Officials Face Difficult Choices : AIDS Victims in Prison: Death Row in a Hospital

Jimmy Bozeman doesn’t want to die in prison, but he knows he is likely to do just that.

Although he killed a man in a fight seven years ago, the chunky 28-year-old has not been sentenced to death. He developed AIDS-related complex, a deadly ailment that has weakened his system’s resistance to infections, and he believes that he will not live long enough to serve the five years remaining on his eight-year sentence.

He is not alone. As of last October, at least 552 prison inmates in the United States, including 71 in California, had been diagnosed with AIDS or AIDS-related complex, latest government figures show. In addition, a dozen other California inmates--11 men and a woman--have tested positive for exposure to the AIDS virus but have not yet developed symptoms of the disease.

Prisoners with acquired immune deficiency syndrome are a growing problem for correctional officials across the country, and their presence raises many of the same issues facing the outside world. For prison officials, it poses questions about who should be tested for exposure to the disease, what to do with carriers, where to house AIDS victims, how to pay for their care and whether condoms should be issued to check the spread of the disease.

One San Francisco lawyer, Ephraim Margolin, has also raised such constitutional questions as whether healthy convicts can legally be sentenced to a prison where they may be exposed to the AIDS virus.

“We may rapidly be approaching a situation in which a jail or prison term will no longer be judged solely on the basis of ‘is it cruel or unusual,’ but more emphatically on terms of ‘does it expose prisoners to potential capital punishment?’ ” he wrote in an open letter to San Francisco Superior Court judges.

Most of the infected prisoners, officials believe, are intravenous drug abusers who contracted the disease by sharing hypodermic needles before being jailed.

For 529 people, being incarcerated with AIDS was a kind of death sentence. That many have died of the syndrome while in custody, and 151 AIDS patients--and uncounted numbers of victims of ARC (AIDS Related Complex) and outwardly healthy carriers of the AIDS virus--have been released from jail, either having served their sentences or having been paroled. In California, 28 AIDS and ARC patients have died in custody and 52 have been released.

For those remaining, the AIDS ward is grim. Inmates are free to pace the old, faded linoleum of the institutional gray hallways, but recreation is limited to a communal television room and a pair of compact concrete-and-grass exercise yards that are equipped with weights and a lone basketball hoop and bounded on three sides by multistoried cell blocks.

Problem of Boredom

AIDS ward inmates are denied access to other prison facilities--the library and the main yard, for example--because of prison officials’ worries about violence and the spread of the disease. The inmates, most of whom seemed deceptively fit, also complain that they cannot see a doctor whenever they please. Boredom is a major part of their lives, giving them long hours to dwell on their fate.

“This wing here is a Death Row,” Bozeman said glumly, sitting in the AIDS ward at the California Medical Facility, the statewide medical center for male inmates of California’s prison system. “Everybody’s going to die.”

During the most recent period studied by federal researchers, the number of AIDS victims in prison grew more slowly than the number in the general population--up 61% in jails and 79% overall between November, 1985, and October, 1986. This apparently is because inmates had a much higher infection rate to start with.

Despite the slower growth rate, correctional officials agree, the problem of AIDS in prison can only worsen. This, they said, is because inmates more often engage in the two activities believed to promote the rapid spread of AIDS--intravenous drug abuse with shared needles and certain homosexual acts.

‘Growing More and More’

“It’s growing. No doubt. And it is growing more and more,” said Dr. Nadim Khoury, chief of the health services unit for the California Department of Corrections. The deadly contagion killed 17 California state prison inmates in 1986, and he expects the number to grow tenfold within a decade.

In an effort to arrest the spread of AIDS within their institutions, prison officials across the country are scrambling to initiate preventive measures, from intensive education programs to segregation of known AIDS carriers. A few states have started to test each inmate for the disease--an idea the California Legislature is debating and one that touches such matters as the civil rights of prison inmates.

One state, Vermont, has begun distributing condoms to inmates. Condoms are advocated by Surgeon Gen. C. Everett Koop as one way of reducing the risk of spreading or acquiring the virus. California state prisons permit women to bring condoms for use during conjugal visits with their inmate spouses, and San Francisco gives condoms to men as they are released from the County Jail, but neither plans to offer them to inmates.

“It is a felony to engage in homosexual activity in here,” said Lt. Bobby Houston of the California Medical Facility. “Handing out condoms, to me, just seems to condone that action.”

Instead of condoms, California officials prefer to hand out pamphlets. Some are standard-issue educational and “safe sex” manuals produced by such mainstream organizations as the San Francisco AIDS Foundation. Others are generated by the Department of Corrections specifically for inmates and their families.

Inmates argue that the distribution of condoms--and hypodermic needles--would not encourage illegal acts any more than confiscating them has. They contend that by banning needles, prison officials are unwittingly encouraging inmates to share whatever needles they can get.

‘They Can’t Stop It’

“They can’t stop it (homosexuality or drug use), and they know they can’t stop it,” Bozeman said. “I think that they should pass out condoms; they are not going to stop that activity. And (other inmates) are going to shoot drugs, regardless. I think they should try to make it safer.”

