African-Americans contract HIV and AIDS at an ever-growing rate, and some political advocates say the trend may relate directly to the rising number of blacks in jails and prisons.
"There seems to be a relationship," said Terje Anderson, executive director of the Maryland-based National Association for People with AIDS. "Most people working in the field are very concerned about it."
Blacks make up 13 percent of the U.S. population, but account for almost half of the AIDS cases in the United States, according to the Centers for Disease Control and Prevention. And in the last decade, African-Americans became 10 times more likely to become infected with HIV and AIDS than whites, a newly released CDC study shows.
In the same decade, the number of people in jails and prisons in the United States shot up by 31 percent, and roughly 40 percent of inmates are African-American, according to Bureau of Justice statistics.
Prisons and jails become hotbeds for HIV because the inmates?"many of whom were intravenous drug users before they were locked up?"have unprotected sex with each other. Then when released, they return to their communities and reunite with girlfriends and wives, continuing the spread of the disease.
Keith DeBlasio should know. When sent to federal prison in Michigan for embezzlement and fraud in 1996, he said he was raped repeatedly. Now he's HIV positive.
"I never dreamed it would be something that would happen to me," he said.
DeBlasio said HIV in prisons is something that can't be ignored.
"It is continuing to be a high risk for people on the outside," DeBlasio said. "[Inmates are] having unprotected sex while they're incarcerated, and then they're bringing it back to their families."
Since African-Americans make up a disproportionate number of the inmate population, the spread of HIV affects the general black community even more acutely. Although Geraldine McQuillan, the CDC's lead researcher, said she didn't have evidence to tie the rise in HIV infection among African-Americans to the rise in prison populations, she suggested the high proportion of blacks in prison could have an impact because "most people select their sexual partners within their racial boundaries."
Experts also attribute the rise to a lack of education about the disease, a reluctance to use condoms and drug use.
One of the experts, Lara Stemple of the Stop Prisoner Rape advocacy group, said unprotected sex in prisons remains one of the most serious and least-talked about ways that the disease spreads so rapidly among African-Americans.
"When you look at the populations affected, it's hard not to think they're connected," she said.
One out of every five inmates has sex with another inmate, according to a 2000 study by Cindy Struckman-Johnson of the University of South Dakota. And those in prison are at least five times more likely to have HIV than people on the outside, although current methods of testing don't accurately measure when people contract the disease.
"What is interesting is that we know a lot of people are coming out of prison with HIV or AIDS," said Jaime Sellner, a spokeswoman for the New York City-based Human Rights Watch.
But researchers can't determine exactly how the disease spreads behind bars because very few jails do comprehensive HIV testing of inmates when they're booked and released.
The Illinois Department of Corrections, the agency that operates prisons here, offers HIV tests to inmates as they enter the system, but does not require it.
At the Cook County Jail, inmates must request an HIV test. In the last year, about 110,000 people came through the jail. Of those, 3,915, or 3.5 percent of inmates were tested and 88 were diagnosed as positive, according to a spokesman for the jail's medical provider.
DeBlasio said many state and local governments don't make HIV testing required because they don't want to have to spend money to treat people who test positive, adding that his medication costs $30,000 a year.
"By avoiding mandatory testing, they avoid mandatory costs," DeBlasio said.
Many activists, including the Rev. Jesse Jackson, are pushing for increased testing. In December 2002, Jackson preached the importance of testing to Cook County Jail inmates. He, along with others, want jails and prisons to allow or issue condoms.
"One of the key things, if there is ongoing risk behavior?"and let's face it, in prisons or jails there is?"just relying on entry and exit testing isn't enough," said Anderson, whose National Association for People with Aids group supports the use of condoms behind bars.
"Despite the fact that people recognize that sex happens, among a population with a high infection rate, there is very little people can do to protect themselves," said Human Rights Watch spokeswoman Rebecca Schleifer.
Only five jails?"Los Angeles, New York City, Philadelphia, Washington, D.C., and San Francisco?"provide condoms to inmates and only two states, Vermont and Mississippi, hand out condoms in prisons.
The Cook County Jail and the Illinois Department of Corrections both ban condoms.
"We don't condone inmates having sex in prisons," said Dede Short, spokeswoman for the Illinois Department of Corrections.
Although passing out condoms in prisons and jails seems too taboo for many lawmakers, Congress did pass legislation to try to limit sexual assault in prisons.
The Prison Rape Reduction Act in 2003 holds facilities accountable for inmate behavior. Under the new law, the Department of Justice will conduct annual anonymous inmate surveys about sexual assault, and the states with the highest incident rates could lose federal funding.
Rep. Frank Wolf, R-Va., who co-sponsored the bill, said the spread of disease behind bars was a reason for the new law. "The high incidence of rape within prison leads to the increased transmission of HIV/AIDS, hepatitis and other diseases, which in turn costs all of society," he testified to a Senate committee in July 2002.
This sentiment is shared by one who knows.
"There's mornings where I'm sick and the medication makes me have dry heaves," said HIV-infected DeBlasio. "It gives me the incentive to keep on fighting."
But in the future, DeBlasio said he hopes others won't have to suffer like him.