Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_11-cv-00224/USCOURTS-almd-2_11-cv-00224-5/pdf.json

Nature of Suit Code: 446
Nature of Suit: Americans with Disabilities Act - Other
Cause of Action: 42:12101 Americans with Disabilities Act

---

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE

MIDDLE DISTRICT OF ALABAMA, NORTHERN DIVISION

LOUIS HENDERSON, DANA )

HARLEY, DWIGHT SMITH, )

ALBERT KNOX, JAMES )

DOUGLAS, ALQADEER HAMLET, )

and JEFFREY BEYER, on )

behalf of themselves and )

of those similarly )

situated, )

)

Plaintiffs, )

) CIVIL ACTION NO.

v. ) 2:11cv224-MHT

) (WO)

KIM THOMAS, Commissioner, )

Alabama Department of )

Corrections; BILLY )

MITCHEM, Warden, Limestone )

Correctional Facility; )

FRANK ALBRIGHT, Warden, )

Julia Tutwiler Prison )

for Women; BETTINA CARTER, )

Warden, Decatur Work )

Release/ Community Work )

Center; EDWARD ELLINGTON, )

Warden, Montgomery Women’s )

Facility, in their )

official capacities, ) 

)

Defendants. )

OPINION

The seven plaintiffs (Louis Henderson, Dana Harley,

Dwight Smith, Albert Knox, James Douglas, Alqadeer

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 1 of 153
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Hamlet, and Jeffery Beyer) bring this lawsuit on behalf

of themselves and a class of all current and future HIVpositive prisoners incarcerated in Alabama Department of

Corrections (ADOC) facilities. They challenge the ADOC's

policy of categorically segregating HIV-positive

prisoners from the general prison population, arguing,

among other things, that, despite the dramatic advances

in the treatment of HIV and despite the plaintiffs’

differing individual circumstances, the plaintiffs are

being denied the opportunity to be even considered for

various rehabilitative services and programs offered to

other prisoners. They have named as defendants ADOC

Commissioner Kim Thomas and the wardens of the four ADOC

facilities that house HIV-positive prisoners. 

The plaintiffs claim that the HIV-segregation policy

discriminates against them on the basis of a disability

(HIV status) in violation of Title II of the Americans

with Disabilities Act (ADA), 42 U.S.C. § 12101 et seq.,

and § 504 of the Rehabilitation Act, 29 U.S.C. § 794.

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Jurisdiction is proper under 28 U.S.C. § 1331 (federal

question).

Based on the evidence presented during a month-long

non-jury trial and for the reasons that follow, this

court holds that the ADOC has violated the ADA’s Title II

and the Rehabilitation Act’s § 504.

I. BACKGROUND

A. HIV/AIDS

The human immonodeficiency virus, or HIV, is a

chronic disease. If left untreated, it weakens the

immune system and eventually leads to death. The disease

unfolds in several stages. Soon after contracting the

virus, an infected person enters acute infection. During

this time, the person’s viral load (the extent to which

the virus is present in the blood) rockets upward.

People in this stage of the disease can have hundreds of

thousands of copies of the virus. Despite that, people

in this stage test negative for HIV. This phase, known

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1. As the facts will show, not everyone with HIV

will enter this final stage. 

4

as the “window period,” generally lasts for a few weeks,

but can extend as long as three months, and the people

experiencing it represent the most infectious group of

individuals with HIV. 

Acute HIV gives way to chronic-HIV infection. During

this stage, the viral load lowers. The final stage,

advanced-HIV infection, occurs when the body’s CD4 Tcells, which play a critical role in the immune system,

drop to low levels and the viral load rises.1

 More

commonly, this final stage is known as acquired

immunodeficiency virus, or AIDS. 

HIV emerged in the United States in the early 1980s

and soon grew into an epidemic. HIV inevitably

progressed to AIDS. Virtually everyone infected died.

Meanwhile, no one, including the medical community,

understood how HIV was transmitted. Fearing that even

casual contact could spread it, doctors treating patients

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with HIV wore protective gear so extensive it was

nicknamed a “space suit.” The profound consequences of

the disease, combined with lack of knowledge about how it

could spread, created an era of hysteria in the

epidemic’s early days. 

The tide began to turn in the decade that followed.

In 1996, the first protease inhibitors were approved to

treat HIV. Highly active antiretroviral therapy (HAART),

emerged as an effective weapon against the disease.

These treatments did not eliminate the virus, but they

did restrict its ability to progress and could stave off

AIDS. However, while important developments, early

treatment combinations had many deficiencies. The

medications had to be administered multiple times each

day; they had severe side effects, including diarrhea and

peripheral neuropathy; and because the regimes were so

complicated and so punished patients with side effects,

many HIV patients failed to take their medication. 

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Today, advances in HIV treatment have profoundly

changed the disease. There is still no cure for HIV:

indeed, there is only one known case in which a person

was completely cured of it. However, modern treatment

regimes have rendered it manageable. The vast majority

of HIV patients can be treated by one pill once a day;

side effects are less severe, and, where they do occur,

multiple treatment options allow patients to try

different medications until they find one that works;

and, most importantly, although people with HIV will

require treatment for their entire lives, HIV is no

longer invariably fatal. People who receive treatment

for HIV can expect to enjoy near-normal lifespans.

HIV can be transmitted through contaminated blood and

bodily secretions, commonly during unprotected sex

(between a man and a woman or between men) and needle

sharing (for drug use or tattooing, for example). It is

not transmitted through casual contact or through the

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2. The U.S. Centers for Disease Control and

Prevention excludes HIV from its list of diseases that

can be transmitted through the food supply.

7

food supply.2

 A person would have to drink a 55-gallon

drum of saliva in order for it to potentially result in

a transmission. There is no documented case of HIV being

sexually transmitted between women.

Moreover, simply because HIV can be transmitted in

certain contexts does not mean that it will be, or even

that it is likely to be, transmitted by that means.

Advances in antiretroviral treatment have not only

ameliorated the effects of HIV, but have also powerfully

reduced (and in some contexts, even vitiated) the

possibility of transmission, even when individuals engage

in high-risk behavior. This is true because transmission

typically occurs only when a person’s viral load is at a

certain minimum threshold. Modern treatments, however,

if successful (which they generally are), result in

“viral suppression,” a state in which the person’s viral

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load is so low that the likelihood of HIV transmission

is, generally speaking, virtually non-existent. 

