In Her Own Words: Violations of Women's Human Rights and HIV
August 14, 2006
XVI International AIDS Conference
Toronto, Canada

Remarks by Paulette Nicholas and Judith Auerbach

Available in Word and PDF

Paulette Nicholas: Hello. I'm Paulette. One of the issues that I'm faced with that is very challenging is the discriminating practices in the prison system of many women living with HIV. Alabama has a practice that violates rights of many women because of their HIV disability and it segregates you, denying you the opportunity and the access to rehabilitation services of any program within the correctional system. Men and women are basically placed in a part of the prison that looks very much like a dungeon and you have no contact with anybody other than the correctional staff and other HIV positive inmates. It is pretty challenging because in the prison system you have men and women who are living with Hep-C and TB who interact in the population which is a far more challenging issue than living with HIV—yet HIV is singled out. And, specifically, emphasis is placed on segregation. One of the biggest challenges with that is that there are clear discrimination laws with the American with Disabilities Act as well as the Department of Justice, Civil Rights Division who represent laws for such violations and not very much is being done and these practices continue to exist. With these practices you find that it inflicts health issues on men and women living with HIV needlessly. Not only that, it increases stigma and it's criminalizing as well.        

Judith Auerbach: When Paulette and I first met over the telephone and started talking about how we were going to do this panel we naturally and organically got into more of a discussion rather than sequential presentations. Paulette has particular experience as a positive woman in a prison-you haven't talked much about your own experience as a positive woman in a prison. Do you want to say anything more about that before I say anything?

PN: One of my personal experiences is that I was convicted and was sentenced to ten years and I did three of those ten years on that specific segregated unit. So, I have this experience of living on that unit. Living in a system where HIV is not recognized—in other words, you are thought of in that system as dead. You are not worthy to have any other right other than you are going to die. The medical treatment is very inadequate and basically the knowledge and the motivation and the hope of women living with HIV in that unit is very dismal.

JA: Thank you for adding a little bit more. So part of what Paulette's story tells us is the reality of HIV positive women generally, and particularly in prison, is the intersection of race, class, and sex and gender in the United States, which still produces terrific amounts of discrimination and has a very disparate impact with respect to HIV and AIDS on different communities of women. So, in the prison system, for example, even among women, positive women are discriminated against. It's probably no coincidence that women of color represent a disproportionate share of the HIV/AIDS epidemic in the United States, and at the same time women of color are disproportionately represented in the prison system…so this is a particular setting in which we can see that intersection. And I remember when Paulette and I were first talking and you also mentioned—you said a little bit just now—about the ways in which treatment in prison is not provided for women. I should add to Paulette's reference to Alabama—it currently is the only state in the United States that has segregated wards. There were other states that had them in the past but there has been a trend away from segregating those who are HIV positive residents. So Alabama is really probably the most arcane in that respect.

A thing to note if you are not from the States-prison population and prison practices very much differs by state. There are federal prisons and there are local prisons so the policies that affect HIV positive women, or women more generally, are going to be different from one state to the next. So it is very hard to talk about a U.S., or U.S. government approach, to this question.

But I wonder, Paulette, if you could talk a little bit more about access to treatment and how the health care providers do or don't make that a good or a bad experience for positive women in prison?

PN: Judy, I would just like to point out that nothing for people living with HIV is anything that anyone makes easy, and it's even worse in a prison setting. You have no choices or control over what you do get and what you do not get. But there, the treatment, the medical care, is very inadequate. A lot of times the medical staff do not have the knowledge for the protease inhibitors and a lot of times monotherapy is just forced upon inmates and it is just accepted because most of the women don't have knowledge that it's not okay to take monotherapy. A lot of times the medications come late, or often, dosages of medications are missed because it does not have the significance, or it is not important that you need your medicines at a specific time and you need to have this on a routine basis. This has often times caused opportunistic infections that have often led to death.

JA: I just want to add a couple of points to this, just to make the point about this terrible situation and particularly the difficult situation for positive women in the prison system. And that is that women inmates are 36 times more likely to be living with HIV and AIDS than non-incarcerated women. So you have a very disproportionate number of women with HIV infection in the prison system relative to unincarcerated women. And at the same time female state prisoners-I think state prisons are the bulk of the prison population in the United States-are 60 percent more likely to be HIV positive than their male counterparts. So women in the prison system are more likely to be positive than are men in the prison system. So again we have a situation in the U.S.—I think everybody here is pretty well convinced that we are not a model in many respects, in fact we have many problems—but it is not well known all the time about how gender, race and class intersect in ways that really produce some pretty horrible situations and I think that the situation of positive women in prison is a particularly bad one.

Charlayne Hunter-Gault: I would like to just ask you one question before we move on. Is there any light at the end of that tunnel? Do you see any place where there is progress being made?

PN: Thank you for that question because that gives me an opportunity. There has been tremendous progress beginning with the fact that I now go back to that specific unit and provide HIV education and empowerment. And with knowledge, education and empowerment it has tremendously made a difference in the women's lives, starting with the ability to advocate for their own needs. So bringing in the knowledge and empowering these women, and this coming from a woman who was there living with them, has made a major impact toward change for that unit. And one other thing is that the Supreme Court did rule several years ago that it is unconstitutional to segregate and discriminate; however, no major change has been brought forth in providing programs to those women. But the biggest change is hope through empowerment.

CHG: Thank you. Thank you so much.