In 1997, an inquest was held into the death of BILLY BELL, an inmate who had spent years in Kingston Penitentiary (here in Ontario), and who was subsequently released to a halfway house, where he died 6 months later of AIDS-related meningitis (brain infection).

The inquest came up with a scathing report on the health care provided to inmates, by Correctional Services Canada. The inquest jury made a number of recommendations concerning such things as availability of pain control meds etc.

Just to give you an idea of the inadequacy of health care, the prison's CHAPLAIN diagnosed Billy's meningitis, not the medical staff!

Please don't discount the Canadian situation, simply because you are in the U.S. or elsewhere.
If you do any kind of advocacy work on behalf of inmates, or even just have a friend or family member in jail with so much as a toothache, the issue of medical rights for inmates affects you. (Does YOUR prison's dentist disinfect his tools properly to prevent AIDS transmission?)

This link has extensive info on the issue of AIDS and Hep C in prison (which of course, is the most pressing medical concern).

<www.aidslaw.ca/Maincontent/issues/prisons.htm>

Menolly

(P.S: Sorry. I'm kinda new here, and just realized I should have posted this under the category for health care. Mea maxima Culpa!)

Whoever moved this to the appropriate section- thanks.

I didn't know how to do that, and was too lazy to type it all out again!

Menolly

I just received this so maybe there is hope, it's just a shame it has to come at such a high cost.----Ken

FOR IMMEDIATE RELEASE


LANDMARK HEPATITIS LAWSUIT AGAINST PRISON SETTLES
Justice Now Wins Ground Breaking Quarter-Million Dollar Settlement For Prisoner’s Family


June 12, 2002 Sacramento, Calif.


Justice Now, an Oakland-based non-profit, settled a lawsuit against the California Department of Corrections (CDC) for the wrongful death of Rosemary Willeby. Ms. Willeby, a Los Angeles native, died on October 22, 1999, as a result of appalling medical neglect and mistreatment. This lawsuit was one of the first cases nationally to challenge the standard of Hepatitis C (HCV) care in prisons. It is also one of the first cases to challenge the CDC’s common practice of gross deception when communicating with prisoners’ families.
With the current imprisonment boom across the U.S., HCV has reached epidemic levels in prisons nationwide. Though the CDC itself estimates 40% of prisoners are HCV+, they have very little in place to address this crisis. Rosemary Willeby was one of five prisoners who died at the Central California Women’s Facility (CCWF) from September-October 1999; three of those deaths were due to HCV and liver failure. “What happened to Ms. Willeby is all together too common,” said Cynthia Chandler, co-director of Justice Now. “The same factors that make someone vulnerable to imprisonment and policing poverty, lack of resources, and being of color are the same factors that are increasingly being linked to one’s vulnerability to life-threatening disease. This settlement is essentially an admission of the Department of Corrections’ inability to address this epidemic. More broadly, this case speaks to prisons’ inability to respond to medical crises and the human cost of mass imprisonment.”
Ms. Willeby was sentenced to three years in prison at CCWF on a drug possession charge. Upon her arrival, she informed medical staff that she had HCV and active liver disease. Yet she was swept up in an aggressive prison-wide tuberculosis protocol. Despite having no TB symptoms, Ms. Willeby was prescribed a prophylactic course of anti-TB medications that are commonly known to be liver-toxic and contraindicated for patients with liver disease. Ms. Willeby died shortly thereafter. Despite repeated requests, she was denied access to a liver disease expert until 10 days before she died. “Even as her stomach swelled and she looked nine months pregnant, no one ever treated her for the condition she did have (HCV),” said Cassandra Shaylor, co-director for Justice Now. “Her continued treatment with medications that are labeled liver toxic constituted a clear violation of her Eighth Amendment rights to be free from cruel and unusual punishment.”
As Ms. Willeby’s health declined, prison officials continually deceived her family. At one point, a correctional officer told Ms. Willeby’s sister-in-law that Ms. Willeby was dead, when in fact she was not. Prison staff also told Ms. Willeby’s mother that she was in “stable” condition when she was fighting for her life. “Because they told us Rosie was alright and denied us access to her, we weren’t able to be with her when she died,” said Catherine Cox, Rosemary Willeby’s mother. “She died alone and the whole time we were told she was okay. I cannot begin to tell you how horrifying it is to think that my daughter died that way.” This settlement occurs at a time when new prison policies are restricting family access to prisoners even further.
“This case takes the CDC to task for its abuse of prisoners and their families,” said Cassandra Shaylor, co-director of Justice Now. “It is further proof that we need to rethink our reliance on prisons as a catch all ‘solution’ to social problems like drug addiction, and begin developing alternatives that provide families and communities with real solutions to public health crises”.

Perhaps some change will come about.

I hope so. I do have a friend in a private prison in New Mexico. He has AIDS and since he was moved to the private prison, he told me he doesn't trust the medical departement at all. that is sad. But he fell in love and since then his health has improved. the power of love :D

MIAMI-DADE COUNTY=
BY ERNESTO LONDO
Special to The Herald

Thirteen years spent behind bars in Florida jails and
prisons have come in handy in John Delgado's latest en-
deavor: assessing the HIV-related needs of inmates in Miami-
Dade County jails.

"It's a time bomb," said the 33-year-old ex-convict,
whose rap sheet reaches back to 1987.

Despite not having a college degree, Delgado has turned
his criminal past into unbeatable credentials for "hardcore"
HIV outreach work -- a much needed service in a city with
the highest AIDS rate in the nation.

A $50,000 grant awarded by the U.S. Department of
Health and Human Services to Delgado's employer, Borinquen
Health Care Center, is funding the probe into what several
local HIV/AIDS activists and healthcare providers hope will
be the next big thing to come out of the closet in their
line of work: HIV and AIDS in sex in the prison system.

"A few months ago, it was impossible to talk about it,"
said Luis Penelas, executive director of Uni=F3n Positiva, a
Little Havana-based HIV/AIDS outreach group. Penelas decries
Florida detention facilities' zero tolerance regarding sex
among prisoners as "extremely hypocritical and archaic." Sex
is forbidden in Florida's jails and prisons, and condoms are
considered contraband.

"Inmates who engage in sex are disciplined," said
Miami-Dade Corrections & Rehabilitation Department spokes-
woman Janelle Hall.

However, Penelas counters that sex in detention centers
is often condoned by officials. He says placing one gay man
who is actively seeking sex per fl oor has become standard
procedure in several jails and prisons across the state.

"In most cells they place a loca -- or screamer -- so
inmates can relieve the tension," Penelas said.

That's old news to Delgado and Nathaniel Ponder, 33,
recently released from Miami-Dade County jail where he
served six months after being convicted of Medicaid fraud.
Sexual activity is regulated not by jail custodians, but by
cell leaders -- the most influential inmates, said Ponder,
of Miramar. "If he's gayish, he'll tolerate homosexual
activity," Ponder said. Custodians, he added, only show up
to perform head counts. Rape and sexual harassment often go
unreported out of fear of reprisal and stigmatization,
Ponder and Delgado said.

"[I] never heard of that," said Hall, regarding the
purported custom of housing a gay man in each cell. "I would
think that would be against the law."

Bringing abuse to the attention of custodians likely
results in harassment and dishonor from fellow inmates and
corrections officials, said Dr. Anne De Groot, a physician
who runs the HIV Prison Project at Brown University.
"That's the same reason most don't step up and ask to get
tested," De Groot said. "They don't see the benefits; they
don't want to be told that they smell like death."

As of April, Miami-Dade County detention facilities
housed about 6,000 people, more than 11 percent of Florida's
51,813 incarcerated population, accor ding to the Florida
Department of Corrections.

A survey last conducted in 1999 by the U.S. Department
of Justice on HIV in jails and prisons revealed that with
2,663 reported HIV-positive inmates in state and federal
prisons, Florida had the second-highest infected detain ee
population in the country. Miami-Dade County has the largest
detained population in the state.

No such study has been conducted locally in recent
years, said Patricia Ward, spokeswoman for the Department of
Justice in Miami. Ricardo Menendez, th e department's infec-
tious disease coordinator, declined to comment.

Federal prisoners are tested for tuberculosis and HIV
upon entering detention facilities, but "it's been extremely
difficult for us to get into jails," said Kira Villamizar,
Miami-Dade County Health Department Human Service program
manager. His team has been granted limited access into
county detention facilities to counsel inmates about HIV and
other health related risks.

