"The Judge Gave Me Ten Years. He Didn't Sentence Me to Death.".

• Author: Cusac, Anne-Marie
• Position: Inmates with HIV or AIDS, US

Inmates with HIV deprived of proper care

In prisons and jails across the country, inmates with HIV or AIDS are being denied proper treatment. In many cases, guards and medical staff have blocked inmates from getting their vital drug regimens, sometimes for months at a time, or have prescribed regimens that are dangerous. Such negligence can lead to drug resistance. It can also lead to death.

"We routinely get letters from people who are not getting their medications," says Christine Doyle, research coordinator for Amnesty International, U.S.A.

The mistreatment appears to be widespread and may affect thousands of inmates.

It may also be illegal. The Supreme Court has ruled that prisoners must receive adequate medical care. The 1976 decision in Estelle v. Gamble states, "Deliberate indifference to serious medical needs of prisoners constitutes the `unnecessary and wanton infliction of pain' ... proscribed by the Eighth Amendment. This is true whether the indifference is manifested by prison doctors in their response to the prisoner's needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed."

Since 1996, combinations of three antiretroviral agents, including one protease inhibitor, have dramatically improved the health of many people with HIV and AIDS. The basic government recommendations for HIV and AIDS medications, as outlined by the National Institutes of Health at the Department of Health and Human Services, urge three-drug combination therapy for "all patients with symptoms ascribed to HIV infection." Using a combination of two drugs, or one drug alone, is strongly discouraged.

But some state systems are denying inmates the three-drug regimen as a matter of policy. For years, the Mississippi State Prison at Parchman required inmates with HIV or AIDS to prove they could handle a two-drug regimen for six months before they were allowed access to expensive protease inhibitors. This prison-wide policy applied even to those inmates who had successfully followed a three-drug regimen outside prison.

On March 5, 1999, ten HIV-positive patients at the Mississippi State Prison at Parchman filed a motion for a preliminary injunction as part of an ongoing class-action lawsuit at the prison. They alleged that the medical care they were receiving was endangering their lives.

U.S. Magistrate Jerry Davis responded by filing a preliminary injunction ordering the state of Mississippi to provide its HIV-positive inmates with triple-combination therapy and the standard of care established by the federal government.

"The court finds that the HIV-positive inmates are entitled, at a minimum, to the degree of care outlined in the guidelines of the National Institutes of Health," reads the court's Memorandum Opinion of July 19, 1999. "Simply because they are incarcerated should not subject these inmates to a level of care that will significantly lower their chances of surviving with the virus, especially since the treatment that will give maximum suppression is known."

"In case after case I reviewed, prisoners were deliberately denied the standard medical treatment for HIV infection," Robert Cohen testified for the plaintiffs. "It is my professional opinion that the grossly inappropriate care currently being provided is resulting in unnecessary pain and suffering and will be responsible for unnecessary deaths for patients who would respond to appropriate treatment."

Cohen, a medical doctor in New York, has worked in the field of prison health care for twenty-five years. He served as the director of the Montefiore Rikers Island Health Service, where he oversaw health care for 13,000 prisoners, and he has reviewed medical care for the Department of Justice.

"What they were doing [in the Mississippi State Prison at Parchman] was barbaric," he says.

Cohen filed a "Report on the Medical Care of Prisoners with HIV Infection at the Mississippi State Prison Parchman Farm," dated February 25, 1999. "There is a policy at Parchman, clearly stated within the medical records, that patients cannot receive [the protease inhibitor] Crixivan until they have received two medications alone for six months," he wrote. "Adding one new drug to a failing two-drug regimen assures the early development of resistance. This is almost always the wrong approach, and it is the only approach taken at MSP/Parchman."

One inmate whose medical records he examined was mistreated for more than a year. "Contrary to standard practice, the patient was started on two medications, AZT and 3TC" on September 16, 1997, Cohen wrote. Beyond that, the inmate had trouble getting any care at all, even when he developed potentially serious symptoms.

"The abysmal care this patient received, and continues to receive, is shocking," Cohen wrote. "He is left to waste away in his cell, constantly having seizures and uncontrolled diarrhea, while the medical staff ignore him, refuse to examine him, make no effort to find out what is wrong with him. When they discover a serious abnormality in the brain, they ignore it. He receives inadequate doses of medication to control his seizure. He complains of loss of vision, and no evaluation takes place. He was intolerant of his medications, yet no effort was made to give him medications which he could tolerate."

Cohen...