This first theme seeks to tackle the intersection of prison, healthcare, and infectious disease, and the systemic factors contributing to inadequate healthcare and high rates of disease in prisons. The articles included here feature one from the summer of this year, two from the end of 2019, one from the summer of 2018, and one reaching back to December of 2011. This post is timely with the ongoing COVID-19 pandemic, and includes one article specifically focused on its impact in prison systems. While scholarship on the pandemic’s impact on prisons is limited to date, a small section at the end of the post includes a handful of articles from both anthropology journals and medical journals which are quick and informative reads.
In the summer 2020 issue of the Journal of Criminal Law and Criminology, U.S. magistrate judge Gabriel Fuentes discusses the impact of COVID-19 on decisions for detention or release by federal judges in the U.S. in his article, “Federal Detention and ‘Wild Facts’ During the COVID-19 Pandemic.” Fuentes analyzes the typical use of the Bail Reform Act by federal court judges in determining whether a defendant poses too much risk to the general public if released. Fuentes then breaks down the ways in which a defendant may use the Bail Reform Act in their favour to argue for release based on the risk of contracting COVID-19 if detained. Finally, Fuentes identifies the need for judges to take seriously the “wild facts” of COVID-19 which come from human experience and scientific discovery as opposed to law. He notes that despite lockdowns, health screenings, increased sanitation measures, and visitation restrictions imposed by the U.S. Bureau of Prisons, COVID-19 is still spreading quickly in prisons. Fuentes indicates that the decision judges must face in their rulings has expanded from ‘will the defendant pose a risk to the community if released?’ to ‘is the risk that the defendant poses to the community greater than their risk of contracting COVID-19 while in prison?’
The Pennsylvania Magazine of History and Biography’s October 2019 issue included a historical article by Kristin O’Brassill-Kulfan, which utilizes a case study of Philadelphia’s Arch Street Prison to analyze the intersections of criminal justice and penal policy, poverty, and disease in the 19th century. The article, “‘Severe punishment for their misfortunes and poverty’: Philadelphia’s Arch Street Prison, 1804-37,” analyzes prison records from an investigation into the conditions of the Arch Street Prison, following the cholera epidemic in 1832, after it decimated one third of the prison’s population. The prison itself housed vagrants and debtors in poor, unclean, overcrowded conditions, exacerbated by the increased arrest of supposedly disease-ridden and dirty vagrants to prevent the spread of cholera in the general public. While New York City released its petty criminals during the 1832 pandemic, Philadelphia did not, and the spread of cholera within the city was blamed on vagrants and the Black population – the Arch Street Prison population. The investigation of the Arch Street Prison concluded that its poor cleanliness, air quality, prisoner diets, and housing situation were as much to blame for the vulnerability and spread of disease as poverty, particularly when contrast with the conditions and lack of cases in prisons housing convicts, and resulted in policy changes and reform of the penal system.
In December 2019’s issue of the International Journal of Prisoner Health, Terrylyna Baffoe-Bonnie, Samuel Kojo Ntow, Kwasi Awuah-Werekoh, and Augustine Adomah-Afari published an article entitled “Access to a quality healthcare among prisoners – perspectives of health providers of a prison infirmary, Ghana.” The authors conducted a study in the James Camp Prison (JCP) in Accra, Ghana, through interviews and participant observation with the five medical staff working in the facility. Based on World Health Organization (WHO) guidelines to adequate health systems and information obtained in the study, the authors determine that the facility’s health system is inadequate on many fronts: it has a poor health information system, with medical records not being transferred from other prisons, and medical records not kept in the JCP or released with prisoners; there is a lack of even basic medical supplies and equipment, which are heavily reliant on donation; there are not enough qualified health workers in the JCP, particularly in light of their risk of exposure to infectious diseases; access to healthcare delivery within the prison is limited by resources and staff, and there are inadequate methods of transferring patients to a hospital if necessary; and financing provided by the prison is insufficient and delayed.
A few months prior, the August 2019 issue of the International Journal of Prisoner Health featured an article by Diana Palma and Jennifer Parr, “Behind prison walls: HIV vulnerability of female Filipino prisoners,” which articulates the results of a study conducted with female Filipino prisoners and NGO directors to understand the vulnerability of pre-trial female prisoners to HIV. Palma and Parr highlight the disproportionate number of female sex workers with HIV in the Philippines (representing 62% of cases), as well as their limited access to testing, and the recent increase of female prisoners due to the criminalization of drug use and sex work. Not only are female sex workers more vulnerable to HIV contraction, they are then detained in an environment with high-risk for the spread of HIV. Their findings from the study indicated that the confluence of a lack of prisoner knowledge of HIV prevention and contraction, unsafe sexual practices inside and outside of prison, lack of education, childhood sexual abuse, no male and female separation of prisoners, health care staff with little training and knowledge of the disease, HIV testing but no treatment, stigma around HIV and contraceptives, and inequitable gender norms contributed to the vulnerability and high risk of female prisoners to HIV. The authors end by denoting the cyclical loop in which females are more vulnerable to HIV as a result of social determinants, these social determinants increase the chances of imprisonment, and imprisonment serves to maximize exposure and female vulnerability to HIV contraction.