"The strategy in place makes no sense," Villamizar
said. "The idea is to prevent people from getting infected.
Here we are telling them how not to get infected, but we're
not allowed to give them condoms, or test them on the spot."

Voluntary testing can be requested by inmates, said
Arthur Brown, director for patient healthcare at the Miami-
Dade County jail.

Brown said he had no statistics on the HIV/AIDS popula-
tion in custody, nor an estimate of how many inmates re-
quested testing. "Patients are duly informed," he said.

Inmate advocates argue that the policy has been driven
to a certain extent by the public's lack of concern.

"In many cases, the rationale has been, they did wrong,
let them die," said De Groot, adding that during the 20
years she has worked as a physician in correctional facili-
ties, she has faced strong resistance in advocating quality
healthcare for inmates and prisoners.

According to Penelas, Delgado and Ponder, healthcare in
Miami-Dade County detention facilities is lacking, especial-
ly when it comes to treating individuals who are HIV-
positive or have AIDS.


"There was a guy in my cell who waited two months
before getting his pills for his HIV," Ponder said.

Corrections officers declined the Miami-Dade Health
Department's offer to administer 99-percent accurate oral
HIV tests to inmates who volunteer, Villamizar said.

"I think one of the issues may be cost -- once you find
someone is positive, the state needs to provide healthcare,"
Villamizar said.

Although medication for an HIV-positive inmate may cost
approximately $12,000 annually, according to De Groot, a
thorough census of the HIV-infected population in custody
and prompt treatment would reduce infection and be cos t-
effective in the long run.

Earlier this year, state Rep. Frederica Wilson, D-
Miami, introduced a bill making it mandatory for Florida
inmates to get tested for HIV before being released. The
bill was signed into law on May 30 by Gov. Jeb Bush. "We're
thrilled," Wilson said. "This is going to save many lives."

Some people forget, Delgado said, that most prisoners
get released and hit the streets. "It's not an isolated
problem; it's the community's problem," he said.

For whatever reason, this story reminds me of the boy who was told "this is fire, it hurts when you touch it" and he just kept touching it.

I don't think there will ever be adequate HIV education, prevention or for that matter treatment available to anyone in the country let alone our nations prison system. I hope for change...I hope for it to come soon.

Part One: __________________________________________________ ________

Collaborative Programs in HIV, STD and Hepatitis Prevention
Centerforce Center for AIDS Prevention Studies (CAPS), and
San Quentin State Prison

San Quentin State Prison, California Staff at Centerforce have been providing HIV Prevention Education since 1986 at San Quentin State Prison. Since 1992 we have been evaluating many of these programs in collaboration with the Center for AIDS Prevention Studies (CAPS), University of California, San Francisco. From 1986, these programs were based at the Marin AIDS Project; since 1997, they are based at Centerforce. These programs have expanded and evolved over the years, constantly changing to meet the needs of the incarcerated population and their families. The health programs now include information on HIV as well as other sexually transmitted infections, hepatitis, tuberculosis and other relevant health concerns.

Our advisory committee of inmate peer HIV educators helps us to develop new programs, modify existing strategies, and provide ongoing input to evaluate the effectiveness of our interventions. The success of these programs can be attributed to the commitment of all those involved: prison administrators, correctional officers, educators and counselors, university researchers, community-based service providers, the inmates themselves and family members.

A summary of these collaborative evaluation projects was published in a special issue of Health Education and Behavior.

http://www.caps.ucsf.edu/projects/mapabst.html

Part Two: __________________________________________________ ______

Collaborative Programs in Prison HIV Prevention

Prevention Programs for Incoming and Current Inmates
All men entering San Quentin are mandated to receive HIV education. Since 1991, we have been training inmates as peer HIV educators. Twice a year, volunteers are solicited to receive the comprehensive peer education training and then to work as peer educators within the prison. In the beginning all peer educators were themselves living with HIV; this has changed due to increased interest by uninfected men. Today, peer health educators conduct a variety of services within the prison including teaching the Health Orientation Class for incoming inmates, providing individual counseling for newly diagnosed inmates and helping releasing inmates develop individualized risk reduction plans. About 40 peer educators are trained each year.

Marin AIDS Project and CAPS collaborated to evaluate the HIV prevention orientation class for incoming inmates (Grinstead O, Faigeles B, Zack B. The effectiveness of peer HIV education for male inmates entering state prison. Journal of Health Education, 1997, Vol. 28, p. S31-S37). We have also collaborated to evaluate a pre-release risk reduction program conducted by inmate peer educators (Grinstead O, Zack B, Faigeles B, Grossman N, Blea L. Reducing post-release HIV risk among male prison inmates: a peer-led intervention. Criminal Justice and Behavior, 1999, Vol. 26, p. 453-465).


Inmate Peer Educator Training

http://www.caps.ucsf.edu/projects/mappeer.html

Peer-led Health Orientation Class

http://www.caps.ucsf.edu/projects/maporient.html

HI im curious did anyone posted about AIDS subject here? i would like to read them. thanks

Lilsquaw, go to the search engine on the upper right side of the PTO homepage, and type AIDS, this will display all the different posts on the subject.

Hope that helps
Phil

ok thanks so much phil

Subject: State Prison HIV care inhumane
Date: Mon, 10 Mar 2003 14:36:42 EST

http://www.decaturdaily.com/decaturdaily/news/030228/aids.shtml

Decatur Daily Friday February 28, 2003

Observer: State prison HIV care 'inhumane'

By Deangelo McDaniel and Holly Hollman
DAILY Staff Writers
dmcdaniel@decaturdaily.com

CAPSHAW - A paralegal for the Southern Center for Human Rights said
conditions for dispensing medication to HIV-positive inmates at
Limestone Correctional Facility are inhumane and deplorable.

Armed with an order from a federal judge, Lisa Zahren and a
photographer were allowed this morning to film how prison officials
hand out medication to HIV inmates.

"It's absolutely shocking that they wake up people who are sick at 3
a.m. and make them wait outside to get medication," Zahren said.

The Southern Center filed the lawsuit in November in the Northern
District Court of Alabama on behalf of five HIV-positive inmates. The
lawsuit, in part, alleges that the state denies adequate medical
treatment to AIDS inmates.

The state houses all its known HIV-positive inmates at Limestone
Correctional Facility.

Warden Billy Mitchem would not allow a DAILY reporter to tour the
AIDS area because of the ongoing lawsuit.

Zahren said they had to get permission from a federal judge to film
the medication dispensing process. She and the photographer arrived
at the facility this morning at about 2:30 before guards woke inmates
at 3.

The inmates stand outside in a line, some for as long as 45 minutes,
to receive their medication, Zahren said.

One inmate, an amputee, was in a wheelchair, she said.

"I had on proper clothing, and I was cold," the paralegal said. "We
could see that some of the inmates were cold."

Zahren said prison officials required the inmates to take their
medication at the window.

She said giving medication in this manner does more harm than good
because the Food and Drug Administration requires patients to take
some of their AIDS medicine with food.

"This morning, they served breakfast after pill call, but the inmates
had already taken the pills," Zahren said.

She added: "This is one of the most outrageous things I have ever
heard of...how they wake sick prisoners up in the middle of the night
to make them stand in line outside in the cold for an hour to receive
their medication."

An audit of the facility supports some of the claims in the lawsuit.

Jacqueline Moore and Associates of Chicago visited Limestone
Correctional Facility on Oct. 1 and Nov. 8.

The company said the death rate of AIDS-infected inmates is more than
twice the national average.

The Birmingham-based company NaphCare is the prison's health
management contractor. Company President Lee Harrison called the
audit misleading. He said the death rate for AIDS inmates is actually
one-third the rate for the general population.

The audit said Limestone houses AIDS inmates in an old warehouse with
high, leaky ceilings and double bunk quarters that foster infection.
Mitchem has said the warehouse is a solid building that was renovated
in 1994 or 1995.

The audit also said chronic-care inmates go as long as seven to eight
months without seeing a doctor.

Zahren's organization, which is based in Atlanta, filed the lawsuit
after the audit reported that health care at the HIV prison at
Capshaw was "dangerous and extremely poor."

THE DECATUR DAILY
201 1st Ave. SE
P.O. Box 2213
Decatur, Ala. 35609
(256) 353-4612

Subject: AIDS in Prison must be dealt with: Skosana
Date: Wed, 26 Mar 2003 11:57:47 EST

Ben Skosana, the Correctional Services Minister, says his department does not
know the extent of HIV/Aids infections in prisons. Skosana says their
department's main focus is to deal with the disease best they can with the
information on hand.