For the moment, at least, such arguments remain hypothetical, because polls of prison inmates in New York and elsewhere show that few of them contract the deadly disease in prison. In California, for example, 68% of AIDS-infected inmates developed symptoms of the disease, which has a long incubation period, within the first year of incarceration; 92% showed signs within 18 months and no one has yet been diagnosed after more than about four years in prison.

“This tells me it is something they are coming (in) with and not getting within the prison,” said Khoury. “I can’t say conclusively that they are not being exposed to it in prison, but this is about as conclusive as I should hope for without a complete epidemiological investigation.”

However, as more and more carriers of the AIDS virus--known as HIV or human immunodeficiency virus--are introduced into the nation’s prison systems, prison officials worry that the number of infected inmates will mushroom. One inmate openly acknowledged during an interview that he has had sex five or six times during his stay in the AIDS ward here.

So, although the National Institute of Justice concluded in its latest report, in May, that the figures “suggest low rates of transmission” in prisons, it cautioned that “the extent to which HIV infection is transmitted within correctional institutions remains a controversial subject.”

AIDS infection among inmates varies widely across the country and does not always reflect general-population morbidity, statistics show.

Law-Abiding Gays

The highest inmate infection rate is in New York state, which also has the most AIDS victims in its general population. In contrast, California has the second-highest overall AIDS rate but ranks fifth among the country’s 89 largest jail systems.

Khoury said this is because most California AIDS victims are law-abiding homosexuals who stay out of prison and that most AIDS victims in the East are drug addicts who commit crimes to support their habits.

California’s prison officials and inmates agree, however, that the state has many infected inmates who have not yet shown symptoms of the disease or whose symptoms have not yet been properly diagnosed, as well as many who suspect that they may be infected but who decline to step forward.

“There are a lot of people who know they have it but don’t want anyone to know it because of this,” Bozeman said, gesturing to the aging isolation ward where he and other AIDS carriers live, “because of all the restrictions.”

State legislators have had similar thoughts and have proposed the mandatory testing of every inmate. State Sen. John Doolittle (R-Rocklin) has written a bill that would require tests, and Senate Republican Leader Ken Maddy of Fresno recently suggested a two-week trial of testing new inmates as a way to estimate the true extent of inmate AIDS.

Unsure of Results

Prison officials are unsure what such test would find. In Nevada, all 3,820 inmates were tested in 1985, and 96, or 2.5%, demonstrated exposure to AIDS. Four other states found exposure rates among new inmates of 0.5% or less. Iowa found no exposed inmates among the 800 tested early in 1986.

California, however, may have a higher rate of exposure simply because AIDS is more common in the state’s general population.

If a higher rate is found, it could mean trouble for prison officials. The state, for example, could find that it has dozens of new AIDS victims, enough to overwhelm Vacaville’s newly expanded 150-bed AIDS ward. California could then be forced to allow outwardly healthy AIDS virus carriers to live with the general prison population, where they could spread the disease and perhaps face violent retribution from other inmates.

Meanwhile, several articulate inmates, including David Allen, 25, a convicted thief from Los Angeles, are calling for better treatment of AIDS carriers while opposing the routine segregation of AIDS inmates.

“I don’t see how these people can talk about mandatory testing,” he said. “They can’t even take care of the people they have now. . . . People in the street cannot be discriminated against. Why do they discriminate against us?”

Allen said, for example, that segregation is needlessly cruel because other prisoners would not mind sharing space with AIDS patients.

Inmates Fear Attacks

Houston, the prison spokesman, disagreed. “We have reason to believe,” he said, “that some of the other general population inmates might try to harm them because they have AIDS.” For security reasons, he did not say how prison officials came to that conclusion.

California’s segregation policy is not unusual. A federal survey found that 16% of the nation’s state and federal prison systems automatically isolate infected inmates. Another 16% isolate those who have developed AIDS or ARC. Another 16% isolate only people with AIDS. Twenty-seven percent deal with infected inmates on a case-by-case basis.

Lawsuits challenging isolation policies elsewhere have not been successful. In one case, Cordero v. Coughlin, a federal judge upheld the isolation of AIDS inmates in New York prisons, saying that the practice serves a legitimate objective--the prevention of disease--without being cruel and unusual or violating equal-protection statutes.

Houston also denied inmate complaints that they are given inadequate access to doctors. “Doctors do not see each patient every week, but they don’t have to,” he said. “It is just like San Francisco General (Hospital) or any place else--you only see a doctor when you need to. If they are sick, then they see a doctor.”

Acutely ill patients, he added, are taken to a special ward at the North Bay Medical Center in nearby Fairfield or are transferred to the AIDS facility at San Francisco General Hospital.

In addition, Houston said, the state is trying to arrange AZT drug treatment for at least some inmates suffering from AIDS. The drug has been shown to prolong the lives of some AIDS patients. The cost of such treatments, he said, could run between $10,000 and $12,000 a year for each inmate.