I felt nervous sitting in the passenger seat of Dr. McGreevyâs minivan as he peeled out from the hospital parking lot and raced toward the prison. As we moved through traffic, I tried to wipe the sweat from my hands. The anticipation and anxiety of meeting inmates had become far too real. McGreevy, who seemed unaware of my discomfort, handed me a bible and asked me to recite a morning prayer. I chirped âAwake, my glory, Awake, O-harp and lyre, I will awake the dawnâ Dr. McGreevy, an HIV specialist consulting the state prison system, invited me to observe his clinical consultations with inmates. This was my first opportunity to experience life behind bars. On this morning we rushed to meet inmates before officers conducted their morning count, a human inventory that temporarily restricts inmates from coming and going to the medical dispensary.The heavy door hissed and clanked, rolled back, and I entered the central courtyard of Menâs Medium Security Prison. Appearing before me were hundreds of inmates dressed in tan uniforms. While some of the men did pull-ups and lifted weights, others reclined in the grass or walked circles along the perimeter. There was no longer a comfortable distance between myself and the plight of the so-called âcriminal justice-involved populationâ, which, up until this point, I could only sympathise with through media reports and academic texts. Nothing could have prepared me for my first glimpse of mass incarceration. Even now, after spending hundreds of hours inside the prison system, I struggle to comprehend the sheer size of this human experiment.
This book presents research that explored the âlived experienceâ of 34 male and female inmates living with the human immunodeficiency virus (HIV) as they progressed through a combined U.S. state jail-prison system1 and into the community. The study of HIV-positive inmates offered a point of entry into understanding how âviolenceâ was situationally created and reproduced between inmates and a range of medical, social welfare, and security staff. Therefore, this book documents the way HIV-positive inmates went about achieving agency through harm to their body and social standing in order to improve their health under conditions of remarkable constraint.
This book draws from ethnographic research conducted inside a New England state prison system and the surrounding community from 2011 to 2013. The setting is hereafter assigned the fictional name âMelvilleâ in order to maintain the study participantsâ anonymity. The research comprised 77 semi-structured interviews and hundreds of hours of observation across seven correctional facilities ranging from minimum to supermax security. Participants in this research included short and long-term inmates, correctional healthcare providers, correctional officers, prison administrators, ex-inmates, families of inmates, and community-based physicians and social workers. An assortment of public and private peri-carceral spaces collectively comprised the research setting.
The prison was located atop a high hill, rolling up from a river, in an area known as the Melville reservation. Situated 10 miles southwest of a major New England city, the reservation has a university campus-like feel consisting of a series of Victorian stone structures, several twentieth-century colonial revival brick buildings, and an assortment of modern cinderblock structures completed between the 1970s and mid-1990s. The reservation was home to seven active penal facilities, which housed up to approximately 3800 offenders at any given moment. Also located on the reservation was the Melville State Sheriffâs Department, adult Probation & Parole, the only state psychiatric hospital, correctional officerâs union, and prison administrative buildings.
This book depicts the lives of inmates living with HIV and who passed through the Melville prison system during the course of research. In prison, this group had access to HIV and primary medical care, mental health services, dental care, addiction treatment, and integrated case management support linking persons in the correctional setting to the community. Upon release, inmates received continued case management services through community HIV services, primary medical care, addiction treatment, mental healthcare services, health insurance programmes, and other public assistance.
1.1 Who Is Behind Bars?
The U.S. incarcerates 2.2 million people at any given moment, making it the largest prisoner population in the world (Wagner & Sawyer, 2018). By comparison, other industrial nations imprison 5â7 times fewer people than the U.S. (Dyer, 2000). From the 1920s to the 1970s, the growth rate of U.S. incarceration remained relatively stable (National Research Council, 2014). However, in recent decades the number of people behind bars has quadrupled. This historical expansion of the prison system has led scholars to refer to the current period as the era of âmass incarcerationâ (Garland, 2001). Expansion of prisons can be attributed to strict sentencing guidelines developed during the late 1980s and 1990s (e.g., âget tough on crimeâ, âwar on drugsâ, âthree strike policyâ, and mandatory minimum sentencing laws) (Butterfield, 2003; NAACP, 2015).
The prison population unduly draws from poor urban communities with limited access to health and social resources both before and after incarceration (Mallik-kane & Visher, 2008; Travis, 2000; Travis, Solomon, & Waul, 2001). Racially, the prison population is disproportionately comprised of Black men. In 2013, the Federal Bureau of Justice Statistics reported that 526,000 African-American men did time in state and federal correctional facilities, representing 37% of the total prison population. Additionally, there were 1,157,000 African-American men on parole and probation during this time (Carson, 2013). Taken together, 1.68 million Black men were under some form of state or federal supervision (excluding local jails) during 2013, a figure that equates to over 800,000 more black men behind bars when compared to the number of Black men listed as âslavesâ in the 1850 U.S. census (Mulvaney, 2014).
State inmates average less than eleven years of schooling, up to a third of inmates are unemployed upon entering prison, and the average wage of those who were employed at the time of their incarceration was lower than persons with the same level of education (Western & Wildeman, 2009). Imprisonment does not help people escape from poor community conditions but rather amplifies social and structural deprivation. Western & Pettit found that if a person serves any time behind bars, his hourly wage will decrease by approximately 11%, annual employment by nine weeks, and annual earnings by 40% (Western & Pettit, 2010). Further, incarceration has deep-seated collateral consequences that transcend localised community settings. For example, American epidemiologist Ernest Drucker found that 50% of people sent to prison from New York City came from fourteen neighbourhoods in the Bronx, Manhattan, and Brooklyn, neighbourhoods where only 17% of New York adults reside (Drucker, 2011). In turn, individuals left behind in the community experience fractured social ties, economic losses for dependents, increased divorce rates, and prolonged stress among family and friends. This condition has lasting intergenerational impacts on health and future criminal justice involvement (Barreras, Drucker, & Rosenthal, 2005).
The prison population experiences a high burden of communicable and non-communicable disease (Flanigan et al., 2009; Maruschak, Berzofsky, & Unangst, 2015), mental health challenges (James & Glaze, 2006), and alcohol and drug dependency (Chandler, Fletcher, Volkow, 2009; Charuvastra et al., 2001). Because of these factors, the prison has been identified as a vital space for delivering public health and safety (Greifinger, Bick, & Goldenson, 2007). For example, inmates consistently demonstrate elevated HIV levels when compared with the general community (Massoglia & Remster, 2019). In the U.S., HIV is 5-times higher in prison than in the general population (Flanigan et al., 2009). Approximately 1.2 million persons living with HIV, one-sixth of all Americans living with this condition, will pass through the U.S. prison system at some point in their lives (Spaulding et al., 2009).
Over 95% of inmates will eventually leave the correctional setting (Hughes & Wilson, 2004). However, two-thirds of state prison inmates will be re-arrested for a new crime within three years of release, and three-quarters within five years of release ...