A recent report by Washington-based researcher K.C. Goyer estimated that
almost half of the country's 175 000 prisoners are HIV-positive. Skosana says
he thinks the figure is inaccurate as there have been conflicting reports
ranging from 10% infection rate to 60%.

However, Skosana said: "The central message is we have this disease in prison
and we must deal with it...we are putting firm programmes in place. HIV/Aids
is one of those features that are in prison and we are concerned about it
because it is also increasing."

I think this article should be taken seriously, because there are many inmates with HIV that don't get the adequate treatment that they need. This is so very important. It's just a shame that inmates always get passed up with no good medical care!

pookie

Sad, sad, sad!!! How can they do this?!! I know Tim told me of an incident where he got in trouble. He had the flu and so did many of his fellow inmates. The pill window is supposed to open at 7am. It was pouring raining outside, and it was well after 7am and the pill window still was not opened!! All the sick inmates were standing in a long line in the rain waiting for that window to open......and still no sign of opening up!! So Tim took it upon himself to go up to the head of the line to knock on the window.....well the lady got pissed that he came knocking and she says, "I will open this damn window when I damn well please!!!" She was just yelling and shouting at Tim just for knocking on the window. He talked back to the mean woman and said you don't have to yell at me like a dog!!!! So the lady lied on him saying he cursed at her and all. Tim ended up in the hole, went to a hearing, was found guilty. So those folks don't give a damn who is sick or what time it is to open up to give the sick inmates their medications. Awful just ain't the word to describe such actions on the gov employees part!! But I believe that what goes around certainly will come around!!

pookie

HIV Prevention, Treatment Needed in Prisons: Report
Fri May 2, 2003 04:54 PM ET
NEW YORK (Reuters Health) - Despite widespread calls for increased HIV prevention services in prisons, few programs have actually been put in place, according to two Emory University researchers.
Currently, health experts estimate that 25 percent of people living with HIV in the United States pass through correctional facilities each year. And the percentage of prison inmates who are confirmed to have AIDS is four times higher than in the general population, according to the report published in the American Journal of Public Health.

With these facts in mind, public health advocates see correctional facilities as ideal places to instill HIV prevention messages with the hopes of thwarting HIV transmission among prison inmates and among the general population after inmates are released.

In addition, many believe that prisons offer healthcare professionals an opportunity to get HIV- infected individuals into treatment programs.

One primary, but controversial, part of HIV prevention is promoting safer sex practices, including using condoms.

Currently, only two state prison systems -- Mississippi and Vermont -- and five city and county jail systems -- New York, Philadelphia, San Francisco, Los Angeles and Washington, D.C. -- make condoms available to male inmates, according to the authors of the report, Drs. Ronald L. Braithwaite and Kimberly R. J. Arriola, who are both at Emory's Rollins School of Public Health in Atlanta, Georgia.

One possible barrier to an increase in such programs, according to Braithwaite and Arriola, is that there continues to be stigma associated with discussion of HIV and AIDS, particularly in correctional settings where many risky behaviors, such as injection drug use and unprotected anal intercourse, are not allowed.

"Bold and progressive risk reduction policy action is required by correctional policy makers to advance the health and well-being of incarcerated populations and, ultimately, the community at large," they add.

Braithwaite and Arriola recommend that state prisons adopt a mandatory HIV testing system.

To date, only 16 states and the federal prison system have such policies in place. Such testing, the authors contend, could reveal numerous undiagnosed cases of HIV infection that could be treated.

The team also suggests that correctional facilities should take steps to see that inmates continue to receive HIV treatment after they leave prison.

"Some correctional systems supply released inmates returning to their community with only 5 days' medication," they write. "This is woefully inadequate."

In addition, the authors recommend that correctional facilities open their doors to community-based organizations to provide HIV/AIDS education and prevention services. Training programs for prison personnel might also heighten staff sensitivity to the needs of such volunteer educators, they point out.

"Prevention specialists are frequently humiliated and negatively stereotyped by correctional officers," according to the researchers.

Ultimately, only the collaboration between inmates, correctional officials, public health officials and community service providers will help "establish a seamless system of prevention and treatment services that transcends prison walls," Braithwaite and Arriola conclude.

SOURCE: American Journal of Public Health 2003;93:7-11.

AIDS deaths decline in prison
State officials seeing fewer cases, better care
By Farah Stockman, Globe Staff, 9/15/2003

A decade after the much-publicized deaths of several inmates with AIDS prompted criticism of the state's health care services for prisoners, the death toll in Massachusetts prisons has dropped by half, mostly due to fewer inmates with AIDS and better treatment for HIV, according to specialists.


The number of prison deaths in Massachusetts declined from 36 to 18 since 1995 while deaths known to be related to AIDS dropped from 14 to two in the same period, according to the Department of Correction and the Bureau of Justice Statistics, an arm of the US Department of Justice.

"Just like in the community, people are living longer with HIV," said Dr. Arthur Brewer, medical director of the University of Massachusetts Correctional Health, which provides health care for the state's prisons.

But the victory against AIDS in prison comes as state budget cuts are making it more difficult for low-income residents outside prison walls to receive the drugs they need from assistance programs.

"I think there is no question that the prison system has dramatically changed the way they looked at HIV," said Dr. Barbara Herbert, who served on a blue ribbon panel in 1992 investigating allegations of inadequate care for inmates with AIDS at MCI-Framingham. "The medical care that people get in prison at this moment in time in some cases supersedes the level of care they get out of prison."

While Massachusetts has historically provided AIDS drugs to needy residents who could not afford them, recent budget cuts that sliced a third of the state HIV/AIDS Bureau's funding will probably force the agency to make difficult choices about who should be eligible for the drugs, said Rebecca Haag, executive director of the AIDS Action Committee of Massachusetts.

"The statistics do demonstrate that by having early access to care and treatment and drugs, you can have an impact on the death rate," Haag said. "With the one-third reduction in resources, that will force the government to make choices amongst the populations in need. . . .These drugs are life and death to these people."

And DOC is spending the money to buy them. AIDS drugs, which cost the state about $10,000 per inmate annually, have made up about 20 to 25 percent of the department's medical budget for the last several years.

"We're getting the best possible price," said Justin Latini, DOC spokesman. "The price has obviously gone up because of the quality of the drug."

Government agencies buy the drugs in bulk to cut costs, he said.

Between 1999 and 2003, the amount DOC spent on medicines overall increased from $6 million to more than $11 million, $3 million of which paid for a drug cocktail that combats AIDS for about 300 of the state's 9,150 inmates.

AIDS drugs are not the only reason deaths have declined in prisons. The number of suicides also has dropped, from three in 1995 to one in 2002. Homicides also appear to have declined. In 1996, there were at least two murder investigations. But no inmate had been killed in the years that followed, until the recent slaying of defrocked priest John J. Geoghan.

Yet, AIDS and the advent of new, powerful drugs are by far the largest factors explaining the drop in deaths, Brewer said. Prison deaths skyrocketed in the early 1990s and began to fall in 1995 as protease inhibitors became available to the public.

The Massachusetts statistics mirror trends in prisons nationwide. In 1995, a third of all deaths in state prisons nationwide were due to AIDS-related illnesses, but that dropped to just 6 percent in 2000, according to the Bureau of Justice Statistics. Because the rate of HIV-infection among prison inmates is more than four times higher than the general public's, the drugs had a more dramatic effect on the death toll in prisons.

Massachusetts, where heroin abuse gave rise to the third-highest rate of HIV-infected inmates in the nation, has seen its percentage of known infected inmates drop from more than 5 percent of all inmates to about 3 percent.

The state also became known as a leader in assuring access to AIDS drugs for all residents.

"Massachusetts has a very good reputation in providing comprehensive care, treatment, and support services to people living with AIDS, with a combination of both state and federal resources," said Julie Scofield, who heads the National Alliance of State and Territorial AIDS Directors in Washington, D.C.

Some states have waiting lists for the drug and have capped enrollment in AIDS drug assistance programs.

"But Massachusetts has been devastated by budget cuts in the last year, so it is dropping fast down that list," said Scofield.

AIDS has long been a source of controversy for DOC. In 1987, inmates at MCI-Norfolk rioted, citing lack of AIDS testing as a major grievance. That same month, two inmates filed a lawsuit against Governor Michael Dukakis, alleging the state failed to protect them from AIDS because it had not instituted mandatory screening.

