Mass Incarceration in the U.S.

As of 2017, there are more than 2.3 million people confined by the American criminal justice system, spread out among state prisons, federal prisons, juvenile correctional facilities, and local jails. Of this number, almost half a million are locked up because of a drug offense. Nonviolent drug convictions play a significant role at the federal level, and are less prevalent at the state and local level. However, most states continue to arrest people for drug possession, which destabilizes individual lives, families and communities subject to over-policing, and results in criminal records, reduced employment opportunities, stigmatization, and the possibility of longer sentences for future offenses.

Women in the Criminal Justice System

There are more than one million women behind bars in the United States. Since 1985, the number of women in the criminal justice system has increased at nearly double the rate of men, making women the fasting growing segment of the incarcerated population. Like the incarcerated population at large, women of color are overrepresented in the criminal justice system, with black women representing 13% of the general female population in the United States, and 30% of all incarcerated women. Additionally, Hispanic women represent only 11% of the general female population but make up around 16% of incarcerated women.

Among those in jail, African American women are more than twice as likely to be diagnosed with HIV than are white or Hispanic/Latino women. Drug use and HIV infection are more prevalent among women in prison than among men in prison, due mainly to the circumstances and behaviors that affect women in particular. For example, injection drug users and sex workers are overrepresented in the correctional system. Because women constitute a relatively small fraction of the prison population, they are often surrounded by facilities, programs, and services that have been tailored for men, even though their needs are often very different. Responding to the particular needs of incarcerated women involves developing alternatives to imprisonment to reduce overcrowding, the prevention of sexual violence, and expanding health services to match those of the community.

USA High Rights of Icarceration

• More than 1% of all adults in the United States are currently in a jail or prison. This mass incarceration, particularly of African American men, fosters conditions that facilitate the spread of HIV in communities where both HIV and incarceration are endemic. Recognition of the role of mass incarceration in the perpetuation of the HIV epidemic is essential to development of effective HIV prevention policies.

• The United States is home to 5% of the global population but accounts for 25% of the world's prisoners. Per capita, the United States incarcerates more of its own people than any other nation, with 1 in 99 adults currently behind bars, in either a jail or a prison; an additional 4 million people are supervised under parole or probation. The consequences of this large-scale incarceration, beyond the considerable financial cost to taxpayers, are multiple and not always obvious. The policies that have led to mass incarceration have affected minorities and those living in poverty the most, and this unevenness in the application of the law has perpetuated economic and other disparities, as ex-offenders struggle to find work, housing, and stable medical care. In addition, the incarceration of a sizable proportion of the community causes societal disruptions that foster the spread of infectious diseases, including HIV.

  • This commentary describes how the coincident epidemics of incarceration and HIV infection have led to a concentration of HIV in US prisons and jails, which facilitates the spread of HIV infection in communities where both incarceration and HIV are prevalent.

• This shift toward a more punitive and less rehabilitative approach to public safety not only led to large-scale imprisonment but also disproportionately affected racial and ethnic minorities and people living in poverty. The United States currently incarcerates a greater proportion of its black population than did South Africa during the Apartheid era. States with the highest rates of incarceration are found in the Southern region of the United States.

• At the same time that incarceration rates were increasing in the United States, so too was the incidence of HIV infection. Initially confined to populations of men who have sex with men in large cities on the East and West coasts, HIV infection quickly entered into and spread among networks of injecting drug users and those using crack cocaine. Consequently, the policies that were established to arrest and imprison those involved in the use and trafficking of illicit substances inadvertently targeted for incarceration those with an elevated risk of HIV and viral hepatitis infections, including substance users, many of whom suffer from mental illness.

• At present, the national prevalence of HIV infection in state and federal prisons is estimated at 1.5%—approximately 5-fold greater than the rate in the general US population—but rates vary greatly by state. In a study performed by our group at the University of North Carolina (UNC) at Chapel Hill, excess blood specimens that remained after routine medical screening of over 23,000 adult men and women entering the North Carolina prison system in 2008–2009 were anonymously tested for HIV antibodies. Overall, 1.45% of inmates entering the prison system during this period tested HIV seropositive; this rate is many times greater than the state's HIV prevalence rate but on par with the average for prisons nationally.

• The flip side of the concentration of HIV infection in our nation's correctional facilities is the high prevalence of imprisonment among persons living with HIV. According to one study, an estimated 14% of all persons living with HIV infection in the United States, and 20% of African American HIV-infected individuals, pass through a jail or prison each year (as do one-third of all those identified with chronic hepatitis C virus infection).