Positive in prison

The state needs to begin testing inmates for HIV/AIDS, if it is to stem the spread of the disease inside and out of prisons

Unlike 22 states, including most of the Southeast where HIV/AIDS has cut a painful and deadly swath, North Carolina has no program requiring that prison inmates be tested. Talk about burying one's head in the sand.

Civil rights groups pressing the legislature to pass a mandatory testing bill say rates of infection among inmates are seven times higher than in the general public. That may be inflated -- the U.S. Department of Justice says that nationally, it is 2 1/2 times higher -- but the groups' point shouldn't be missed. The fact is, consensual and forced sex behind bars, illicit though that sexual activity is, helps spread the disease.

As noted in an N&O news article Sunday, few inmates participate in North Carolina's voluntary testing program. Yet most inmates eventually get out of prison, and they can go on to infect unsuspecting new victims. Surveys by medical researchers indicate that ex-inmates are spreading the virus at an alarming rate among women, especially in the African-American community.

The U.S. Centers for Disease Control and Prevention says that more than 14,000 North Carolinians reported having HIV/AIDS through 2005 (probably the tip of the disease iceberg, since far more people are afflicted than know or admit it). Nearly 67 percent of the total were African-American. In 2006, more than 80 percent of new cases in the state were women. A recent study showed that for the vast majority of HIV-positive women, their last three sexual partners had been in prison during the prior year.

AIDS for many sufferers may no longer amount to a death sentence, at least in the near term, but the drug treatments that sometimes tame the worst symptoms and enable people to live with the virus are expensive. Indeed, the cost of testing and treatment -- about $21 million annually, prison officials estimate -- seems to be a main reason why North Carolina has declined to go that route. But from a public policy standpoint, the approach is counterproductive.

The state pays for the care of most North Carolinians with the disease, since they usually are poor or addicted to drugs or they eventually become so sick that they can't work. To paraphrase the television commercial, the state can address the problem in prisons now or it can pay later. It can help stem the spread of new cases by treating inmates -- some medicines not only ease symptoms but also reduce the chances of infecting others -- or it can watch as more and more people have sex or share needles with former inmates who left prison not even aware they were infected.

Besides, the state shouldn't ignore its legal -- and moral -- responsibility to treat those held in prison. Cost doesn't -- or at least shouldn't -- prevent inmates with cancer from receiving medical care. The no-test policy on HIV/AIDS leaves as targets every potential sex partner of an HIV-positive former inmate.

Well-run prisons, of course, are one front against the spread of the disease, since they will have less sexual activity of a risky nature and especially rape. But mandatory testing in prison needs to be part of the state's public health strategy, in light of both budgetary prudence and the duty to take reasonable care of people confined under the state's custody.