Medicine Behind Bars: Quality Care Is Elusive, Despite Lawsuits : Inmates With AIDS Decry Stigma and Confinement to Virtual ‘Death Rows’

Carmen Harris, isolated with other female Alabama prisoners carrying the AIDS virus, feared that she would bleed to death in her cell.

Stitches from routine uterine surgery had torn open, but nurses on three shifts failed to answer her pleas for help in November, 1987, she said.

“They was afraid of the blood. They was afraid of catching the virus. They had a fear of the word AIDS,” said Harris, who waited 12 hours before she was taken to a hospital near Montgomery.

“You’re treated like an alien, like you had the plague,” she said. “I got sentenced for manslaughter. The judge could have just as well sentenced me to Death Row. It’s like being punished for my crime and my diagnosis.”

Some states isolate inmates who have the virus even if they have not developed symptoms. Those in segregation consider it cruel confinement to a new Death Row. Prison officials defend it as a way to contain the virus and protect those infected from harm.

Although arguments can be made for segregation, nothing excuses the failure to provide medical care, inmates’ advocates say. But prisons are not equipped to treat the long-term debilitating illnesses wrought by AIDS.

“Those on the new Death Row are not getting appropriate medical attention. They are being condemned to waste away,” said Benjamin Schatz, director of the AIDS Civil Rights Project of the National Gay Rights Advocates. “They are treated as if infection indicates they have done something wrong.”

“AIDS has made the job of providing prison health care more difficult, more hazardous and more expensive,” said Curtis Prout, director of the internship program at Harvard Medical School.

Acquired immune deficiency syndrome is most commonly transmitted during homosexual acts and the sharing of contaminated needles while injecting drugs, two behaviors common among prisoners.

In the most recent count last October, 3,136 AIDS cases had been diagnosed among the U.S. prison population of more than 627,000, according to the National Institute of Justice. AIDS in prison increased 60% last year, compared to a 76% jump in the general population, which can pursue high-risk behaviors more freely.

Alabama and five other states--California, Georgia, Nevada, Tennessee and Wyoming--segregate prisoners who carry the human immunodeficiency virus that causes AIDS, whether or not they have the disease.

Prisoners who have the disease are segregated in 20 other states, and 14 states test or will soon start testing all incoming inmates for the disease.

Federal prisons randomly test 10% of incoming inmates and all those leaving the system. Those with AIDS or the virus are not isolated.

Other Solutions Favored

Mandatory mass screening and segregation of all HIV-positive inmates is opposed by the National Commission on Correctional Health Care, which sets voluntary standards for health care in prisons. It favors solutions such as education and changing behaviors that cause AIDS.

Alabama inmates who tested positive for the AIDS virus have charged in a class-action lawsuit that they receive poor medical care and cruel treatment. The federal trial began in March.

Suits are pending in two other states that segregate. Inmates with AIDS in Connecticut say their medical care is grossly inadequate. California prisoners assert that the level of their medical and psychiatric care is “atrocious.”

“They’re treated like lepers. They might as well be wearing a scarlet letter. They’re shunned, ostracized and stigmatized,” said Alexa Freeman, an attorney with the American Civil Liberties Union, which filed the Alabama suit.

“There is no logic, no rational basis and no medical basis” to the segregation, said Robert Cohen, former medical director at New York City’s Rikers Island Prison and an expert medical witness. “It is only fear and discrimination which gives rise to such barbarous actions.”

Most Carriers Are Men

Of the 12,000 inmates in Alabama, 138 have tested positive for HIV since 1987. All but eight are men.

Men are segregated at the Limestone Correctional Facility inside Dorm 7, where even the exercise yard is cut off from the main yard by a 14-foot-high chain-link fence topped with razor wire.

The sense of doom is so heavy that inmates call it Thunder Dorm, recalling the futuristic city in “Mad Max Beyond Thunderdome,” a movie about society’s collapse after a nuclear holocaust.

Inmates eat with wooden ice cream sticks instead of forks and spoons. Meals come on color-coded trays. Their dirty laundry goes out in red plastic bags so it is washed separately.

They worship apart from other inmates and do not have equal access to programs that would allow them to have jobs or earn early parole.

One inmate with the virus was forced to mop the halls behind him as he walked. Others were given surgical masks and made to clean telephones with bleach or ammonia swabs after making calls.

“The same hysteria on the streets is multiplied in prison,” Alvin Bronstein of the ACLU said.

Sense of Doom

Michael Marsh, 41, a thief, said life in Thunder Dorm features fights, knifings and high-risk sex among prisoners who figure that they are going to die anyway.

“Guys would rather be killed here than die from AIDS. They hunger for death another way. Any other way. Something that would be honorable,” Marsh said. “It’s like living in the valley of the shadow of death. If AIDS don’t kill you, one of the guys might.”

Some inmates want to keep the HIV prisoners isolated, saying those infected would be killed “as soon as they got into the yard.”

“It’s either we take them out or they take us out,” said Stewart Hughey, 28, a rapist, who testified in favor of segregation in the Alabama case. “If one of them gets his semen or blood on an open cut, they just signed your death warrant.”

In New York state, where AIDS is the leading cause of death among inmates, medical care is deficient, according to an 18-month study released last year by the Correctional Assn. of New York.

Diagnoses During Autopsies

Doctors were unfamiliar with AIDS treatment and detection, the study said. Since 1981, more than 500 prisoners have died of AIDS; in 25% of the cases, the disease was not diagnosed until an autopsy.

Prisoners with AIDS also have an unusually low survival rate, the report said.

Inmates from New York City who got the disease from dirty needles had an average survival rate of 159 days, half that of those in the outside community with similar backgrounds.

“AIDS and prison is proving to be a devastating combination,” said Cathy Potler, author of the report. “Imprisonment becomes a virtual death sentence.”