Our Relationships Carry the Movement

The radical HIV prison activist movement has always been, in practice, an abolitionist movement. Set in Philadelphia in the early 2000s, this article centers the relationships through which leaders of ACT UP Philadelphia, the Philadelphia County Coalition for Prison Health Care, TEACH Outside, and Project UNSHACKLE worked to transform the social conditions for which prisons have been posited as the solution and to create a prison-free future in real time. Its pages unfold a three-part methodological toolkit for HIV prevention justice. First, harm reduction demands that one show up and provide relief, no questions asked. Second, mutual aid grounds the forging of new social relations that are more survivable than those produced by HIV stigma, mass criminalization, and organized abandonment. Third, transformative justice offers both a vision and a practice for challenging criminalization in all its intimate, communal, and structural forms, and building a racially just and strategic HIV movement.

Behind the Wall of Indifference: Prisoner Voices about the Realities of Prison Health Care

While most Americans never see or become ensnared in the nation’s vast correctional system, there are unprecedented costs—economic, social, and ethical—that are being paid, one way or another, by everyone in this country. It is no secret that prison inmates face health threats behind bars that equal anything they face in the streets. Violent assault, rape, or the outbreak of highly infectious diseases are much more common in correctional facilities than in the general population. Prison conditions can easily fan the spread of disease through overcrowding, poor ventilation, and late or inadequate medical care. Effectively protected from public scrutiny, the prison health care system has almost zero accountability, thus escaping outside attention to serious failures of care. If you want to know about the practice of health care in prison settings, ask someone who has been “in” the system. Prisoners have a story to tell and this article gives voice to the experiences of those who have been directly impacted by the provision of health care in the prison system.

Leave no one behind: including the health of prisoners in international development frameworks is essential for achieving sustainable development goals

PurposeThe pledge of the 2030 Agenda for Sustainable Development is “to leave no one behind.” However, there are significant groups of people who are at risk of being left behind. The health and social issues facing prisoners are well known, but past initiatives to address them through international development initiatives have failed to gain widespread support. The purpose of this paper is to advocate for inclusion of prison health care in current international development frameworks such as Universal Health Coverage and the 2030 Sustainable Development Goals.Design/methodology/approachThis is a commentary paper.FindingsThe governments of most countries have accepted both the 2030 Agenda for Sustainable Development and Universal Health Coverage as frameworks for future national development planning. Including prison health care in these frameworks will provide a powerful platform for those advocating for better prison health services and will allow governments wary of offending public opinion to make significant changes to the way prisons are managed. Providing better prison health care services will not only lead to better long-term population health outcomes overall but will also contribute to achieving the 2030 Agenda aspiration to “leave no-one behind.”Originality/valueThis paper provides a discussion of current international development guidance and identifies that prison health care is not sufficiently recognized as an essential contributor to achieving the sustainable development goals.

Isolation and Rethinking

Rather than be corrected or seek penitence, Berkman used his prison time to write to his friends, comrades and family, and to rethink his political trajectory. Often in isolation, and moved around without notice, he tried to figure out how to do his time, make a life and escape the incompetence of prison health care. Sent to Connecticut to stand trial for the robbery, he was given a concomitant sentence along with his federal prison time, then was charged, along with several of his comrades, on a federal conspiracy case.

Becoming Brother Doc

Berkman prepared for his upcoming trial, as sympathetic Black prison inmates called him Brother Doc. Only a few months into his pre-trial imprisonment he tore his Achilles tendon and then developed life threatening Hodgkin’s lymphoma, neither of which was treated properly by prison health care. His transport between hospital and prison, or prison to prison, involved gun-wielding marshals and troopers. He was sentenced to ten years, although the government had asked what amounted to a life sentence. He now faced years in prison.

A Conspiracy for Life

Once again, Berkman’s cancer care was delayed, mistreated and ignored in the prison health care system. As he would tell a CBS News interviewer on “60 Minutes,” if he hadn’t been a doctor, he would have died because again and again only his own knowledge and actions saved him. Sure that he would perish if their trial went on as planned, his comrades agreed to plead guilty and to take harsher punishments so that he would be severed from the case. Sent to a federal prison near the Mayo Clinic, Berkman finally healed and was released in July 1992.

Let My People Go

The COVID-19 pandemic has opened our eyes to the myriad vulnerabilities in the prison health care system. We need only record the number of pandemic-related deaths of federal inmates to grasp that the prison health care system is profoundly ill-equipped to handle the needs of inmates during a public health crisis. Currently, prisoner infection rates outpace those of the general, unincarcerated population by more than 150%, and prisoners are dying four times as often as prison staff who test positive. Results are far worse for elderly inmates. While COVID-19 afflicts people of all health profiles, its grip on the elderly is the most arresting. Though some effort has been exerted, federal prison officials fail to adequately protect the rights of the imprisoned elderly. It cannot be ignored that prison officials owe basic duties of care to the incarcerated, chief among them, the responsibility to provide adequate health care. However, prisons, by their very nature, are unable to care for an old and ailing population. This glaring deficiency is rendered indisputable by the novel coronavirus pandemic. For this reason, vulnerable inmates, especially the elderly, should be released to home confinement forthwith. Anything less is profoundly inhumane and represents a colossal miscarriage of justice.

Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services. Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries. Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.