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At the root of this proposal is a legitimate concern that released prisoners take HIV home. But such testing is off target, as home is where HIV is acquired. The approach blames the inmate for the spread of HIV rather than a system that incarcerates a substantial proportion of the black men, destabilizing communities and relationships in a way that promotes sexually transmitted diseases.

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ALL CAN AGREE THAT SCREENING FOR HIV INFECTION in correctional facilities needs to be enhanced, and the Department of Correction and HIV experts at UNC are examining ways to improve the delivery of testing services. But if forced testing raises ethical and efficacy issues, and passive voluntary testing misses some who are infected, what is the solution in the meantime?

A reasonable approach can be found in the CDC's general HIV testing recommendations. This roadmap for identifying those unknowingly living with HIV calls for testing to be routinely offered to most everyone participating in medical care, just like screening tests for abnormal cholesterol or prostate cancer. Those at high risk are offered testing regularly.

The CDC testing strategy respects the magnitude of the threat of undiagnosed HIV infection but also the right of an individual to make an informed decision regarding whether to be tested. The soundness of these recommendations does not stop at the prison gate, and they should be adopted for all North Carolinas, incarcerated and free.

(David A. Wohl, M.D., is associate professor of medicine at the UNC Division of Infectious Diseases and co-director of HIV Services for the state Department of Correction. David Rosen, Ph.D., is with the UNC School of Medicine.)

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