In 1992, the AIDS-related death of inmate Robin Peeler sparked two investigations, a flurry of debate in the State House, and changes in how DOC treated AIDS, advocates said. In recent years, public health officials and the DOC have worked to implement early AIDS intervention programs in prisons and jails, said Jean McGuire, director of the state's HIV/AIDS Bureau.

Although Massachusetts remains one of a few states where an inmate's request is the only way for an AIDS test to be administered, the state has focused on persuading inmates to volunteer for tests with inmate-led AIDS-awareness classes and the Transitional Intervention Project, which counsels inmates and helps them sign up for drug benefits when they leave prison.

Do the prisons do testing for it?

I know they tested my husband when he was first transferred there, then they tested him again when he moved yards, for everything though, Aids, drugs, TB, a whole physical he got. We're in California, not sure if that makes a difference!

they test in Jersey for evrything as well

They test for anything communicable. HIV, AIDS, hepatitis series, TB, etc.

They tested my husband before we got married as a measure to protect me. They give you the results as you are being processed for your first trailer so you will know the results prior to go in with him.

they test in south carolina for everything too.

yes. i know Joe requested to have a test. he wanted to prove to me. so, yes, they do.

Yep in Cali my guy(?) got tested

I KNOW THAt THEY TESTED MY HUSBAND FOR AIDS. HE SENT ME THE RESULTS AND I HAVE KEPT THEM.

yes they check you when you go to reception before you are ever given your number there i know, after all i was there, and tested they also check you again depends on how long you are incarcerated.

Georgia yes they test for many things including HIV.

ONE

Yes, In Georgia, my husband was tested.

My husband has gotten tested in Florida, they do it upon entry to prison, and you can also request one to be done through medical if you want to.

They test in Nevada too.

It is sorry crazy I found this thread but I was just talking to my boyfriend about this, I want him tested when he gets out before we you know hook up :) but will they be able to test him right before he gets out if he asks because he is at a firecamp in cali so I am not sure if they will or not???

I'm in Indiana and am trying to understand why our prisons do not test for HIV upon release. With "down low" and high-risk behaviors it seems that it should be one of the first things done when an inmate is ready to go back home. Someone please help shed some light.

My husband tells me they can get tested every six months. At least in the prisons he's been in here.

Well I found out that at the camp my man is at takes them to another place to get tested but it is only upon request

One thing that I found since I began actually doing research on correctional health care is that frankly many people are not that concerned about the health of inmates and/or the health of the communities in which they return to.

Unfortunately public health in this country receives very little attention and subsequently very little financial support. I am of the opinion that when the "down low" issue begins to effect the society at large in greater numbers then they will take a look at these issues.


I'm in Indiana and am trying to understand why our prisons do not test for HIV upon release. With "down low" and high-risk behaviors it seems that it should be one of the first things done when an inmate is ready to go back home. Someone please help shed some light.

HEALTH-ZAMBIA: RELEASING HIV-POSITIVE PRISONERS GET MIXED REVIEWS

Inter Press Service English News Wire; 10/22/2004; Zarina Geloo

LUSAKA, Oct. 21, 2004 (IPS/GIN) -- The HIV pandemic has proved a divisive force in several African countries, not least Zambia. As IPS reported last month, the question of whether to make HIV tests mandatory has sparked fierce debate in the country. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) Zambia currently has a 19 percent HIV prevalence rate. However, another controversy is also afoot about the wisdom of releasing prisoners in the advanced stages of AIDS. Since late 2001, more than 300 sick inmates have been freed by President Levy Mwanawasa on compassionate grounds. Commissioner of Prisons Jethro Mumbuwa says Zambia's jails simply lack the resources to look after convicts who are seriously ill.

"The prisons are under-resourced both financially and (in terms of) human resources. Besides, we think that when people are terminally ill they are better off spending their last days with their families," he noted. With many of the former inmates having been given life sentences for serious infractions, protests from the victims of their crimes might have been expected. But surprisingly, some of the strongest opposition to the releases has come from the prisoners' families. "Why, why give me this shell?" asks the wife of HIV-positive ex-prisoner Samson Nkumba (not his real name). "They (the government) must keep him, because I cannot do what they have failed to do. I cannot afford ARVs (anti-retroviral drugs). It is traumatic for the children to see their father in this way," she adds. These words are echoed by Clement Mfuzi, chairman of the Network of Zambian People Living with HIV/AIDS (NZP+). "Zambians are poor. (If) you lock up the bread earner, where do you expect families to get money to look after a sick relative?" he asks. An instance where release worked to good effect was that of Jack
Chiti, who was jailed for attempting to topple former president Frederick Chiluba in October 1997. Chiti's relatives petitioned for his release, and he subsequently died in the care of his family. NZP+ believes that government is entrenching the stigma surrounding HIV-positive persons by washing its hands of prisoners with AIDS-related diseases. While prison authorities claim inmates are counselled about their condition before being released, NZP+ also queries whether this process is adequate - and whether the convicts' families are
being properly advised on how to care for them. "You just do not unleash people with HIV onto an unsuspecting public. What if the convicts themselves are in denial (about their HIV status) and continue to have unprotected sex with their spouses?" asks Mfuzi.

Prison often hardens convicts rather than rehabilitating them, he adds. This might encourage reckless behaviour on the part of former inmates - which makes the need for prison and home-based counselling still more urgent.
Says Nkumba, "They removed us from society because they said we were a danger to the public. They now throw us back to the same society when we are even more dangerous than before." "Neither myself or my family were counselled, and I had not heard of any of my colleagues who were in the same situation being counselled. We are just told we are being released - that's it," he adds. At present, Zambian courts do not take HIV status into
consideration when sentencing felons. There are no voluntary counselling and testing facilities in prisons, and HIV tests are only conducted when a convict falls ill repeatedly.

Nonetheless, the dirt, congestion and poor nutrition that prevail in many prisons all but ensure that those HIV-positive prisoners at risk of developing AIDS-related diseases do so. Unprotected sex between male inmates also fuels the spread of HIV. "The convicts cannot be forced or coerced into testing for HIV because of the human rights issue. But, I see a time when this will be a necessity because HIV is flourishing in the prisons," says Leslie Phiri, a lawyer based in the capital - Lusaka. Zambia's Permanent Human Rights Commission insists that no prisoner should be forced to test for HIV, however.
Instead, it recommends that prisons be reformed to ensure that HIV-positive inmates receive the treatment needed to keep them alive. Elsewhere in the region, officials are also grappling with the effects of HIV on prisons. According to a 2003 study conducted by the Pretoria-based Institute for Security Studies, the HIV policies that South Africa's Department of Correctional Services has introduced are "excellent" in certain respects. It notes, however, that the distribution of condoms in prisons
- something advocated by UNAIDS and the World Health Organisation
- would be considerably improved if it were to include the discreet provision of condoms in common areas rather than requiring prisoners to request condoms face to face with a member of the health staff.

The study, entitled 'HIV/AIDS in Prison: Problems, Policies, and Potential', goes on to state that "the provision of water-based lubricant in a similarly accessible manner" would help to reduce condom breakage and damage to the rectum during anal sex. Breakages and rectal damage facilitate the transmission of HIV. Malawi, with its Banja la Mtsogolo (Family of the Future)
programme, aims to educate over 5,000 prisoners in 21 jails about HIV. The initiative also incorporates treatment for prisoners who have sexually-transmitted infections. According to UNAIDS, HIV prevalence in Malawi is at 15 percent.

Copyright 2004 IPS/GIN.

I wondered if they tested for Hepatitis C or you have to ask to tested. The statistics for inmates with Hepatitis C are in the 80 percentile so they must or they use some formula. In the general population of USA, you have to ask
There are so many dying from this disease. Many are not offrered treatment or do they know they have. It is called ., " Silent Killer"

There are reasons for this. First the liver which it destroys is a vital organ, it fliters toxins from the body, and has no pain receptors. This means the liver cannot feel pain. Secondly as the virus starts to destroy there is regeneration ( not all regererate) . As many as 30% of the Hep population (which is now about 5 millon, 3 million still do not know), do not have elevated enyzyme,( a blood test widely used for diagnoisis)

Many go years and years with the virus replicating without symptoms, but the liver is slowing being destroyed. Not all will. By the time some find out they have cirrhosis( caused by the virus, add drinking to that is certain death)

It is treatable and I will leave this at that point.

If you have a family member that has Hepatitis C, and you have no idea what it is or how to learn. Please fell free to post. I hope that you can add mail.
Please no personal mail . I merely want to help other heppers such as myself.

