Indifference, Interruption, and Immunodeficiency: The Impact and Implications of Inadequate Hiv/aids Care in U.S. Prisons

Since its discovery in the 1980s, HIV/AIDS has claimed an estimated halfmillion lives in the United States alone, and the Centers for Disease Control and Prevention report that over one million citizens are currently HIV/AIDS seropositive. While medical treatments have progressed significantly, HIV/AIDS remains incurable and some one-third of infections still progress from initial HIV infection to AIDS within a single year. Further, rates of infection disproportionately affect particular contingents of society, notably racial minorities, intravenous drug users, and those of lower socioeconomic status. These same risk indicators correlate to another population: prisoners. In fact, the rate of HIV/AIDS among incarcerated populations is 3.5 times that of the general population. This high rate of infection draws attention to the role America's "War on Drugs" plays in racializing our prison population, incarcerating high rates of intravenous drug users, and implementing police procedures that often target low-income communities. It also illustrates the importance of prison as a point of public health intervention for successful HIV/AIDS treatment.This Note examines the legal implications of HIV/AIDS treatment in prison. Recognizing that seropositive individuals, once incarcerated, are often denied adequate and consistent HIV/AIDS treatment, this Note argues that courts considering claims of inadequate treatment have erred in widely rejecting affected prisoners' Eighth Amendment claims under Estelle v. Gamble's "deliberate indifference" standard. Exploring Estelle's progeny, this Note establishes that deliberate indifference to a serious medical need may be shown through disregard of an overwhelming and obvious risk. On this basis, the Note argues that widespread social and cultural recognition of HIV/AIDS, as well as clear cognizance among prison administrators of the disease and its health implications (derived from nearly three decades of housing seropositive prisoners) prove the obviousness of risk associated with HIV/AIDS in prison. Moreover, clear treatment guidelines from leading prison healthcare accreditation agencies indicate that the appropriate standard of care is well known to prison administrators. As such, this Note concludes that prisoners' claims of inadequate treatment warrant reconsideration under Estelle.INTRODUCTIONIn the 1970s and 1980s two events began which, in combination, have reshaped the nature of America's prisons. The first event was the outbreak and spread of HIV/AIDS, a biological epidemic and arguably the most destructive disease of the twentieth century.1 The second event was America's "War on Drugs," a package of legislative policies marketed as the means to combat a very different epidemic, increased drug abuse among American citizens.2 Since this "war" began, federal prison populations have increased by more than 600%. 3 Beyond sheer numbers, however, the "war" has had another, unforeseen impact: the men and women most commonly incarcerated for drug crimes also have come to exhibit a number of high-risk factors for HIV infection, resulting in prison populations with a significantly increased incidence of HIV/AIDS seropositivity.4 This Note focuses on the resulting intersection between HIV/AIDS and incarceration, exploring how massive increases in incarcerated populations have strained prison budgets and too often resulted in inadequate health care for prisoners suffering from HIV/AIDS infection.5 Toward this end, this Note touches on issues of social policy, public health, and constitutional rights. It seeks first to explain what factors cause high rates of HIV/AIDS seropositivity behind bars,6 then to explore what standard of care is constitutionally guaranteed to seropositive prisoners, and finally to argue that a failure to uphold such standards results in a constitutional violation of the rights of prisoners that is deserving of remedy.Part I begins with a brief history of HIV/AIDS and then compares the seropositivity rate among prisoners to that of the general population. …