Because modern treatment is effective as prevention,

the medical community now recommends that antiretroviral

treatment be offered to everyone living with HIV who is

ready and willing to take it. This approach represents

a sea change that has revolutionized the public-health

strategy for preventing transmissions. 

While in 2012, outcomes are better, treatment

simpler, and prevention possible, social perceptions of

HIV have yet to catch up with the modern realities of the

illness. Undoubtedly exacerbated by the terror that

accompanied the disease in its early history, a

relentless stigma adheres to HIV. This stigma has at

least two plausible sources. First, HIV is most

frequently found among historically marginalized

populations: particularly, gay men. Prejudice against

homosexuals intensifies prejudice against HIV, and

prejudice against HIV becomes a proxy for prejudice

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3. Unfortunately, the transcript from the trial is

not yet available, and the court is therefore unable to

cite to it.

9

against members of the gay community. Because HIV is

also more common among minorities and the poor, the

stigma attached to HIV deeply implicates race and class

prejudice, as well as homophobia. 

A second source of stigma stems from the means of HIV

transmission. The plaintiffs’ expert, Dr. Frederick

Altice, an international authority on HIV and the

Director of the HIV in Prisons Program at Yale University

School of Medicine, explained: “People make judgments

just by the virtue of HIV that you must have done ...

something dirty or something awful to have acquired HIV.

Being gay. Being a prostitute. Being sexually

promiscuous.”3

 These impressions build upon negative

stereotypes about the groups most commonly affected by

HIV. 

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The progression of how HIV has been handled in

American prisons somewhat mirrors its progression in the

free world: initial (and understandable) terror about its

spread gave rise to drastic prevention measures, which

subsided as both treatment and understanding of HIV

improved. 

The first report of HIV in prisons was made in 1983.

Soon after, a critical minority (but never a majority) of

state-correctional systems began segregating HIV-positive

prisoners from the general prison population. In the

mid-1990s, as the fear surrounding HIV began to subside,

most States that had enacted such policies reversed them.

By 2006, only three States still segregated HIV-positive

prisoners: South Carolina, Mississippi, and Alabama. In

2010, Mississippi ended its segregation policy as well.

Today, preeminent public-health organizations, including

the U.S. Centers for Disease Control and the National

Commission on Correctional Healthcare, uniformly

recommend against segregating prisoners with HIV.

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B. The ADOC’s HIV-Segregation Policy 

As in the rest of the nation, the advent of the AIDS

epidemic generated panic within the ADOC. Billy Mitchem,

the former warden of Limestone Correctional Facility,

explained: “[E]verybody was ... afraid. The inmates were

afraid. The staff was afraid. We didn’t understand,

really, how you could get AIDS. I mean, you used your

imagination, and most of that was wrong.... And people

were dying.”

It was in this atmosphere that the ADOC established

its original HIV-segregation policy. The initial policy

was austere. HIV-positive prisoners were segregated in

every aspect of their daily lives, from the dorms in

which they were housed to the chapels in which they

worshiped. They had no access to the myriad programs

available to the general-population prisoners. At

Limestone, the dorms where HIV-positive prisoners were

housed were cordoned off from the rest of the prison by

a fence with a locked-metal gate. Plaintiff Dana Harley

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described the circumstances of HIV-positive women in a

letter to the warden of Tutwiler: 

“We are in isolation from general

population like we are contagious

animals. Officers only come and see

about us when they see fit....

Basketballs are flat and playing cards

are beyond recognition. It’s enough to

be living every day with our virus and

trying to cope. We are confined and

can’t even participate in everyday

activities such as trade schools or

state jobs to stay occupied.... It’s

like punishment three times over:

Prison, the virus, then the denial of an

education or trade. We are secluded

from everyday life.” 

Pls.’ Ex. 82. 

During this time, a class of HIV-positive prisoners

twice challenged the ADOC’s segregation policy. In the

first challenge, the plaintiffs alleged that the

segregation of recreational, religious, and educational

programs violated the Rehabilitation Act. The district

court denied their claims, and, after a decade of

litigation, the Eleventh Circuit Court of Appeals upheld

that decision. See Onishea v. Hopper, 171 F. 3d 1289

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(11th Cir. 1999) (en banc). Before the Onishea

litigation had concluded on appeal, the same class of

HIV-positive prisoners challenged the same policies, this

time under the ADA and the Eighth Amendment. See Edwards

v. Ala. Dep’t of Corr., 81 F. Supp. 2d 1242 (M.D. Ala.

2000) (Thompson, J.). This court found that the

plaintiffs’ claims in Edwards were identical to those

denied in Onishea and therefore barred under the doctrine

of res judicata.

In 2007 and 2008, the ADOC relaxed its segregation

policy. HIV-positive prisoners were integrated into

trade schools, substance-abuse programs, and other

activities, and, for the first time, they were permitted

to participate in the work-release program. 

At trial, the parties offered competing

characterizations of the department’s policy as it

operates today. The court finds that the policy itself

is best described as, in general, a series of

categorical, non-individualized determinations that the

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department makes with regard to HIV-positive prisoners.

Simply put, in a number of aspects of institutional life,

HIV results in automatic placement and automatic

exclusion. Outcomes that depend on a complex web of

factors for HIV-negative prisoners are determined based

on a prisoner’s HIV-positive diagnosis alone. Because

the policy differs with respect to male and female

prisoners, the respective practices are discussed

separately below.

1. Men

Every male prisoner entering the ADOC first reports

to Kilby Correctional Facility to undergo classification.

There, each prisoner is given a physical and mentalhealth evaluation, is interviewed by a classification

specialist, and his behavioral history (particularly his

criminal history) is reviewed. As a result of this

process, the prisoner is assigned a custody level.

Custody levels for men include “close,” “medium,”

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4. Close custody is the most restrictive custody

level. Prisoners who are classified at this level must

be housed in a single cell, with movement outside of the

housing area restrained, and the prisoner must be

accompanied by armed correctional personnel. Medium

custody prisoners may live in dormitories or double

cells, must be assigned to a medium- or close-security

institution, and must be supervised by armed correctional

personnel when outside of the institution. Prisoners

classified as minimum-in can participate in work

assignments at ADOC facilities or off ADOC property with

the supervision of correctional officers. Minimum-out

prisoners can be assigned to off-property work details

without the direct supervision of correctional staff.

15

“minimum-in,” and “minimum-out,” and this designation

determines the ADOC facilities to which the prisoner may

be sent.4

 Different facilities provide varying levels of

freedoms and restrictions. For instance, if a prisoner’s

classification number signifies that he is medium

security, he may be placed at only a major facility that

has armed guards. On the other hand, a prisoner who is

designated as minimum-out can be placed at a communitywork center.

