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Prisoner Health Update: HIV

by Eike Blohm, MD

Human immunodeficiency virus (HIV) is highly overrepresented among U.S. prisoners, along with other infectious illnesses such as MRSA, Hepatitis-C and tuberculosis. [See: PLN, Jan. 2023, p.38; Feb. 2023, p.52; and June 2023, p.41.]

The high prevalence of HIV among prisoners is due to the selective incarceration of Americans who struggle with intravenous substance use, as well as a lack of mandatory and universal testing protocols in prisons.

After an initial outbreak infected five gay men in Los Angeles in June 1981, the then-unknown disease was called GRIDS: gay-related immunodeficiency syndrome. Coinciding with what was then still a young movement for gay rights, HIV/AIDS became stigmatized as a punishment for what many religious people view as sinful and immoral behavior. Sadly, the negative impact of this stigmatization persists even today.

How is HIV transmitted?

HIV is a virus transmitted from one person to another by blood, usually due to unprotected sexual intercourse or sharing needles (e.g., during tattooing or drug use). It cannot be transmitted through casual contact such as shaking hands or exchanging hugs, nor by inanimate objects such as toilets seats or drinking cups. Thus, an HIV-positive cellmate does not pose an infection risk unless the two of you are having sex or sharing needles.

Why is HIV so hard to treat?

Our genetic information is stored in our DNA. In each new cell the DNA is transcribed into an RNA strand – like a working copy that allows preservation of the original. In turn, the RNA is then translated into a protein by a cellular machine called a ribosome. Viruses hijack cells and substitute their own DNA for this process, tricking ribosomes into producing more virus instead.

HIV does not have DNA. It is a retrovirus (retro means “backwards”) that stores its genetic information as RNA. It brings along its own enzyme called “reverse transcriptase,” which transcribes the RNA into DNA and the viral DNA is then inserted into the human DNA of the cell. In other words, HIV welds itself into our genome. Doctors are not yet able to selectively excise the viral DNA from our chromosomes.

What are symptoms of an HIV infection?

A person who contracts HIV experiences symptoms like the flu within a few days of exposure. Fever, headache, joint and muscle pain last for 1-2 weeks, then disappear. Unlike other sexually transmitted illnesses, there are no genital lesions, rashes, or discharge. What follows is an invisible war between the virus and the immune system, with no outward symptoms at all during a period that can last for years. But because HIV infects cells of the immune system, it is slowly weakening the body’s defense mechanism until it can no longer fight off other infections.

What is the difference between HIV and AIDS?

HIV is the virus; AIDS – acquired immunodeficiency syndrome – Is the illness that it eventually causes. AIDS is diagnosed when a person starts having opportunistic infections, like thrush, a fungal mouth infection that a person with a healthy immune system would not get. Not every person with HIV will develop AIDS; modern medications are now so effective that HIV can be suppressed indefinitely.

Can a person with HIV still have children?

If a prisoner or his partner is HIV-positive and they plan to start a family after release from prison, they can safely do so. To prevent infection during intercourse, the HIV-negative partner should take prophylactic medication. That’s doesn’t mean swallowing a condom, but taking a prescription drug like Truvada, Descovy or Apretude, designed to provide “Pre-exposure prophelaxis” (or PreP) to HIV infection.

While the baby grows inside the mother, their blood does not mix, so an HIV-positive mother will not infect her unborn child. However, the trauma of vaginal delivery can lead to blood-to-blood contact and thus infection, so the baby must be delivered by Cesarean Section. HIV can also be transmitted by breast milk, so an HIV-positive mom must bottle-feed her baby.

How can I get tested?

HIV testing is usually done with a blood test, although mouth swabbing is an alternative. The prison medical staff should be able to perform this test in accordance with its protocols. The test looks for antibodies to HIV that your body has produced, and it requires a certain amount of virus to be present, so a person who just got infected might still test negative. About two weeks after exposure, the test becomes more reliable.

Living with HIV

With proper medication and regular checkups, you can live a long, full life with HIV. What was a death sentence 40 years ago today has become a long-term manageable disease, not unlike diabetes. But just as diabetics risk death without regular medication, those positive for HIV should not skip proper healthcare. Prison and jail medical providers are required to treat HIV, just as they must treat any other disease. After release, Medicaid is available to help former prisoners avoid disruption in treatment due to financial need. If a case worker is not available at your prison prior to your release, find the nearest public health officer after your release to get signed up.

Disclaimer: This column aims to educate prisoners about a common health condition, but it does not constitute medical advice and is no substitute for evaluation by a trained medical professional.