If you have tatoos, piercings , had surgical , dental , or any medical procedure that is invasive (meaning your body was cut, injected etc) you could have Hepatitis C. Hepatitis C is not a STD - unless there is a blood to blood entry it in impossible to get. So please don't let anyone stigmatize you. It is a virus - it is not who you are or what you do. hugs:)

I have been helping people with Hep C for 6 years. I myself have it and I am clear. IT is a horrible disease. A horrible death. Please contact me or post.

God Bless you

Please don't assume they are telling you all you need to know. Many prisoners do not get treatment in prison as it costs 30 thousand dollars a year for the meds alone. Let me help you..

Mandela dons prison number for AIDS campaign

Agence France Presse English; 11/25/2004

Nelson Mandela, South Africa's former president and apartheid hero, donned his former prison identification number 46664 for a fundraising event aimed at fighting the AIDS/HIV epidemic.

The 86-year-old Mandela, wearing 46664 on a black shirt, oversaw the launch of the book "46664: The Concert", a book of photographs taken at an AIDS benefit concert last year.

"This book is a record of that amazing night... that raised awareness and inspired the fight against AIDS," the Nobel peace prize winner told a London audience.

He was joined at the event by British music stars Annie Lennox, Brian May from the group Queen, Peter Gabriel and Yusuf Islam, formerly known as Cat Stevens.

Mandela has lent his prison number 46664 to AIDS campaigns, for the first time last November at the rock concert in Cape Town.

"Not only governments and the drug companies, but we too have a responsibility to act. Each of us must do more. Do more to educate each other about the facts of infection and how to prevent it," he told the London book launch.

"We are all leaders now, and good leaders must lead. The fact is that every HIV infection can be prevented and every AIDS case can be treated."

Mandela, the world's most respected statesman, is also fighting legally to keep his name and his number from being used by businesses that have nothing to do with him or the AIDS campaign.

Mandela's foundation recently discovered, when trying to obtain a telephone number with the 46664 digits, that a Johannesburg-based coin dealer Investgold ICC had already beaten them to the punch.

South Africa's first black president from 1994 to 1999, Mandela has also built a charity empire that includes his Nelson Mandela Foundation and two other smaller organizations, the Nelson Mandela Children's Fund and the Mandela Rhodes scholarship foundation.

© Copyright Agence France Presse

China to test prisoners for HIV

Agence France Presse English; 11/25/2004

China will begin to test its prisoners for the HIV virus starting this month.

Inmates who are HIV-positive or have AIDS will receive proper medical care, the Ministry of Health was quoted by Xinhua as saying Thursday.

Most Chinese prisons and detention centres have no facilities to treat HIV/AIDS patients and many infected prisoners serve their sentences outside of prison, Xinhua said, adding that China has a prison population of 1.5 million.

China says it has an estimated 840,000 HIV/AIDS patients, of which some 20 percent are believed to have been infected through unsanitary blood-buying schemes carried out in the early 1990s.

International AIDS experts say the actual number of HIV/AIDS cases in China is probably much higher, with the United Nations predicting 10 million cases by 2010 if the epidemic goes unchecked.

© Copyright Agence France Presse

Lending HIV-Positive Offenders a Helping Hand
By Meghan Mandeville (http://www.corrections.com/news/staff.html), News Research Reporter

Last fall, at Georgia's first annual Excellence in Corrections conference, one HIV-positive ex-offender had a chance to share his thoughts with corrections professionals and community service providers about a program that has made a huge difference in his life.

He spoke about how the Department of Corrections' Pre-Release Planning Program (PRPP), which is geared towards HIV-positive offenders, helped him get his feet on the ground after he was released from prison. He is now in treatment for his substance abuse issues, visits a medical clinic regularly, lives on his own and works full-time at a job where he has, so far, gotten two raises.

"He's doing great," said Chayne Rensi, Pre-release Coordinator for the DOC.

Rensi was hired by the DOC a little over a year ago to begin working with HIV-positive offenders who are within six months of release to prepare them for their transition back into the community. She works with inmates from 11 DOC institutions in the central region of the state to connect them with some of the services they will need when they are released from incarceration.

"This is basically a reentry program. These people are getting out and anything that we can do to help them stay out is going to be beneficial," Rensi said.

Starting the Connection

In Georgia, all inmates are tested for HIV upon intake. Rensi gets a list of all those who test positive in the targeted facilities and meets with them to tell them about the pre-release program.

"I will see if they want to consent to the program," Rensi said. "If they do, they'll have some [paperwork] to sign and we'll do an initial assessment [of their needs]."

According to Rensi, all of them, because they are HIV-positive, need medical care and most, she said, also require some substance abuse treatment. The two most important elements of her job are to hook these offenders up with treatment for their HIV and case management services, she said.

"Without a doubt, the two things that I am going to set them up with is a clinical appointment and a case management appointment," Rensi said. "I haven't had one yet that I haven't also been able to get into some other stuff."

Rensi has been so successful at matching these offenders with services, because, in the year since the program began, she has worked hard to make connections with community organizations and treatment providers to provide inmates with the care they need when they return home.

"Any community-based organization I have worked with has been very receptive," Rensi said. "They have [all] been so willing to work with us."

While Rensi is already collaborating with agencies like AID Atlanta and The Living Room, non-profits providing services, housing and education to people with HIV, she is continually trying to develop new relationships with additional service providers in the community.

"Really the biggest barrier is just not knowing about each other," Rensi said. "I have people [who] are released all over the state of Georgia."

Aside from creating ties with community-based organizations, Rensi also spends a good deal of time educating prisoners about their disease so that they behave responsibly when they return to the community.

"One of the major public health benefits is that they're getting one-on-one education about their disease and about prevention," Rensi said. "[And they are getting that education] in a very safe setting so they can ask questions."

Rensi typically meets with the offenders three to four times prior to their release to discuss what services they will need in the community and education is always a component of those encounters.

"We do some education and some counseling around risk reduction before they get out," said Jennifer Taussig, Statewide Public Health Coordinator. "We hope that it raises awareness of the need to [use] protection and reduce transmission in the community.

Rensi also goes further to make sure these inmates are successful. Rensi follows-up with the inmates post-release at three months, six months and one year. So far, she has contacted about 20 people who have been released and only one has been returned to prison, she said.

Although she has been in touch with some ex-offenders, Rensi said the evaluation component of the PRRP is weak. She hopes that as the program evolves, the DOC will be able to better assess its impact on offenders.

"It's a learning experience," Rensi said. "We've got a whole lot of tweaking going on."

Rensi also hopes that someday, if funding permits, the program will grow to include more offenders.

"I would love to see this program expand," Rensi said. "I would love to see more pre-release coordinators, at least four or five in the state, so that every prison in the state has someone [who] works with these people in this capacity."

Resources:

To contact Rensi call (478) 445-7209

April 29, 2005, EDITORIAL

A Simple Way to Fight H.I.V. and AIDS



In any given year, perhaps a third of the people infected with hepatitis C and more than 15 percent of those with AIDS spend time behind bars. With infection levels far higher than in the outside world, the jails and prisons are a potential public health menace. Officials have a special duty to curb the spread of disease among the more than 11 million people who pass through the system each year.

No one knows for sure how many people pick up H.I.V. while incarcerated. But a 2002 survey of prisoners' own estimates found that about 44 percent of the inmates were probably participating in sex acts. Researchers suspect that about 70 percent had their first same-sex experiences in prison. If those estimates are anywhere near accurate, the risk of infection behind bars is substantial, and the men who contract H.I.V. in prison return home to infect wives and girlfriends. Still, condoms are barred or unavailable in 95 percent of the country's prisons.

The national picture could well change if the California Legislature passes a timely bill, introduced by Paul Koretz, a Democrat from West Hollywood, that would require California's corrections system, the nation's largest, to allow public health and nonprofit groups to distribute condoms. In documents filed in support of the bill, Mr. Koretz notes that prevention programs make financial sense, too, given that treating an H.I.V.-positive person outside prison costs California nearly $23,000 a year.

Distributing condoms does not encourage sex in prison - that appears to be going on anyway. And data from Canada and American jurisdictions found no evidence that sexual activity goes up or that security declines once prisoners have access to condoms. On the contrary, jurisdictions that adopt such programs tend to keep and build upon them. Corrections officers usually support the programs once they have been proved to be effective.