The classification team also evaluates the prisoner’s

need for educational programs, trade school, substanceCase 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 15 of 153
5. Atchison explained that the automatic decision

with regard to HIV is a “placement directive.” Placement

directives come from the commissioner rather than from

the classification specialists and override normal

classification considerations. 

16

abuse treatment, and certain mental-health programs. As

Stephanie Atchison, Classification Assistant Director for

the ADOC, explained, this impacts the department’s

placement decisions. If, for example, a prisoner “needed

to participate in a substance abuse program,” the

classification team would “approve a group of

institutions that offered substance abuse treatment, and

whichever one had the space available, that’s the one he

would go to.” Finally, each prisoner is subject to a

medical and mental assessment, which can further limit

the number of facilities for which he is eligible. 

For the approximately 250 men within the ADOC who are

HIV-positive, however, all of the factors normally

considered in the classification process are overridden

by an HIV-positive diagnosis.5

 Upon entering the system,

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6. The diagnostic test upon entry is required by

state law. See 1975 Ala. Code § 22-11A-17(a).

7. Testimony at trial demonstrated that, in addition

to the stress of being confined in an isolation cell,

this practice is harmful because it comes across as a

punishment for being diagnosed with HIV. Plaintiff

Albert Knox explaned: “I didn’t feel like I deserved to

be locked up in [a segregation cell] .... I always

considered seg to be a place where you [go when you]

screw up in prison or whatever ... that’s a disciplinary

that you get .... [F]or me to be locked up in there, and

I didn’t do anything wrong, I didn’t think it was right.

It was punishment.”

8. The testing process cannot reliably diagnose all

HIV-positive prisoners, however, because, as discussed

above, individuals who have recently been infected and

fall in the “window” period will not test positive for

HIV, despite being very contagious. 

17

every prisoner is given an enzyme-linked immunosorbent

assay (ELISA) test, which measures an antibody to HIV.6

If the test is preliminarily positive, the prisoner is

placed in an isolation cell to await confirmatory testing

with a Western blot test.7

 If the Western blot test

confirms the diagnosis, the prisoner is transferred to

Limestone Correctional Facility.8

 This occurs regardless

of whether the prisoner has complex medical needs or very

simple ones. HIV is the only disease or medical

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condition listed on the ADOC’s medical-classification

chart for which diagnosis alone, without any

consideration of actual treatment needs, limits the

prisoner’s placement possibilities to a single facility.

This placement is also made without regard to securityclassification procedures. Limestone is equipped to

house only general-population prisoners who are medium

and minimum custody; the only close-custody prisoners

there are those who have HIV. 

The decision to house men exclusively in Limestone

results in a number of inevitable consequences. For

instance, prisoners who are not HIV-positive are assigned

a mental-health code of zero through six; any prisoner

with a mental-health code that requires special housing

is sent to Bullock Correctional Facility (which can house

codes three though six) or Donaldson Correctional

Facility (which can house codes three and four).

However, regardless of their mental-health needs, HIVpositive prisoners are precluded from Bullock and

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Donaldson and instead placed at Limestone, which is only

designed to house codes zero through two. 

Program opportunities are also necessarily limited.

For instance, the ADOC’s sole 12-15 month therapeuticcommunity program for substance-abuse treatment is

offered at St. Clair Correctional Facility. HIV-positive

prisoners are never placed at St. Clair, no matter how

dire their addictions. Further, while approximately 85 %

of HIV infections in Alabama come from Mobile,

Montgomery, and Birmingham, all of which are in central

or southern Alabama, Limestone is located on the State’s

northern border, far from these cities (Mobile is an over

five-hour drive from the prison). Therefore, while

general-population prisoners are by no means guaranteed

a placement near their homes and families, most HIVpositive prisoners are completely barred from this

possibility. For many of them, this makes family visits

difficult or impossible.

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The segregation policy continues within Limestone.

There, HIV-positive men are separated into two HIV-only

dormitories: Dorms B and C. Together, these dorms are

known as the “Special Unit.” HIV-positive prisoners who

are mentally ill, because they are barred from going to

Bullock or another facility equipped to treat serious

mental health needs, are housed in the Residential

Treatment Unit, a set of nine cells in Dorm C cordoned

off by a large metal cage, which juts out into the dorm’s

common area. If an HIV-positive prisoner is placed in

administrative or disciplinary isolation (for example, as

punishment for his conduct), he is placed in the same

isolation dormitory as the HIV-negative prisoners, Dorm

E. Although that dormitory includes only individual

isolation cells that are locked closed throughout the

day, which completely prevents any physical contact among

prisoners, the HIV-positive prisoners are placed together

in a row, separated from cells occupied by HIV-negative

prisoners by a floating metal gate. 

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Because HIV-positive men are uniformly housed in

Limestone’s Special Unit, they are necessarily excluded

from any benefits that stem from being housed in other

dorms. Limestone has, for instance, a Senior Dorm, which

provides a safer and calmer environment. There is also

a Faith-Based Honor Dorm, whose prisoners enjoy

occasional (though rare) benefits such as a family night,

during which family members can visit and bring food.

Limestone also offers a Pre-Release Dorm for prisoners

who are within 120 days of their end-of-sentence dates.

This dorm is designed to provide a supportive atmosphere

for prisoners who will soon transition back into the free

world. 

HIV-positive prisoners are also barred from certain

aspects of the Substance Abuse Program (SAP). In that

program, which can last either eight weeks or six months,

prisoners live together in a special dorm, take classes

together, and eat their meals together. Dr. Altice

explained at trial that this “milieu environment” is

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9. At trial, the ADOC downplayed the importance of

the residential aspect from which HIV-positive prisoners

are excluded. However, this representation is belied by

the department’s own description of SAP’s objectives:

“The goals of the program are to: (1) offer a stable,

quiet and residential environment wherein recovering

inmates can live together as a family, reinforcing each

others[’] sobriety.” Pls.’ Ex. 51, at 15 (emphasis

added). The very existence of a SAP dorm could be viewed

as communicating the ADOC’s belief that substance-abuse

programming benefits from a residential component.

22

often “extremely effective” because the “minute-by-minute

interaction in the bathroom, in the dorms or in their

housing units, [and] at meals” creates an “ongoing

dialogue about the sort of issues that are taught” in the

program. 

