Waters seeks to sway AIDS groups on prisoner testing

A new bill introduced by Rep. Maxine Waters (D-Calif.) would require federal prisons to provide HIV/AIDS tests to all inmates at the beginning and end of their periods of incarceration, a new version of a concept that has raised civil liberties concerns in the past.

A new bill introduced by Rep. Maxine Waters (D-Calif.) would require federal prisons to provide HIV/AIDS tests to all inmates at the beginning and end of their periods of incarceration, a new version of a concept that has raised civil liberties concerns in the past.

AIDS activists, civil libertarians and prisoners’-rights groups have resisted calls for mandatory HIV/AIDS testing of prisoners, citing concerns about confidentiality and about prisoners’ fear of being ostracized by guards and fellow inmates.

The group AIDS Action, for example, describes mandatory testing as “unethical, ineffective, and an invasion of privacy.” According to a 2001 report by the group, 19 states require inmates be tested when they enter prison and three require they be tested before they are released.

Likewise, international public health entities have rejected mandatory testing. HIV/AIDS screening of prison inmates “should be voluntary, confidential and with counseling,” a World Health Organization (WHO) spokesperson wrote in an e-mail, citing a report issued in July by the WHO, the United Nations Office of Drugs and Crime and the Joint United Nations Program on HIV/AIDS.

Seeking to address these criticisms, the Waters bill would allow prisoners to refuse the screenings.

Waters acknowledges that, even with an “opt-out” provision in the bill, the proposal might raise alarm bells among advocates for HIV/AIDS patients and prison inmates.

“There’s some discomfort. There’s a division among the AIDS groups,” Waters said. “I’m moving beyond where they would normally want to go.”

One AIDS advocacy organization looks favorably on Waters’s approach. “We are pleased that Congresswoman Waters has brought up this important issue of HIV in prisons,” said Donna Crews, AIDS Action’s director of government affairs.

Waters insisted that the pervasiveness of HIV/AIDS infections in the black community necessitated more aggressive means of controlling the spread of the disease, and addressing HIV/AIDS among prisoners is only part of the strategy.

Despite relatively good news about HIV and AIDS in the U.S. population at large, the problem continues to plague African-Americans, Waters said. “We’re not making a dent. Minority AIDS keeps rising.”

According to 2004 figures from the National Institute of Allergy and Infectious Diseases, the rate of AIDS diagnoses for black women was 23 times the rate for white women and the rate for black men was eight times the rate for white men. African-Americans also make up a disproportionate share of the prison population.

HIV/AIDS infection is especially prevalent in the prison population, the most recent federal survey illustrates. The infection rate among the 192,000 inmates in federal prisons is estimated to be .9 percent to 1 percent, Mike Truman, a spokesman for the Department of Justice’s Bureau of Prisons (BOP), wrote in an e-mail.

In 2005, the Department of Justice’s Bureau of Justice Statistics released a study of 2003 data that show that 1.8 percent of men and 2.6 percent of women in federal and state prisons are known to be HIV-positive. The rate of AIDS infection in federal and state prisons is .51 percent, compared to .15 percent in the general population, the study shows.

The BOP already has policies in place for screening and treating inmates for HIV/AIDS. “The cornerstone of HIV infectious disease programs is education regarding HIV transmission and infection and changing behavior from those at high risk to low risk,” Truman wrote.

According to guidelines published in June, prisoners are entitled to an HIV/AIDS test on request and prison medical personnel are advised to administer tests on inmates who show signs of infection. “BOP clinicians should have a very low threshold for testing inmates for HIV infection,” the guidelines stated.

In certain cases, the tests are mandatory and prisoners cannot refuse, as described in a 2005 policy statement issued by the BOP. “Mandatory testing is performed when there are risk factors and the test is clinically indicated and/or surveillance testing is required. Inmates must participate in mandatory HIV testing programs,” the document says.

Waters described the BOP’s standing policy as “not very comprehensive” and said that her bill would expand the number of prisoners who get tested and improve the care they receive in prison and when they are released.

The legislation would direct BOP to guide former prisoners toward treatment and counseling resources available in the community. “That kind of continuity planning is really important,” said Lester Wright, chief medical officer and deputy commissioner of the Division of Health Services in the State of New York Department of Correctional Services.

Wright, who has worked in the New York prison system for more than 11 years, cautioned that though the Waters bill would lead to more screenings and better care, there is no way to predict how many prisoners would refuse testing. New York state prisons provide “confidential and anonymous” HIV/AIDS testing to prisoners at any time and conduct about 15,000 tests each year, Wright said.