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May 3, 2005

The Inexplicable Survivors of a Widespread Epidemic

By CAROL POGASH
SAN FRANCISCO, April 28 - Before powerful antiviral medicines became available, Kai Brothers lost his partner and many friends to AIDS. Thinking he was next, he quit his job, emptied his 401(k) and waited to die.

Nothing happened.

It has been 16 years since Mr. Brothers learned he was H.I.V. positive. Since then, he has never taken AIDS drugs or had any illnesses associated with the disease. Despite his good fortune, Mr. Brothers says he feels isolated.

"I don't identify with people who are H.I.V. negative because I'm not," he said. "I could infect someone. I don't identify with the positive people, because I don't have to deal with my health and medications and the things they have to worry about."

Once a month Mr. Brothers visits the laboratory of Dr. Jay Levy, a professor at the University of California, San Francisco, who is director of the university's laboratory for tumor and AIDS virus research. Since the epidemic began in 1981, Dr. Levy has been trying to understand why Mr. Brothers and others who are H.I.V. positive can remain medicine-free yet fit for decades, while the average person with H.I.V. progresses to AIDS within 10 years, if untreated.

An answer to that question could help in the development of a vaccine.

As a long-term survivor, also known as a long-term nonprogressor, Mr. Brothers, 42, is a much sought after anomaly. Dr. Levy believes that about 5 percent of people with H.I.V. are medicine-free and still healthy after 10 years.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases defines nonprogressors as treatment-free people with H.I.V. who have so little virus in their blood that it cannot be routinely detected. He suggests their numbers are far smaller, more like 0.2 to 0.4 percent.

Whatever the percentage, locating these research subjects is challenging. In the early years, one of Dr. Levy's volunteers trolled gay bars looking for survivors. A number of Dr. Levy's volunteers take part in other studies, here and at the infectious diseases institute in Bethesda, Md.

Long-term survivors have been around for a long time, said Dr. Mike McCune, senior investigator at the Gladstone Institute of Virology and Immunology.

"We just don't know why they do what they do," Dr. McCune said.

Martin Delaney, founder of Project Inform, an H.I.V. information and advocacy organization based in San Francisco, said: "The disappointing thing is that there's no consensus about what the long-term nonprogressors do. Different things explain it in different people."

For many years, Mr. Brothers said, he carried a sense of guilt. Before his infection was discovered, his church encouraged him to donate blood four times a year. The blood bank discovered that one of its donors was H.I.V. positive and asked that Mr. Brothers, too, be tested. Reluctant to learn the truth, he refused and quit donating blood.

In retrospect, Mr. Brothers, who had a flu-like illness in 1981, an early symptom of infection with the virus, believes he was H.I.V. positive before he began donating blood.

"This is something I contributed to and could possibly have meant dozens of people contracting the virus and dying," he said in an interview.

For years, he wanted to be part of a study. Five years ago, friends told him about Dr. Levy's research. Even when AIDS was a death sentence, Dr. Levy, a virologist, knew that every virus had its survivors.

He believed he could learn from those whose bodies had kept the virus in check.

Some of Dr. Levy's subjects have been H.I.V. positive for 27 years, longer than there has been an epidemic.

The dates of infection were confirmed by the San Francisco Department of Public Health, which in 1978 began a hepatitis B study of 6,704 gay men, whose blood was preserved. Over time, some of these nonprogressors have turned into slow-progressors, dying of AIDS. But there remain a dozen who are infected but have stayed healthy for more than 20 years without treatment.

In 1986, Dr. Levy discovered that in survivors, the white blood cells, known as CD8 cells secreted minuscule amounts of an antiviral factor that blocked replication of viruses in cells but did not kill them. The better the antiviral activity of those cells, the healthier the individual.

Dr. Levy has devoted his career to trying to determine what that factor is. "It is the hardest thing I've ever had to do," he said.

When Dr. David Ho, the founder of the Aaron Diamond AIDS Research Center, reported that he had found the substance, Dr. Levy told him he was mistaken.

Repeatedly, Dr. Levy has told peers that they are wrong. He is also his own worst critic: "After a while they say 'Levy is spending all this time telling us what it isn't. What is it?' " he said.

Over the years, Dr. Fauci said, many people have grown skeptical. "I have tried to find the factor, and I can't find what it is," Dr. Fauci said. "I can demonstrate the phenomenon, but I can't isolate the factor."

Ten years ago, Dr. Robert C. Gallo, a co-discoverer of the AIDS virus and the director of the Institute of Human Virology and Division of Basic Science at the University of Maryland Biotechnology Institute, said he was "fed up" waiting for Dr. Levy to reveal the elusive substance.

While searching for it, Dr. Gallo, along with Dr. Paolo Lusso, discovered three chemicals, called chemokines, in the blood of long-term nonprogressors that inhibit a certain subset of the virus, "like bouncers at a disco," Dr. Gallo said.

He did not find Dr. Levy's mysterious factor. But Dr. Gallo's research has opened a new field of therapy.

By 1996, when better treatment became available and people with H.I.V. were living longer, interest in survivors had diminished. But when it became apparent that a vaccine was still sorely needed, Dr. McCune said, the interest re-emerged.

Many researchers have focused on the late stages of AIDS, but Dr. McCune compares that method to piecing together the fabric of an ancient civilization by examining its ruins. He and others are now focusing on H.I.V.'s early stages. By studying long-term nonprogressors, they are raising questions about what types of immune responses are useful against H.I.V. and about when, in the course of the disease, they can have an effect.

"The main thing long-term nonprogressors teach us, and it keeps coming back again and again and again, is that it's not just the virus; it's the host," he said.

Dr. Eric Rosenberg, an infectious disease doctor and assistant professor at Harvard who focuses on the earliest stages of infection, compares CD4 cells to generals in a bunker. In most people with H.I.V., he said, the generals quit ordering the CD8 "soldiers" cells to kill H.I.V.-infected cells. But in the nonprogressors, the CD4's continue to give their marching orders.

Although many survivors attribute their good health to daily exercise, positive thinking, visualization or eating egg whites, Dr. Levy said it was all about genetics. When his subjects ask him why they're surviving so long, Dr. Levy said, he tells them, "You chose the right parents."

Dr. Mark Connors of the infectious disease institute's Laboratory of Immunoregulation has enlisted 19 subjects from around the country.

"Many of these folks are true altruists," he said. "These are very healthy people," yet they drop their careers to have blood examined at his laboratory.

Robert, a computer programmer who stopped by Dr. Levy's laboratory to have his blood drawn, said, "I feel strongly about making a contribution as I pass through this life." Robert, who did not want his last name used out of privacy concerns, has been healthy and medicine-free for the 19 years he has been infected.

Being in good health, after so many of his friends have died, seems somehow wrong. He harbors "this horrible secret," horrible, he said, because "I look healthy but I'm a carrier; you're carrying something that's fatal, but it's not fatal to you."

Long-term nonprogressors "are telling us we're missing something big with regard to how immune system works," Dr. Connors said.

Ninety-five percent of the long-term nonprogressors he studies share a gene that encodes molecules, allowing the immune system to recognize infected cells. Only 10 percent of progressors have that gene.

While researchers ferret out more information, Mr. Brothers has changed his ways. He has developed a long-term relationship, bought a house and is adding to his 401(k).

"I want to indulge in the future," he said. "I plan on being here for the long run."


Copyright 2005 (http://query.nytimes.com/ref/membercenter/help/copyright.html) The New York Times Company (http://www.nytco.com/)

July 22, 2005
Fighting AIDS Behind Bars

The United States has done relatively little to curtail the AIDS epidemic that rages within the prison system, where the H.I.V. infection rates are many times as high as in the world outside. Strategies for fighting disease behind bars are better developed in Europe, where the World Health Organization is 10 years into a public discussion project aimed at slowing the spread of H.I.V. and other deadly infections in the prison population. The Europeans seem to have grasped the idea that infections contracted behind bars end up back in the broader society when infected inmates get out.

The World Health Organization's most recent update consolidates what the Europeans have learned over the last 10 years and should be required reading for public health and prison officials in this country. The emerging consensus is that prison has become the perfect environment for the transmission of dangerous diseases like tuberculosis, hepatitis C and AIDS because of crowding, unprotected sex among inmates and widespread needle-sharing for intravenous drug use.

The rising infection rates among addicts in general show clearly that merely declaring sex and drug use illegal has not worked. The prison systems that have managed to slow the spread of AIDS have employed drug treatment and "harm reduction" strategies - like offering methadone maintenance and distributing condoms.