HIV and substance abuse are frequently comorbid:

currently, around 41 prisoners with HIV are enrolled in

some component of SAP. However, while HIV-positive

prisoners can participate in SAP classes, they are not

permitted to live in the SAP dorm, and must return to the

Special Unit for meals and when classes end each day. As

a result, they are deprived of one of the fundamental

qualities that makes SAP effective.9

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10. There was conflicting testimony at trial about

when the armbands policy was initiated. Testimony from

the plaintiffs’ witnesses suggested that, originally,

only HIV-positive prisoners had armbands and that other

dorms were given armbands only after the onset of this

litigation. The ADOC disputes this chronology.

Currently, every dorm except for the pre-release dorm

uses armbands.

23

In addition to the housing-segregation policy,

prisoners with HIV at Limestone are required to wear

white armbands. The ADOC attests that all prisoners are

required to wear armbands of various colors and that

each color simply designates the dorm to which each

prisoner belongs.10 Commissioner Thomas explained that

the armbands “help control the flow of inmates throughout

a facility”: they prevent violence and unauthorized

activity because correctional staff can better monitor

whether the prisoners are in their proper dorms.

However, while no other two dorms share the same armband

color, both of the Special Unit dormitories, Dorm B and

Dorm C, are assigned white armbands. A correctional

officer stated that this makes it difficult to tell

whether the HIV-positive prisoners are in their correct

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dorms, hollowing out the purported security purpose of

the armbands. 

There is one circumstance in which HIV-positive

prisoners may be housed outside of Limestone: when they

participate in the work-release program. Work-release

placement allows selected prisoners to work (for pay) for

participating employers in the community during the day,

and then return to a work-release facility each night.

While the ADOC operates a number of work-release

facilities, HIV-positive prisoners are housed exclusively

at one: Decatur Work Release. There, unlike at

Limestone, HIV-positive prisoners are not required to

sleep in a designated dorm, but instead share dormitories

and the dining hall with prisoners who do not have HIV.

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11. This period of isolation, occurring just after

the woman enters the prison and is newly diagnosed with

HIV, is frequently traumatic. The women are provided

with no educational materials or counseling. Plaintiff

Dana Harley, an HIV-positive prisoner at Tutwiler, is

frequently asked to counsel the women herself.

“[U]sually they’re going crazy,” she explained.

“Hysterical, crying ... like they’re about to pass out,

thinking they’re going to die. I mean just going

absolutely crazy.”

25

2. Women

Tutwiler is the only prison for women in the ADOC.

Upon arrival there, each woman is given an ELISA test to

determine whether she has HIV. If a woman’s test comes

back positive, an officer removes the woman from the

receiving area and escorts her to an isolation cell. The

woman then must wait there for several weeks (at times

for up to a month) for the results of the Western blot to

confirm the diagnosis.11

When diagnosis is confirmed, HIV-positive women are

assigned to Dorm E, which is segregated from the general

population. Like the men at Limestone, they are

permitted to participate in the prison’s various

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programs. However, also like the men at Limestone, they

cannot reside in any specialized dorms, including

Tutwiler’s SAP dorm and Honor Dorm. HIV-positive women

who are mentally ill, instead of being placed in the

open-bay area of the mental-health unit, are

automatically sent to the isolation cells reserved for

the seriously mentally ill (the Intensive Psychiatric

Stabilization Unit), regardless of their actual mentalhealth needs. 

3. Food-Service Jobs

Many prisoners at Limestone and Tutwiler have jobs in

those prisons’ kitchens. In the work-release program,

many of the approved employers are restaurants or food

processing factories in the community. HIV-positive

prisoners, however, are wholly excluded from

participation in any job related to food services: they

may not hold kitchen jobs at Limestone and Tutwiler, and

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they may not work for food-service employers in the workrelease program. 

4. Work-Release Eligibility Criteria

When HIV-positive prisoners are considered for the

work-release program, they must meet a number of criteria

that are not imposed on other prisoners. For an HIVpositive prisoner (male or female) who is not taking HIV

medication, her viral load must be lower than 1,000 and

her CD4 count must be greater than 700 (or her CD4

percentage must be greater than 35). An HIV-positive

prisoner who is taking HIV medications must be approved

for the keep-on-person program and have adhered to it for

six consecutive months or more. Her viral load must have

been less than 48 for four consecutive readings, and her

CD4 count must be greater than 450 (or her CD4 percentage

must be greater than 30). Each HIV-positive prisoner is

evaluated according to these criteria by an institution’s

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 27 of 153
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Site Medical Director or an HIV Specialist, who has the

option to waive them at her discretion.

Although the ADOC manages populations with a number

of illnesses that are equally as serious and as

infectious as HIV, HIV is the only disease with a

separate subset of criteria dedicated solely to it. It

is also the only disease whose criteria are based on

rigid numerical thresholds rather than treatment needs or

functional abilities. A prisoner who does not have HIV

is instead evaluated based on her medical code and the

seriousness of her treatment needs. For instance,

prisoners who are receiving dialysis, hepatitis

chemotherapy treatments, and cancer treatments are not

“clear” for work release (but the criteria do not

categorically require people with these illnesses to

satisfy any numerical criteria divorced from actual

treatment or capabilities). Joint Ex. 35. 

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II. DISCUSSION 

A. Justiciability

Before reaching the merits of the plaintiffs’ claims,

the court must decide whether they have standing under

Article III of the Constitution to raise them. See Lujan

v. Defenders of Wildlife, 504 U.S. 555, 561 (1992)

(holding that standing, an “indispensable part of the

plaintiff’s case, ... must be supported ... at [each]

stage[] of the litigation”). To satisfy Article III's

standing requirements, a plaintiff must show (1) she has

“suffered an injury in fact that is (a) concrete and

particularized and (b) actual or imminent, not

conjectural or hypothetical; (2) the injury is fairly

traceable to the challenged action of the defendant; and

(3) it is likely, as opposed to merely speculative, that

the injury will be redressed by a favorable decision.”

Friends of the Earth, Inc. v. Laidlaw Envtl. Services

(TOC), Inc., 528 U.S. 167, 180-81 (2000) (quotation marks

and citation omitted).

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 29 of 153
12. The plaintiffs assert a challenge both to the

ADOC’s HIV-segregation practice as a whole and to various

aspects of the policy. They also presented significant

evidence about the discriminatory effects of the policy,

at times making it difficult for the court to discern

what the plaintiffs considered to be true aspects of the

policy and what were merely its deleterious effects. As

previously explained, the court considers the heart of

the challenged policy to be a series of automatic

determinations made with regard to HIV-positive

prisoners. However, the challenged conduct is the

determination itself, and not its many effects.

