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Stigma in the situation

Stigma: In and Out is a monthly series profiling the clients, providers and leaders of AFC's Corrections Case Management program, which helps HIV-positive people emerging from prison or jail get the support they need upon reentry.

Stigma in and outCook County Jail is home to 8-11,000 people each day; they share a space of 4,197,925 square feet on Chicago’s West Side. It’s the largest single-site jail in the U.S., and its detainees represent a wide range of lived experiences, traumas and medical conditions — including HIV and AIDS.

The jail hosts seven half-day clinics each week to help detainees living with HIV adhere to care. Dr. Chad Zawitz, Cook County Jail’s Clinical Coordinator of HIV Medicine, has been providing clinical services for detainees in the jail for years. He has seen the effects of stigma firsthand in the correctional facility, and he has learned his ways to counteract it.

Of the thousands of inmates detained on any given day, Dr. Zawitz reports that 2% of that population is HIV-positive (around 200 people per day), and 25% of those detainees living with HIV are either non-disclosed or not yet diagnosed. HIV stigma thrives inside the walls of Cook County Jail, and masculinity rules the roost. Stigma builds and makes its presence known, inside and out.

Dr. Zawitz has developed a reputation within the jail as being “the HIV doctor.” When detainees are seen with him, it is assumed that they are HIV-positive; privacy and stigma interplay in this setting. In response, Dr. Zawitz creates ways of helping his patients feel less stigma, such as referring to the disease as “the situation.”

“I think that a lot of stigma comes from misunderstanding or lack of information about the reality of HIV,” said Dr. Zawitz.

Cook County Jail conducts “opt-out” HIV testing, meaning the tests are given to all new detainees who come into the jail, but a detainee can opt-out of the test. HIV adherence can be a challenge for some detainees; hiding crucial HIV medication from other inmates is a hassle, and coming up with a good enough reason to have the medications without disclosing one’s status can be tricky. There is also the risk of another detainee stealing the medications in hopes of getting high or to be able to trade them for other goods.

“Some detainees, when they find out a person has HIV, are very understanding, supportive and very accepting just like the real world,” said Dr. Zawitz. “But with some people, there is irrational fear and concern.” Sometimes, detainees ask to be moved to a new unit away from their HIV-positive cell mate; they may not want to eat around HIV-positive inmates or share the same toilets, despite the impossibility of HIV transmission in these settings. Sadly, some of these requests are honored by the jail, in an effort to keep peace among detainees.

Being a detainee with HIV is not only accompanied with intense stigma, but also regular challenges. Having access to nutritious food is not always a priority, and having access to the outdoors or workout equipment is limited.

Dr. Zawitz shows high regard for the corrections case management services that are offered through the AIDS Foundation of Chicago and its partner organizations. Working closely with other stigma smashers — including Bridgette Funches of Haymarket Center — Dr. Zawitz is able to prepare detainees being released into care and housing before they are even released. 

Categorized under Case management, Inside Story and Stigma: In and Out.