Many nations, including the United States, are hampered in the fight against AIDS by a pervasive denial of drug use and sex behind bars. Politicians often argue that harm-reduction strategies can seem to promote illicit behavior.

It's understandable that some prison systems may reject the idea of providing needles to people who use drugs behind bars, even though needle exchanges have proved to be a cheap and effective way to slow the spread of disease in the outside world. But it seems inexcusable that prisons don't pursue other strategies - like testing inmates and educating them about disease - while making condoms readily available to those who want them.

It's not necessary to condone behavior that spreads AIDS. But it is critical to acknowledge that such behavior persists in prisons. The aim must be to slow the spread of disease so as few people as possible get out with infections that endanger society.





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August 1, 2005
A Company's Troubled Answer for Prisoners With H.I.V.

By PAUL von ZIELBAUER
HARVEST, Ala. - If there was ever a prison that needed help, it was Limestone Correctional Facility.

Even within the troubled Alabama penal system, this state compound near Huntsville was notorious for cruel punishment and medical neglect. In one drafty, rat-infested warehouse once reserved for chain gangs, the state quarantined its male prisoners with H.I.V. and AIDS, until the extraordinary death toll - 36 inmates from 1999 to 2002 - moved inmates to sue and the government to promise change.

Alabama's solution was to fire the local company in charge of medical care and hire Prison Health Services, the nation's largest commercial provider of health care behind bars. Prison Health's solution was to recruit Dr. Valda M. Chijide, an infectious-disease specialist who arrived last November with a lofty title: statewide coordinator of inmate H.I.V. care.

She was an unlikely candidate for the job in one sense, having never stepped inside a prison. But it did not take her long to conclude that the chaos was continuing, and that much of the problem was Prison Health itself.

Though the company had promised the help of other doctors, she said, she was left alone to care for not only the 230 men in the H.I.V. unit, but the 1,800 other prisoners, too. Nurses were so poorly trained, Dr. Chijide said, that they neglected to hand out life-sustaining drugs or gave the wrong ones. Medical charts were a mess, she said, and often it was impossible to find such basic items as a thermometer, or even soap.

Dr. Chijide lasted barely three months. After she complained in writing, Prison Health suspended her for reasons it would not disclose, and she quit.

Her short, frantic stint - battling for drugs, hospitalizations and extra food for skeletal inmates, she said - was not unusual in the world of Prison Health Services, which has had a turbulent record in many of the 33 states where it has provided jail or prison medicine. But her story, a rare firsthand account of a doctor in charge of a prison's health care, offers an intimate glimpse of the company's work at a moment when the need for change could not have been more pressing, and the spotlight on Prison Health could hardly have been more intense.

Even then, interviews and the reports of a federal court monitor show, the state and the company made promises they did not keep, settling for care that jeopardized inmates' health. And Prison Health, which often laments the difficulty of finding qualified doctors to work in jails and prisons, searched nationwide for a specialist, only to question her integrity.

"If you bring up a problem that they don't want to hear about, they will attack you," said Dr. Chijide, 45. "I felt better resigning than staying on and bending my principles to their principles."

A Prison Health spokesman said the company "had great expectations" for Dr. Chijide (pronounced CHIJ-i-day), but was informed that she had violated company policy, though it would not say how. She was put on leave, the company said, and before it could investigate, she quit.

Dr. Chijide said the company never told her why it suspended her.

Executives said that Prison Health has greatly reduced the number of inmate deaths - to four during its nearly two years in Alabama - and made steady improvements in a difficult program that had been badly run for years. Its corporate medical director, Dr. Carl J. Keldie, said in an interview last December, while Dr. Chijide was still employed there, that the Limestone program was "excellent," and would eventually become one of the best in Prison Health's sprawling operations.

Around the nation, the company has drawn criticism from judges, government overseers, and whistle-blowers, and has paid millions of dollars in fines and settlements. In New York, state regulators have faulted Prison Health in several deaths, and are investigating whether it is even operating legally in the state. Yet the company has continued to grow, absorbing rivals and winning new contracts; its largest, serving New York City's jails, was renewed in January, as Dr. Chijide was lodging her complaints.

A low-key but tenacious woman who had a run-in with an earlier employer, Dr. Chijide says the care at Limestone was far from adequate, and there is evidence to support her. In February, the month she resigned, the court monitor described an H.I.V. unit riddled with rats, where broken windows had been replaced with plastic sheeting that was itself falling apart. Thousands of doses of prescribed medications had never been given, as far as the monitor could tell from the slapdash records. No one was being tested for tuberculosis or treated for hepatitis C, which prey on fragile immune systems.

Limestone is not the only hitch in Prison Health's effort to transform a penal backwater. Two hundred miles south, at the state's Julia Tutwiler Prison for Women, another federal monitor reported that Prison Health lacked any "organized and structured medical program," and deplored the care given two inmates who died last year.

There is, of course, a higher authority that Prison Health must answer to: the state official charged with making sure it lives up to its contract. That person is Ruth Naglich, who as associate commissioner of the Alabama Corrections Department is supposed to review the company's work.

Three years ago, Ms. Naglich was a Prison Health executive, vice president for sales and marketing, at the company's headquarters outside Nashville.

Ms. Naglich said her connections to the company helped her coax it to improve care. And though her department has moved to fine Prison Health $580,000 over the last year for failing to meet certain performance standards - the company is fighting the fines - she said, "I'm pleased with the progress they've made."

The progress required of the company is laid out in court documents; in their suit over the deaths at Limestone, inmates won a settlement in which the state - and, by extension, Prison Health - agreed in April 2004 to make dozens of fixes in the H.I.V. unit and allow the monitor to inspect regularly. The monitor's reports show the company has made advances in some areas but little headway on some of the most critical reforms, and at one point tried to cover up its failure to comply by hastily updating patient charts. In fact, Dr. Chijide said, the company never even told her about the court settlement.

The New York Times began asking Prison Health in April to discuss its work at Limestone. The company offered in June to arrange an interview with its president, Trey Hartman, but never made him available, and eventually answered only a small number of questions via e-mail.

"P.H.S. continues to provide evidence-based medical care to the patients of the A.D.O.C. in a timely and professional manner," said Benjamin S. Purser Jr., a spokesman for the company, referring to the Alabama Department of Corrections.

The company would not address the monitor's reports or the troubles Dr. Chijide said she had discovered.

"If I had known all those things," she said, "I never would have worked for them in the first place."



A History Kept Hidden



Ringed by corn and cotton fields, Limestone looks unremarkable, a collection of low-rise cellblocks crouched in the shadow of a watchtower. But it houses something unusual in the realm of corrections: a prison-within-a-prison where Alabama keeps all its male inmates with H.I.V. or AIDS, whether they are killers or petty thieves.

This unit was created in 1985 on the theory that segregation would curb infection and security risks - a notion that fell out of favor elsewhere, but not in Alabama, which says it is the only state that still quarantines them. Many corrections experts today say the practice actually increases the risk of infection, and invites neglect.

That is how it worked out at Limestone, according to inmates in the unit who filed suit in 2002, arguing that their living conditions and medical care, by a Birmingham company called Naphcare, amounted to a death sentence. The doctor they hired as a medical expert, Stephen R. Tabet, dug through the pile of mortality records - the rate of AIDS-related deaths in Alabama that year was more than twice the national prison average, according to the Justice Department - and assembled a gruesome gallery.

An emaciated 39-year-old wasted away after begging a doctor for sandwiches. A 29-year-old with pneumonia was short of breath when he arrived at the unit, but waited two days to see a doctor and get a prescription; he never received the medication, and on the fourth day, he suffocated. A 41-year-old, also struggling to breathe, was sent off to a hospital two hours away in a prison van with no medical help, even after a guard urged that he be rushed in an ambulance. "He'll be fine," a nurse said, but the man had a heart attack on the way and died.

Treatment was not much better for those who survived. Packed into bunks so close that infectious abscesses "spread like wildfire," Dr. Tabet wrote, they were rousted at 3 a.m. to stand in line outdoors, often in the cold or rain, to get their pills.

Naphcare defended its record in a statement, but conceded that many deaths might have been prevented. It blamed the state for limits on food, shelter and medical services.

The state dropped Naphcare and hired Prison Health Services in November 2003, under a three-year, $142.7 million contract for all Alabama prisons. And in April 2004, the 18-page settlement of the inmate lawsuit was hailed as the blueprint the state and company would use to bring the unit into the 21st century. The old warehouse had been replaced by two cellblocks; in another change, prisoners would no longer have to pack dead cellmates into body bags.