30

As this case is a class action, “each claim must be

analyzed separately, and a claim cannot be asserted on

behalf of a class unless at least one named plaintiff

[individually has standing to raise] that claim.” PradoSteiman ex rel. Prado v. Bush, 221 F.3d 1266, 1280 (11th

Cir. 2000). To analyze each claim separately, the court

must first decide what claims have been raised. That is,

surprisingly, not simple here, because the plaintiffs

have not framed the dispute in terms of discrete claims.12

For reasons that will become clear below, the governing

law in this case requires the court to decide certain

issues separately in a manner that amounts to

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 30 of 153
31

adjudication of several distinct claims for relief. See

Harris v. Thigpen, 941 F.2d 1495, 1526 (11th Cir. 1991)

(requiring the district court to evaluate the risk of HIV

transmission occurring “with regard to each program from

which [HIV-positive prisoners] have been automatically

excluded,” rather than with respect to prison in

general); see also Miller v. King, 449 F.3d 1149, 1150-51

(11th Cir. 2006) (stating that “it is important for lower

courts to determine on a claim-by-claim basis ... which

aspects of the State’s alleged conduct violate[s] Title

II”). The court understands the plaintiffs’ claims

against the HIV-segregation policies and practices at

ADOC prisons to encompass challenges to the following

discrete policies: (1) the policy that HIV-positive men

are segregated within Limestone from the generalpopulation prisoners; (2) the policy that HIV-positive

men are permitted housing only at Limestone and Decatur

Work Release, and excluded from all other ADOC men’s

facilities; (3) the policy that HIV-positive women are

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 31 of 153
32

segregated within Tutwiler from the general-population

prisoners; (4) the policy that women are allowed workrelease housing at Montgomery Women’s Facility, but not

the ADOC’s other work-release facility for women; (5) the

exclusion of HIV-positive prisoners, male and female,

from food-service jobs within the prison and at work

release; (6) the eligibility criteria applied to HIVpositive prisoners, male and female, who apply to

participate in the work-release program; and (7) the

requirement that male HIV-positive prisoners wear white

armbands.

As for the first two claims (segregation within

Limestone and exclusion from other ADOC facilities for

men), plaintiffs Louis Henderson, Jeffrey Beyer, and

James Douglas have standing to challenge these policies.

All three reside in the Special Unit at Limestone and

wish to be integrated into the general population at

Limestone and to be eligible for housing at other

facilities. Plaintiffs Dwight Smith and Alqadeer Hamlet,

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 32 of 153
33

who are currently placed at Decatur Work Release, would

like to be eligible for other work-release facilities;

they therefore have standing to challenge the ADOC’s

policy of housing HIV-positive prisoners exclusively at

Decatur. 

As for the third and fourth claims (segregation

within Tutwiler and eligibility for only one women’s

work-release facility), plaintiff Dana Harley has

standing. At the time this case began, Harley was housed

in Tutwiler’s segregation dormitory and wished to be

integrated. She also wanted to be eligible for all

women’s work-release facilities (rather than only for

Montgomery Women’s Facility). All plaintiffs have

standing to raise the fifth (exclusion from food-service

jobs) and sixth (HIV-related eligibility requirements for

work release) claims, as all desire the opportunity to

work in food-service jobs and to apply for work release

without being subjected to eligibility criteria that they

argue are discriminatory and unnecessary. In particular,

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34

plaintiff Douglas has been excluded from work release

because of the eligibility requirements. Lastly, all

male plaintiffs have standing to raise the seventh claim,

as they all are required to wear white armbands.

The ADOC devoted ample time at trial to the argument

that class representatives who were denied certain

benefits because of the policy lack standing because they

would not have been guaranteed those benefits even if

they were not HIV-positive. For instance, the department

argues that the male plaintiffs lack standing to

challenge their ineligibility for transferring to

facilities other than Limestone because no prisoner has

a right to transfer to the facility of his choosing.

Therefore, the ADOC argues, even if this court were to

order relief, the plaintiffs’ injuries could not be

redressed. However, this argument misses the point. The

plaintiffs are not challenging the outcome of the

department’s decisions, but rather, the fact that they

are entirely barred from consideration because they have

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35

HIV. Therefore, the plaintiffs’ standing hinges on the

fact that they have not been considered even though they

wish to be, not on whether this consideration would

result in a particular outcome. It has long been

understood that governmental policies of exclusion and

segregation create actual, concrete injuries that are

redressable by the courts. See, e.g., Jackson v.

Okaloosa Cnty., 21 F.3d 1531, 1537 (11th Cir. 1994)

(holding that a claim of “exclusion ... and, as a result

of this exclusion, imminent segregation,” alleges a

“redressable injury”); cf. Ne. Fla Chapter of Assoc. Gen.

Contractors of Am. v. City of Jacksonville, 508 U.S. 656,

666 (1993) (“When the government erects a barrier that

makes it more difficult for members of one group to

obtain a benefit than it is for members of another group,

a member of the former group seeking to challenge the

barrier need not allege that he would have obtained the

benefit but for the barrier in order to establish

standing. The ‘injury in fact’ in an equal protection

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 35 of 153
13. The policies and practices that the ADOC

committed to changing include: (1) the exclusion of HIVpositive prisoners from food-service jobs in prison and

in the work-release program; (2) the requirement that all

HIV-positive men wear white armbands; and (3) the policy

that HIV-positive men are placed together in Dorm E

(administrative and disciplinary isolation). The ADOC

also committed to evaluating options for removing the

fence that currently surrounds the Special Unit at

Limestone. 

36

case of this variety is the denial of equal treatment

resulting from the imposition of the barrier, not the

ultimate inability to obtain the benefit.”). 

The ADOC also contends that, because Harley was

transferred out of Tutwiler and into Montgomery Women’s

Facility after the complaint in this case was filed, her

challenge to segregation within Tutwiler is now moot.

Further, towards the end of trial, the ADOC conceded

certain aspects of the plaintiffs’ claims and assured the

court that its practices “would change” in certain

respects.13 Now, the ADOC urges the court to disregard

those claims, arguing that they have been mooted. 

