As uncomfortable and politically sensitive as it may be, the road to ending AIDS in the United States runs through the criminal justice system.
The groups at highest risk for HIV are those most entangled with the criminal justice system. Sex workers, men who have sex with men, lesbian, gay, bisexual, and transgender (LGBT) youth, transgender women, and people who use drugs all draw the attention of law enforcement, particularly if they are people of color. Going to jail means a delay and often a total interruption in HIV medications, with potentially serious health consequences. And with a criminal record, finding housing, employment, and other services is more difficult, and so the cycle begins again.
A recent study looked at people with HIV who inject drugs who were once doing well on their medications but later became ill; incarceration was a primary factor associated with this decline.
And so President Obama’s goal of an AIDS-free generation will not be realized without criminal justice reform. This is the message that Human Rights Watch and 13 other organizations recently sent to the Office of National HIV/AIDS Policy as it revises the national strategy for combatting the epidemic in the US.
Worldwide, more than half of new HIV infections occur among five groups of people who are stigmatized, marginalized, criminalized, or all of the above: men who have sex with men, sex workers, transgender women, people in prison, and people who inject drugs. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have developed guidelines for these populations that include reducing police violence, promoting community engagement, and removing legal and policy barriers that hinder access to essential health services including HIV prevention and treatment. The WHO and UNAIDS recommend improving the legal status of sex workers and people who use drugs by decriminalizing adult, consensual sex work and individual use of illicit drugs.
In the US Congress, bipartisan reform efforts are under way. It is time for the Office of National AIDS Policy and other federal agencies responsible for addressing the HIV epidemic to join this fight as a matter of human rights and public health.