The New York Times - November 17, 1985
Elise S. Yousoufian

They have been collected by, and belong to, a prisoner who works in the library. The inmate - call him Peter J. - makes them available to anyone who asks for information about AIDS. It is his way of helping to reduce the spread of the disease among inmates and guards.

Peter J. and another prisoner, Robert A. (the name also is fictionalized), have been trying to get the state to set up an AIDS education program in the prison system and to have the Department of Corrections guarantee confidentiality between inmates and institutional physicians.

The request for confidentiality was embodied in a civil complaint filed by Peter J. in Federal District Court in Newark last June. It names William H. Fauver, the state's Commissioner of Corrections; Alan C. Koenigsfest, health services coordinator for the Corrections Department, and John J. Rafferty, Superintendent of Rahway State Prison.

In an interview at the prison, Peter J. and Robert A. said that their concern had been aroused by the recent death, from AIDS, of an inmate acquaintance. Inmates who used or still use drugs intravenously, and who shared syringes with others, are especially worried, Peter J. said. (He also said he realized that the AIDS virus could be transmitted through homosexual activity, and that some inmates had requested information regarding oral-genital contact and its link to the disease.) According to James V. Stabile, public information officer for the Department of Corrections, 74 percent of all inmates in New Jersey prisons have used pills, marijuana, cocaine and drugs typically taken intravenously.

Peter J., who said he had spent 10 years behind state prison bars, estimated that about 10 percent of inmates used drugs while incarcerated.

How do drugs, syringes and needles get behind the sliding metal doors and past metal detectors and guards?

Despite the arrests of visitors trying to carry in contraband, syringes and needles may get through in packages mailed to inmates, said Mr. Stabile, and drugs can be carried in unnoticed in bodily crevices.

An outsider who has slipped contraband past the security system must then remove it from his or her body and pass it to the inmate. A prisoner, Peter J. said, then usually insert the syringe or drugs in his rectum.

Inmates are strip-searched after all contact visits, Mr. Stabile said, but usually only the exterior of the body is examined.

Although "the scrutiny is intense," Peter J. said, "there's no problem" for anyone determined to bring in contraband.

The ratio of guards to visitors varies among the state's 35 correctional institutions. Five or six guards watch 300 visitors at some of the prisons, which makes it impossible to observe every move each person makes, Mr. Koenigsfest said.

Mr. Stabile said that increasing the guard force in visiting areas would not necessarily stop the passage of contraband.

The Department of Corrections has recorded 94 cases of AIDS among 13,400 convicts since its first diagnosed case in 1981. The 94 include 66 inmates who have since died, 12 patients at the department's unit in St. Francis Medical Center in Trenton, 15 parolees and one inmate who was granted clemency.

The state's Corrections and Health Departments both recorded higher-than-average proportions of deaths from AIDS - 70 percent and 62 percent, respectively - than the national average of 51 percent. (The Health Department reported 893 diagnosed cases and 555 deaths stemming from AIDS as of Oct. 22, the last date for which official data were available. Nationally, the Centers for Disease Control in Atlanta listed 14,519 diagnosed cases of the disease and 7,450 deaths as of Nov. 4.) In January, Peter J. said, he was a patient at St. Francis. A fellow patient, he said - one who had been diagnosed as an AIDS victim - told him that he had shared a syringe with other inmates before he learned he had AIDS. Peter J. said that the AIDS patient had asked him to encourage these men to request blood tests to determine if they were carrying the virus.

"He told me about this one incident," Peter J. said. "There was no water available, and no one really cleaned the syringe that well if they were using it."

About five people shared the syringe to inject themselves with heroin.

Most inmates, Peter J. said, question the quality of medical care in prison and do not assume there is any confidentiality between inmates and staff members, including physicians.

This distrust is at the core of Peter J.'s demand for a general education program about AIDS, including ways to reduce the risk of contracting the disease and a counseling program for inmates with specific concerns about AIDS. This campaign, he said, would have to be administered by the Department of Health for prisoners to trust it.

He also urged the establishment of standards insuring that only medical personnel had access to a patient's medical records. Then, he said, inmates might seek medical help without fear of punishment for having done something prohibited in prison, such as using drugs intravenously.

Mr. Koenigsfest said in a telephone interview that in 1981, after its first case of AIDS, the Corrections Department began an AIDS training course for nurses and county-jail medical staff members.

Now, he said, the corrections staff has an AIDS team of two, including, to his knowledge, the nation's only full-time epidemiologist employed by a state department of corrections.

Mr. Koenigsfest said that the department trained prison staff members and inmates either directly or, when security measures did not allow that, through inmate representatives elected by members of prison housing units.

But Peter J. said that he recalled only two AIDS seminars having been held in Rahway State Prison since 1981. And inmate representatives, he added, unintentionally distort what they learn about AIDS when they report back to their housing units.

Inmates suspected of having AIDS are examined by a state epidemiologist in Trenton. If a diagnosis confirms AIDS, the prisoner is then sent to St. Francis and remains hospitalized until he dies or is paroled.

Asked whether the Corrections Department supplied inmates with information on reducing the risk of contracting AIDS, Mr. Koenigsfest said they were told that the disease could be transmitted through "unclean needles and homosexuality." However, he added: "You don't want to talk about safe drugs, you want to eradicate drugs. We have a trust. We can't return drug users to society."

Alluding to incidents of sexual assault in prisons (the Corrections Department does not keep figures on sexual assaults), Mr. Koenigsfest said:

"If we were to set up [an advocacy program] for people to use condoms, we would be setting up a victim."

Peter J. agrees with Mr. Koenigsfest that the department should not provide items used in prohibited activities, such as intravenous drug use and homosexual activity.

The Department of Corrections administers its own health-care programs independent of the Department of Health, although health officials will intervene if their help is sought.

Dr. Jack Rutledge, a deputy commissioner of the Health Department, said that "the biggest problem with AIDS in the whole state is education, information."

"Especially with prisoners about to be discharged," he said, "it would be a shame to release them back into society without some information."

"It's in their interest and society's interest," he added.

Another Health Department official, Dr. Frances Taylor, said that the Corrections Department had "not requested our help" on AIDS, but that a program to counsel inmates about to be discharged was in "the talking stage."

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