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37

“[T]he voluntary cessation of challenged conduct will

moot a claim only when there is no ‘reasonable

expectation’ that the accused litigant will resume the

conduct after the lawsuit is dismissed.” Nat’l Ass’n of

Bds. of Pharmacy v. Bd. of Regents of the Univ. Sys. of

Ga., 633 F.3d 1297, 1309 (11th Cir. 2011) (citations

omitted). “Otherwise a party could moot a challenge to

a practice simply by changing the practice during the

course of the lawsuit, and then reinstate the practice as

soon as the litigation was brought to a close.” Id.

(quotation marks and citations omitted). 

The party asserting mootness generally bears the

“heavy burden of persuading the court that the challenged

conduct cannot reasonably be expected to recur.” Friends

of the Earth, Inc., 528 U.S. at 170. At the same time,

however, a governmental defendant enjoys a “rebuttable

presumption that the objectionable behavior will not

recur.” Troiano v. Supervisor of Elections in Palm Beach

Cnty., 382 F.3d 1276, 1283 (11th Cir. 2004) (emphasis in

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 37 of 153
38

original). This court must conduct the mootness inquiry

with attention to three relevant factors: (1) “whether

the termination of the offending conduct was

‘unambiguous’”; (2) “whether the change in government

policy or conduct appears to be the result of substantial

deliberation, or is simply an attempt to manipulate

jurisdiction”; and (3) “whether the government has

‘consistently applied’ a new policy or adhered to a new

course of conduct.” Nat’l Ass’n of Bds. of Pharmacy, 633

F.3d at 1310 (citations omitted). 

The mootness issue with regard to Harley can be

dispensed with easily. The HIV segregation that Harley

challenges at Tutwiler never ended: the ADOC simply

removed her from the location of the challenged conduct.

The only question, then, is whether Harley can expect to

be subjected to the ADOC’s practices at Tutwiler in the

future. Transfers between Tutwiler and Montgomery

Women's Facility are common (indeed, Harley has

previously been moved back and forth between the

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39

facilities), and as such, there is a more than reasonable

basis to believe that she will be subjected to

segregation in Tutwiler again. 

Nor is this court deprived of its power to decide the

plaintiff’s claims challenging policies that the ADOC now

agrees to change. The ADOC has provided no information

about the department’s deliberation process and has

provided only vagueries about the basis for its decision

to alter its policies. Therefore, its policy changes are

far from unambiguous. See Harrell v. The Fla. Bar, 608

F.3d 1241, 1267 (11th Cir. 2010) (“[T]he Board acted in

secrecy, meeting behind closed doors and ... failing to

provide any basis for its decision [to change its

challenged practices]. As a result, [the court has] no

idea whether the Board’s decision was well-reasoned and

therefore likely to endure.”) (quotations and citations

omitted). In addition, while “a defendant’s cessation

before receiving notice of a legal challenge weighs in

favor of mootness ... cessation that occurs late in the

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40

game will make a court more skeptical of the voluntary

changes that have been made.” Harrell, 608 F.3d at 1266

(quotation marks and citations omitted). In this case,

the department committed to policy changes at the close

of trial, despite the fact that this litigation has been

ongoing for over a year-and-a-half. The concessions

therefore seem more likely an attempt to avoid an

unfavorable result in this litigation than “the result of

substantial deliberation.” Nat’l Ass’n of Bds. of

Pharmacy, 633 F.3d at 1310. 

As to the third factor, the court has not received

any concrete evidence as to whether and how any changes

have, in fact, been made, nor has it received any

evidentiary details about when and how future changes to

the current policy might occur. Therefore, the court

cannot be sure whether the ADOC truly has mooted these

claims. All three factors thus counsel against a finding

of mootness on the conceded issues. 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 40 of 153
41

In sum, all of the plaintiffs’ claims present

justiciable controversies. Neither the standing nor

mootness doctrines preclude the court from reaching the

merits of these claims.

B. Title II of the Americans With Disabilities Act and

§ 504 of the Rehabilitation Act 

The plaintiffs assert claims under Title II of the

ADA and under § 504 of the Rehabilitation Act. Title II

provides that “no qualified individual with a disability

shall, by reason of such disability, be excluded from

participation in or be denied the benefits of the

services, programs, or activities of a public entity.”

42 U.S.C. § 12132. Section 504 provides that, “No

otherwise qualified individual with a disability ...

shall, solely by reason of her or his disability, be

excluded from the participation in, be denied the

benefits of, or be subjected to discrimination under any

program or activity receiving Federal financial

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 41 of 153
14. Both statutes clearly apply to Alabama state

prisons. See Pa. Dep’t of Corr. v. Yeskey, 524 U.S. 206

(1998)(holding that state prisons and jails are

considered public entities for the purposes of the ADA);

Pretrial Order (Doc. No. 177) at 12 (Stip. 1) (stating

that the ADOC receives federal financial assistance,

therefore subjecting the ADOC to the requirements of the

Rehabilitation Act). 

42

assistance.” 29 U.S.C. § 794(a).14 Claims under both

statutes are governed by the same standards. See, e.g.,

Cash v. Smith, 231 F.3d 1301, 1305 (11th Cir. 2000); see

also Everett v. Cobb County Sch. Dist., 138 F.3d 1407,

1409 (11th Cir. 1999). To state a claim under either

statute, the plaintiffs must show: “(1) that [they are]

qualified individual[s] with a disability; (2) that [they

were] either excluded from participation in or denied the

benefits of a public entity's services, programs, or

activities, or [were] otherwise discriminated against by

the public entity; and (3) that the exclusion, denial of

benefit, or discrimination was by reason of the

plaintiff[s’] disability.” Bircoll v. Miami-Dade Cnty.,

480 F.3d 1072, 1083 (11th Cir. 2007) (citation omitted);

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 42 of 153
15. The ADA and the Rehabilitation Act define

disability as (among other things) “a physical or mental

impairment that substantially limits one or more major

life activities of such individual.” 42 U.S.C.

§ 12102(1)(A) (ADA); 29 U.S.C. § 705(20)(B)

(Rehabilitation Act). The ADA Amendments Act of 2008

clarifies that “major life activities” includes “the

operation of a major bodily function, including ...

functions of the immune system.” 42 U.S.C.

§ 12102(2)(B). As HIV critically impacts the immune

system, it is within the ambit of the statute.

43

see also Harris, 941 F.2d at 1522 (applying those

elements in the prison context). Because the same

standards govern claims under both statutes, in the

interest of brevity, the court will refer to both as “the

ADA.”

