Miami Herald - Sunday, April 21, 2002
Andrea Robinson, arobinson@herald.com

The diagnosis she got earlier this month was devastating; she tested positive for the virus that causes AIDS. The source of her infection? Her boyfriend, a thirtysomething ex-convict who spent time in prison, she told her doctor.

"She didn't believe she was at risk," said her physician, Dr. Cheryl Holder of the North Dade Health Center. "He didn't [take a] test because he didn't identify with any of the risk groups," people who engage in IV drug use, anal intercourse or other unprotected sex.

Women like Holder's patient may be protected in the future by new legislation that makes testing mandatory for inmates before they leave prison.

The purpose of the bill -- pressed last month by state Rep. Frederica Wilson, D-Miami, and several other black and Hispanic lawmakers from South Florida -- is to educate inmates about the virus and their health status. Hopefully, they will take precautions and not infect others.

Wilson, who fought unsuccessfully for the bill during the two previous sessions, said the measure is aimed at slowing the rate of infection, especially in minority communities. Blacks and Hispanics make up the majority of Florida's prison population.

"A lot of people don't want to talk about" what happens in prison, she said. "But we've got to break through the stigma."

According to the U.S. Centers for Disease Control and Prevention, blacks and Hispanics account for 62 percent of the total AIDS cases reported in the state. Florida ranks third behind New York and California in the number of cases dating back to 1981.

Earlier this year, the CDC announced that Miami had the top AIDS rate among U.S. metropolitan areas, closely followed by Fort Lauderdale, third, and West Palm Beach, fourth.

ADVANCE WARNING

Under Wilson's bill, male and female inmates would be tested 60 days before their prison release date. Those testing positive would receive 30 days' worth of medication, as well as education on preventing the spread of the virus. They also would get names of healthcare and service providers in the cities where they plan to settle.

The results of positive tests would be given only to the inmate, the Department of Health and the county health department where he or she will live. Test results would also be included in the inmate's medical records.

The bill hasn't been sent to Gov. Jeb Bush. But Wilson is optimistic. During the session, Bush asked for and got an amendment that limits the state's liability in administering the tests.

If signed into law, the testing measure would go into effect in September. The state estimates 26,000 inmates will be released from Florida prisons within the next year. The Legislature appropriated $793,244 for medical costs for HIV/AIDS testing and related care, although the Department of Corrections requested $1.4 million.

NOW VOLUNTARY

Currently, inmate testing is voluntary. But state records show that Florida has the second-highest number of confirmed AIDS cases among inmates behind New York. In 1995, AIDS-related diseases accounted for 149 inmate deaths -- more than half the total.

Department of Corrections officials said that with improved drug therapies, the number of inmate deaths has fallen dramatically. In 2000, 46 state prisoners died from AIDS-related causes.

Healthcare officials and backers of the legislation say it's a small step toward lowering the number of new infections and helping prolong the lives of those who don't know they have the virus.

They caution that prisons are a "breeding ground" for risky behaviors that spread infections, including unsafe sex, drug use and needle-sharing and tattooing with unsanitary equipment -- all of which are illegal in Florida prisons.

Records show that in 2000, inmates were disciplined 694 times -- a record number -- for engaging in sex acts in prison. Because Department of Corrections rules prohibit giving condoms to inmates, most of those sex acts were likely unprotected.

The department's records also show that the AIDS infection rate in state prisons is 12 times higher than that of the general population. Among female prisoners, the rate is 60 times that of women on the outside.

LINK WITH OUTSIDE

"If we can't improve the health of the inmates, we can't improve the life of our communities," Wilson said.

Some AIDS activists and prison advocate organizations are critical of the legislation, saying it jeopardizes privacy rights. They also contend that mandatory testing is counterproductive because it breeds hostility among inmates.

"Knowing your status is important, but only if the person is prepared to accept that information and act upon it," said Jack Beck, an attorney with the New York-based Prisoners' Rights Project. His organization supports voluntary testing programs that are accompanied with education.

Beck said the plan is unrealistic, considering the gravity of the diagnosis.

He argues that it doesn't allow enough time for effective education before inmates reenter society.

A positive diagnosis "is bad news for a lot of people. There's anger and denial," he said. "They need the time to process the info. Sixty days isn't enough time before they enter the candy store -- all the things they've been denied for so long."

Last Tuesday, Wilson discussed the bill with a group of inmates at the Dade Correctional Institute, a state prison near Florida City.

The inmates -- all men -- listened attentively as she spoke. Then they responded with several questions and comments.

One inmate asked if names and test results would be posted over the Internet.

"Good Lord, no," Wilson said with a nervous laugh. "If that happened, we'd all be in prison, and I would be at the front of the line."

Another prisoner asked what would happen to inmates who test positive but have no family to care for them after they are released.

Wilson said they would be linked to healthcare services in the community where they're being released.

"They're not going to leave you on the street," she said.

DISPELLING MYTHS

Inmate Larry Daniel said he agreed with the idea of mandatory tests.

"This may do something to dispel the myth that people who are HIV positive can't lead productive lives," he said.

Wilson applauded the inmates for their questions and candor.

She said they could help end the silence associated with the disease and lobby lawmakers to do more.

Holder, the director of the North Dade Health Center, said she has had to deal with the end results of that silence.

"The link is heterosexual transmission. Their boyfriend had been imprisoned at some point," said Holder, a strong proponent of testing. "We know they're getting infected in prisons and coming out and passing it along to their girlfriends."

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