The big moment, however, came last November, when Prison Health hired the H.I.V. specialist who would lead the charge: Dr. Chijide, who had answered the company's help-wanted ad in a medical journal.

Though she lacked prison experience, she did not shrink from a challenge, once spending seven years treating native people in Alaska. She also had grown up in Alabama, so moving back with her husband and two daughters would be a homecoming.

The company offered her $180,000 a year and told her, she said, that she could set her own treatment program and hours. She would be assisted by the prison's medical director and another full-time doctor, she said, along with a nurse assigned to the unit.

But the medical director quit, and Prison Health never produced the other help. It did not give Dr. Chijide any orientation, she said, or the written policies and procedures essential to any prison clinic. The only prison training she got was a week in a California prison AIDS clinic run by the expert monitoring the settlement.

Dr. Chijide said Prison Health never mentioned the terms of the settlement and the obligation it placed on the company. It was the court monitor himself, Dr. Joseph Bick, who suggested she look up the lawsuit on the Internet. Returning home from his clinic, she entered the prison's name on Google and found the horrifying death reports.

"Wow," she recalled thinking. "So this is what's going on."



Running on Empty



The inmate complained of chest pains, so Dr. Chijide sent him to the prison infirmary. But when she checked in on him, she said, he was holding a bottle of nitroglycerin pills that a nurse had handed him, to take as he liked. The nurse was nowhere to be found.

Nurses, she discovered, were prescribing drugs and making diagnoses without her consent. "I found cases where nurses had written 'verbal orders, Dr. Chijide' when I hadn't prescribed anything," she said. Yet her own prescriptions often went unheeded; the antibiotics she ordered for an inmate with perilously weak immunity were found days later on a medicine cart.

Lab-test results were lost or ignored, she said. A rat scuttled through her examination room. Inmates, assigned to the H.I.V. unit without any notice from prison officials, simply showed up unannounced. "Nobody said to me, 'These inmates have arrived; you need to see them,' " she said. So she asked nurses whether they had noticed any new faces, or went searching herself.

The prison medical director, Dr. Wyndol S. Hamer, resigned in early December, a few weeks after Dr. Chijide started. The company said his decision was personal, and Dr. Hamer - who Dr. Chijide said had criticized Prison Health during staff meetings - would not comment.

Whatever the reason, his departure left Dr. Chijide the only physician for all of Limestone. Each day became a race to treat inmates in the infirmary, answer sick calls and hunt down missing medical records. The H.I.V. unit had no clerical help, and the prison had no computer system to track patients, she said, so those records were often little more than notes on scraps of paper.

No patients died under her care, Dr. Chijide reflected with relief. But she felt she had merely been lucky.

When an inmate in the unit contracted tuberculosis in January 2004, before she arrived, Prison Health had to put all 230 prisoners, and several guards, on drugs for nine months to prevent the disease from spreading, Dr. Chijide said. Yet nearly a year later, she said, the unit still had no place to quarantine inmates with TB or hepatitis C.

Appeals for anything beyond the routine - treatment at outside hospitals, prescriptions not in the company pharmacy - became tangled in delays and denials, she said. And the dearth of everyday supplies, she said, ventured toward the absurd.

Sometimes, she said, she was forced to write "no thermometer" on a patient's chart - if there was a chart at all. Often, discovering that soap dispensers were empty in the infirmary, where the sickest prisoners were kept, she had to pause between patients and walk to the prison pharmacy, or to a bathroom at the other end of the building. "I had never been in a hospital or clinic that didn't have soap or paper towels," she said.

But, Dr. Chijide said she learned at last, the Prison Health operation was not like any other. "Nobody was really making an effort to run an H.I.V. clinic the way it was supposed to," she said. "They would tell you one thing, but when it came down to it, they didn't provide the resources."



A Reckoning, and a Warning



She was not shy about speaking up. When her complaints drew no response, she started taking notes. And on Christmas Day, her first real break, she laid out her grievances in a 10-page letter to the company.

Dr. Chijide had fought this sort of battle before. In 1993 she sued the Alaska clinic, saying that it had given her an unreasonable schedule and improperly ended her contract. A state court ruled that she had been let go without proper notice, but the Alaska Supreme Court reversed the decision.

This time, she had added backing: the reports of the court monitor, Dr. Bick.

On Jan. 20, nearly a month after her letter, two Prison Health executives sat her down. The timing was significant: Dr. Bick was to return in 18 days. The company had been at the prison well over a year.

Dr. Chijide said the executives blamed her for the unit's troubles, accusing her of seeing too few patients, coming and going as she pleased, and documenting too many problems. If the monitor found Prison Health out of compliance with the settlement, she said they told her, it would not be good for the company - or her.

Undeterred, Dr. Chijide wrote to them again, saying she had been scapegoated. Prison Health suspended her, but prepared for the inspection by granting some of the things she had asked for, including a nurse. The prison staff set out fresh rat traps.

And with Dr. Chijide gone and the monitor about to arrive, a Prison Health doctor raced through more than 100 medical charts in two or three days, jotting notes to make it appear that prisoners had received proper physical examinations.

The monitor was not fooled. "Patients allege that this physician spent a few minutes with each of them, did not touch them, did not answer questions, and rarely looked up from his writing," he wrote. The company's last-minute efforts, he said, "do not meet any reasonable standard of H.I.V. care."

In an interview, Dr. Bick was reluctant to go beyond the statements in his reports, which have commended Prison Health for keeping better records and for stopping nurses from acting beyond the scope of their licenses. He said he believed that the company intended to live up to the settlement, but "you can't be successful when you're trying to hide your warts and not rising to the challenges that you face."

Prompted by his findings, the Southern Center for Human Rights, which filed the original inmate lawsuit, asked a federal judge to hold the company in contempt for violating the settlement; he has not ruled. Human Rights Watch asked Gov. Bob Riley of Alabama to take immediate action to ensure the state's compliance; a spokesman for the governor would not comment.

Dr. Chijide has accepted a job at a Canadian hospital. But she says she still worries about Limestone's fate under Prison Health Services. "They were the type of people who were going to run the facility any way they want," she said. "And they were going to save money any way they can."

On July 1, Prison Health said, it filled her job. But in a report five days earlier, Dr. Bick warned that "the rapid turnover" of doctors was a dangerous problem. He urged the company to stop it.

"Due to the fragile nature of this medical program," he wrote, "I recommend that every effort be made to retain physicians once they are hired."





<LI style="BORDER-RIGHT: #000 1px solid">Copyright 2005 (http://www.nytimes.com/ref/membercenter/help/copyright.html) The New York Times Company (http://www.nytco.com/)

Inmate Homicide, Suicide Rates Decline

By PETE YOST, Associated Press WriterSun Aug 21, 5:23 PM ET


Inmate death rates for suicide, homicide and AIDS are showing substantial declines in jails and state prisons, the government says. The trend reflects improved medical care and closer attention to separating violent criminals from other offenders. State prison homicide rates declined by more than 90 percent, from 54 per 100,000 in 1980 to four per 100,000 in 2002, the latest year for which data is available, the Bureau of Justice Statistics said in a report Sunday.
Jail suicide rates fell more than 60 percent, dropping from 129 per 100,000 inmates in 1983 — when suicide was the leading cause of death among inmates — to 47 per 100,000 in 2002.

Death rates from AIDS-related causes in jails also fell sharply, from 20 per 100,000 in 1988 to eight per 100,000 in 2002. In state prisons, AIDS-related death rates fell from 100 per 100,000 inmates in 1995 to 15 per 100,000 in 2000. One reason for the downward trend is that advocacy groups have become much more aggressive in filing lawsuits to improve conditions behind bars, said Kara Gotsch, public policy coordinator for the ACLU's National Prison Project.
The prevalence of gangs in prisons has resulted in a lot of violence, prompting corrections officials to pay more attention to classifying prisoners, Gotsch said.
"There's much more awareness about the problem of suicides in jails," said Lindsay Hayes, project director for the National Center On Institutions and Alternatives. "Twenty years ago if you asked a sheriff, he wouldn't have any information on it or any sensitivity to it. It wouldn't be on his radar screen."

Today, there is better screening, better training and better mental and medical health staff, said Hayes. The improvements are occurring as the size of the population behind bars heads upward. The number of inmates has been on the increase since the 1980s, with the prison and jail population now at 2.1 million.






Copyright © 2005 The Associated Press. All rights reserved.