The plaintiffs correctly assert (and the ADOC

concedes) that HIV is a disability under the ADA.15

Therefore, the court’s analysis addresses the other

elements of a claim under the ADA. 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 43 of 153
44

1. Segregation

Among the regulations promulgated under Title II of

the ADA is the “integration regulation,” which provides

that, “A public entity shall administer services,

programs, and activities in the most integrated setting

appropriate to the needs of qualified individuals with

disabilities.” 28 C.F.R. § 35.130(d) (emphasis added).

“[T]he most integrated setting appropriate” is defined as

“a setting that enables individuals with disabilities to

interact with non-disabled persons to the fullest extent

possible.” 28 C.F.R. Pt. 35, App. B (2011). Consonant

with the integration mandate, the Supreme Court has

concluded that, “Unjustified isolation ... is properly

regarded as discrimination based on disability.”

Olmstead v. L.C. ex rel Zimring, 527 U.S. 581, 597

(1999).

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 44 of 153
16. The ADOC made this argument despite the fact

that, even during the trial, the department's own website

described the policy as segregation. 

17. The ADOC downplayed the significance of separate

dorms for HIV-positive prisoners by referring to them as

simply “where the prisoners sleep.” See, e.g., Defs.’

Pretrial Br. (Doc. No. 211) at 65 (“Class Representatives

simply cannot sleep in the dorms ... with the rest of the

general population); id. at 67 (referring to the

plaintiffs’ claim as a “sleeping arrangement request”).

The ADOC's expert, Dr. George Lyrene, was particularly

dismissive, stating that, “The argument about the

importance of sleeping together seems petty and spurious

to me.” Defs.’ Ex. 336, at 12. However, the facts show

that the dorm is more than where the prisoners sleep.

Prisoners spend much of the day in their dorms.

(Plaintiff Beyer reported spending an average of 7-8

waking hours in his dorm during the summer months, and 10

hours a day in the winter. Plaintiff Knox testified that

he spends around 6-8 hours each day in his dorm.)

Residents of the Special Unit (and many other dorms at

Limestone) also eat all of their meals there. Beyer said

of his dorm, “It’s the place ... where I sleep, I eat, I

read, I watch TV. It’s just the place where I live. ...

[I]t’s not just where I sleep.” Plaintiff Henderson

(continued...)

45

At trial, the ADOC insisted that its policies do not

amount to segregation.16 The department argued, in

essence, that, because HIV-positive prisoners can

participate in certain integrated programs, they are not

truly “segregated.”17 The ADOC enmeshed these arguments

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 45 of 153
17. (...continued)

echoed Beyer's comments, saying of his dorm, “That’s

where I live.” 

18. “Segregation” is defined as “the separation or

isolation of individuals or groups from a larger group or

from society,” but it can also refer to “the separation

or isolation of a race, class, or ethnic group by

enforced or voluntary residence in a restricted area,

barriers to social intercourse, divided educational

facilities, or other discriminatory means.” Webster’s

Third New International Dictionary 2057 (2002). 

46

with an emphasis on the adequacy of medical care in the

Special Unit and an account of various programs to which

HIV-positive prisoners have access. Thus, the

department's true meaning appears to be that, because the

prisoners are not denied health care and because they

have access to many programs, they have no right to

complain about the fact that they are segregated. The

court agrees that “segregation” is an uncomfortable term,

loaded with implications of prejudice.18 The court also

finds that it is an appropriate way to describe the

policy at issue here. Mandatory separate housing in a

separate dorm (which is, for male prisoners, itself

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 46 of 153
19. The ADOC's work-release policy and its policy

requiring male prisoners with HIV to wear white armbands

are analyzed under different legal frameworks under the

umbrella of the ADA. 

47

within a separate facility) would doubtlessly violate the

ADA if unjustified. The same can be said for the

practice of excluding HIV-positive prisoners from foodservice jobs.19 

However, the ADA extends its protections to only

individuals claiming discrimination with respect to, or

exclusion from, a public entity’s services who were

“otherwise qualified” for those services. Onishea, 171

F.3d at 1300. “‘An otherwise qualified person is one who

is able to meet all of a program's requirements in spite

of his handicap.’” Id. (quoting Southeastern Community

College v. Davis, 442 U.S. 397, 406 (1979)). 

The “otherwise qualified” analysis entails a two-part

inquiry. First, the court must determine whether the

plaintiffs are qualified for integration where they are

currently segregated. Second, if the plaintiffs are not

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 47 of 153
48

qualified as an initial matter, “the court must

nevertheless evaluate ... whether reasonable

accommodations would[, if made by the ADOC,] make

[plaintiffs] otherwise qualified.” Harris, 941 F.2d at

1525; see also Martinez v. Sch. Bd. of Hillsborough

Cnty., 861 F.2d 1502, 1505 (11th Cir. 1988). The

plaintiffs carry the burden of making a prima-facie

showing that they are otherwise qualified or would be if

the ADOC made reasonable accommodations. Onishea, 126

F.3d at 1329-30. If the plaintiffs make a prima-facie

showing, the burden then shifts to the ADOC to establish

that the proposed accommodations are not “reasonable”

because implementation would impose “undue financial and

administrative burdens” or require “a fundamental

alteration in the nature of [the] program” at issue.

Harris, 941 F.2d at 1572 n.48 (citations omitted); see

also Henrietta D. v. Bloomberg, 331 F.3d 261, 280 (2d

Cir. 2003) (“[I]t is enough for the plaintiff to suggest

the existence of a plausible accommodation, the costs of

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49

which, facially, do not clearly exceed its benefits, and

... [o]nce the plaintiff has done this, she has made out

a prima facie showing that a reasonable accommodation is

available, and the risk of nonpersuasion falls on the

defendant.”) (quotation marks and citation omitted).

Courts have prescribed a particular analytical

approach where the disability is a contagious illness.

If a person with a contagious illness poses a direct

threat to the health and safety of others, then she is

not “qualified” within the meaning of the statute. See

Onishea, 171 F.3d 1296-97. To make this determination,

courts apply the factors identified by the Supreme Court

in School Board of Nassau County, Florida v. Arline, 480

U.S. 273 (1987); see also Martinez, 861 F.2d at 1505

(explaining that, when a person is handicapped with a

contagious illness, a court must first apply the Arline

factors, and second, evaluate whether reasonable

accommodations would make the person otherwise

qualified); Onishea, 171 F.3d at 1297 (applying the

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 49 of 153
50

Arline factors to a challenge of the ADOC HIV-segregation

policy). The factors include: "(a) the nature of the

risk (how the disease is transmitted), (b) the duration

fo the risk (how long is the carrier infectious), (c) the

severity of the risk (what is the potential harm to third

parties) and (d) the probabilities the disease will be

transmitted and will cause varying degress of harm."

