system. Black Americans are incarcerated at a higher rate than all other races and ethnic groups.
While it's not uncommon for prisoners to be HIV tested when they enter prison, they aren't likely to be tested again unless they admit to having engaged in high-risk behavior, according to Edward Harrison, president of the National Commission on Correctional Health Care. But many inmates don't want to come clean, says Linda McFarlane, deputy executive director of Just Detention International (JDI), a Los Angeles-based organization that works to end sexual abuse in prisons. "People fear disciplinary action if they expose that either they were tattooing, that they were using IV drugs or that they had any type of sexual activity. Even consensual sex is not allowed in the prisons," McFarlane says.
While it's important for all women to consider the possibility that a sexual partner may have HIV and to protect themselves by getting tested and using condoms, women who date men who have been incarcerated face unique challenges, experts say. It is often more difficult to get former inmates to open up about high-risk behavior that they may have taken part in while incarcerated.
Many times, men won't want to think about prison, let alone talk about it. A man who engages in consensual sex in prison may not consider himself to be gay and is not likely to share that information, or may interpret a request to get an HIV test as a questioning of his manhood. Many of those inmates who are coerced into sex--as many as 20 percent of men behind bars (pdf), according to JDI--"are ashamed to tell their wives or girlfriends that they were sexually assaulted while inside, and did not take precautions" with them, says McFarlane.
To help women who are dating or are married to current or former prisoners, Jackson, now 39, has created Project Home at the Los Angeles-based Center for Health Justice, where she works as a women's health educator. In her role, she teaches women how to communicate with their partners about their time spent in prison and how to protect themselves from the risk of HIV.
"You can't just straight out tell him, 'You've been in prison; you need to go get tested,' " she says, because he may become defensive. If you or someone you know is in a relationship with a man who has been incarcerated, Jackson offers the following suggestions:
Make it about him: Be sure he knows you're thinking of his best interests. "Tell him you want to make sure that your king is healthy when he comes home to his queen," she says.
Don't emphasize sex as a risk factor: Let him know you're aware that there are all kinds of risks in prison, including fights in which blood can be transmitted through an injury. "Tell your man that you've heard about some of the things that go on 'inside' and you're just concerned about his health," Jackson says.
Offer to get tested too: HIV is epidemic in many Black communities. "Tell him, 'I would love for us to get tested together to make sure everything is fine,' " Jackson says.
Take matters into your own hands: If a partner is resistant to testing or doesn't want to use condoms, women now have the option of using female condoms, made specifically for vaginal and anal sex, Jackson says. "Women can control their own health," she adds.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about emotional health and wellness.