The Journal of Immigrant and Minority Health published an article in June 2019 entitled “Guards in Prisons: A Risk Group for Latent Tuberculosis Infection” by Luisa Arroyave, Yoav Keynan, Deny Sanchez, Lucelly López, Diana Marin, Maryluz Posada, and Zulma Vanessa Rueda. The authors focus on an often-neglected prison population which is also at high risk of contracting infectious disease: prison guards. They conducted a study in two all-male prisons in Medellín and Itaguí, Colombia, in which they interviewed and tested 194 guards to assess their working conditions in relation to the prevalence of latent tuberculosis infection (LTBI). Of the 194 guards screened, 75 tested positive for LTBI, with a prevalence of 55.8% at one prison, and 39.1% at the other prison. The tests, together with the interview information, revealed an increased prevalence of LTBI in relation to administrative tasks, longer terms of employment in prisons, drug use at least once, and male sex. Other factors contributing to high rates of LTBI and TB in prisons are similar to studies conducted with prisoners, including inadequate screening, delayed diagnoses and treatment, and high exposure to TB. From this study, the authors conclude that both prisoners and prison guards are vulnerable and at high risk of contracting TB, which is both a risk to the prison guards and the wider community.
The Health and Human Rights Journal’s June 2018 issue included an article by Emily Nagisa Keehn and Ariane Nevin regarding the treatment and prevention of HIV and TB in South Africa’s prisons, and the use of advocacy and litigation in reform of prison health systems. The article, “Health, Human Rights, and the Transformation of Punishment: South African Litigation to Address HIV and Tuberculosis in Prisons,” indicates that the prevalence of HIV and TB stems from the prison conditions themselves, including overcrowding, excessive incarceration, poor infrastructure, and human rights abuses. The authors argue that in order to address and reduce HIV and TB in prisons, the laws and policies governing prisons and incarcerated people require reform, which is most effectively achieved through strategic litigation cases which target “systemic drivers of disease.” The cases analyzed have resulted in reform to unconstitutional health policies and practices, and changes in the criminal justice system at large, serving their purpose in protecting and upholding human rights in prisons despite unpopular public opinion and stigma.
Reaching back a bit further, in December 2011’s issue of the Health and Human Rights Journal, Medea Gegia, Iagor Kalandadze, Mikheil Madzgharashvili and Jennifer Furin published an article entitled “Developing a human rights-based program for tuberculosis control in Georgian prisons.” The authors note that TB disproportionately affects vulnerable populations, and prison populations in particular, stemming from their increased risk in contraction of TB due to overcrowding, unsanitary conditions and inadequate nutrition, and lack of proper diagnoses and treatment. While there was some success following the International Committee of the Red Cross’s initiative to improve diagnosis and treatment in Georgian prisons following a 1997-98 study, TB cases continued to rise both within the prison population and the broader Georgian population. With the prison population increasing from 4,000 to 25,000 between 2004 and 2010, most prisons are operating above their full prisoner capacity, and the Georgian government has declared the situation a health and human rights emergency. The authors conducted a study involving interviews and participant observation in one prison, a hospital, and two health centers, revealing problems with the existing TB control program, including poor infrastructure, inadequate resources and human resources, inadequate screening, and delays in treatment. Finally, the authors propose reforms including the training and certification of incarcerated people as health workers for TB education, screening and care, improved TB diagnosis through molecular testing, enhancements to prison infrastructure to limit mobility, improve air quality and decrease the number of people in one room, and working with a local NGO.
Finally, the ongoing COVID-19 pandemic and its disproportionate impact on vulnerable populations can be helpfully viewed in relation to previous epidemics and infectious diseases, but we also sought out recent scholarship regarding the impact of COVID-19 itself in prisons. Research takes time to do and write up, but scholars already studying prisons have been sharing their perspectives and work. Jason Bartholomew Scott had a one-page article in June’s issue of Social Anthropology entitled “A pandemic in prisons,” Catarina Fróis’s article “COVID-19 Pandemic and Social Distancing in Prisons” appeared in the June issue of Anthropology Today, and the Journal of Institutional Studies (Revista Estudos Institucionais) published “Political Health Inside Rio de Janeiro’s Prison System: Impacts of COVID-19 Pandemic” by Natália Lucero Frias Tavares, Rodrigo Grazinoli Garrido, and Antonio Eduardo Ramires Santoro in April – the abstract is in English through DOAJ, but the article itself is in Portuguese. As well, recent medical journal publications include JAMA Network’s “COVID-19 Cases and Deaths in Federal and State Prisons” by Brendan Saloner, Kalind Parish, and Julie Ward in July 2020, “Prisoners in a pandemic: We should think about detainees during Covid-19 outbreak” by Pamela Tozzo, Gabriella D’Angiolella, and Luciana Caenazzo in the June issue of Forensic Science International: Synergy, and finally, June’s issue of the American Journal of Preventive Medicine included the article “COVID-19 and the Correctional Environment: The American Prison as a Focal Point for Public Health” by Andre Montoya-Barthelemy, Charles Lee, Dave Cundiff, and Eric Smith.As always, we welcome your feedback. If you have any suggestions for journals we should be keeping tabs on for this feature, or if you want to call our attention to a specific issue or article, send an email to firstname.lastname@example.org with the words “In the Journals” in the subject line.