Onishea, 126 F.3d at 1297 (quoting Arline, 480 U.S. at

288). In applying these factors, the court must take

into account the basic principle that “the significance

of a risk is a product of the odds that transmission will

occur and the severity of the consequences.” Id. 

Arline emphasized that these factors must be applied

on an individualized basis: only by doing so can the

court honor Congress's “goal of protecting handicapped

individuals from deprivations based on prejudice,

stereotypes, or unfounded fear, while giving appropriate

weight to such legitimate concerns ... as avoiding

exposing others to significant health and safety risks.”

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51

Arline, 480 U.S. at 287; see also id. (stating that “the

district court will need to conduct an individualized

inquiry” in applying the factors). It follows that, in

the context of a class action challenging the treatment

of persons with a disability as a group, the court must

not make a finding of significant risk as to the entire

group unless it can be sure that no individual within the

group would not pose such a risk.

 When the Eleventh Circuit previously considered

whether the ADOC’s segregation policy violated the ADA,

that court found that the seriousness of HIV, then a

death sentence for everyone who contracted it, rendered

unacceptable even a small (though plausible) risk of

transmission. See Onishea, 171 F.3d at 1293 (“HIV

infection inevitably progressed to AIDS. AIDS always led

to death, often after lengthy suffering.”). The court

held that, “when transmitting a disease inevitably

entails death, the evidence supports a finding of

‘significant risk’ if it shows both (1) that a certain

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20. While the ADOC argues that the Onishea test still

applies to HIV, they, puzzlingly, never argue that HIV is

still invariably fatal; instead, they state that it is

fatal when left untreated. Defs.’ Prop. Findings (Doc.

No. 246) at 6 (“[I]f left untreated, HIV has the same

affect on people that it did before the development of

the current antiretroviral medications, i.e., development

of ‘full-blown’ AIDS and inevitable death.”) (emphasis

added). It strains credulity to imagine that the

Eleventh Circuit meant to encompass in its rule all

diseases that are fatal without the benefit of modern

medicine; indeed, albeit not contagious, conappendicitis,

high blood pressure, and even tooth decay can be fatal

when left untreated.

52

event can occur and (2) that according to reliable

medical opinion the event can transmit the disease.”

Onishea, 171 F.3d at 1299. Because HIV was inevitably

fatal, those infected with it fell outside of the ADA’s

protections. Significantly, the Eleventh Circuit

emphasized that its conclusion was based on “the state of

medical knowledge and art at the time of trial.” Id. at

1293.

Today, however, HIV does not invariably cause death.20

The vast majority of infected individuals can expect to

live a near-normal lifespan. Therefore, the heightened

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53

standard that the Eleventh Circuit applied in Onishea for

fatal illnesses no longer applies to HIV. Instead, this

court must apply the “significant risk” test the the

Supreme Court outlined in Arline.

The court may not simply conduct this analysis with

respect to HIV in prison in general, however. Instead,

the court must consider the risk of transmission with

respect to each specific aspect of institutional life in

which the plaintiffs claim exclusion. See Harris, 941

F.2d at 1526 (reversing the district court because it

“should have determined the risk of transmission not

merely with regard to prison in general, but with regard

to each program from which appellants have been

automatically excluded”). Because the plaintiffs have

not provided clear guidance on how the court should parse

their claims, the court will do so according to the

different contexts in which the transmission risk may

differ. Assessment of the risk with regard to men must

be separate from that with regard to women, since the

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21. The court notes the obvious fact that this is not

a case in which the plaintiffs are unqualified because of

legitimate eligibility requirements unrelated to their

HIV status. See, e.g., Pottgen v. Mo. State High Sch.

Activities Ass'n, 40 F.3d 926, 928 (8th Cir. 1994)

(addressing argument that student was excluded from

interscholastic sports because of legitimate maximumage-eligibility requirement, not because he had learning

disabilities). On the contrary, here, because housing is

a necessary component of institutional life that is

provided to all incarcerated persons, the plaintiffs

clearly “meet all of [the] requirements” for being housed

with the general population in ADOC facilities, Onishea,

171 F.3d at 1300; as such, the plaintiffs are unqualified

for integrated housing only if they would “constitute a

direct threat to the health or safety of other

(continued...)

54

latter transmit the disease in more limited

circumstances. Similarly, the risk differs in the

context of food services from the risk posed by

integrated dormitories. The court will therefore analyze

each context in turn.

a. The Special Unit Within Limestone

The court first addresses the ADOC's housing

segregation policy at Limestone, which requires all HIVpositive prisoners to reside in the Special Unit.21 As

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 54 of 153
21. (...continued)

individuals” and that threat could not be eliminated with

reasonable accommodations. Id. at 1296-97 (citations

omitted); Harris, 941 F.2d at 1525.

55

this court has explained, HIV can be transmitted through

contaminated blood or bodily fluids. In the prison

context, this is most likely to occur during unprotected

sex or needle sharing (for example, intravenous drug use

or tattooing). See Onishea, 171 F.3d at 1294-95.

 The degree to which a person with HIV is infectious

can vary over the course of his disease. As the court

has already described, modern HIV treatments can not only

effectively treat the virus, but, generally speaking,

prevent its transmission. Dr. Altice explained that “the

newer HIV therapy regimens are so effective in

suppressing the virus that HIV transmission is almost

impossible even if high-risk activity occurs between HIVpositive and HIV-negative individuals, if the HIVpositive individual is receiving antiretroviral therapy

and their virus is suppressed.” Altice Report, Pls.’ Ex.

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 55 of 153
56

107, at 6. As the viral load drops, so does the risk of

transmission, and, once full viral suppression is

obtained, the risk is essentially non-existent. 

The level of scientific certainly for this general

principle, however, differs in different contexts. The

best data available come from randomized controlled

trials. In 2011, Science magazine reported the results

of one such trial showing that, among heterosexual

couples, the use of antiretroviral therapy dramatically

reduces transmission of the disease. Science deemed

these results its “Breakthough of the Year.” The

randomized control trial studying the effect of

antiretroviral therapy on transmissions between men who

have sex with men is still underway. However, “community

viral load data among men who have sex with men” suggest

“a markedly reduced level of transmission” for that group

as well. It was clear to the court that both the

plaintiffs and the ADOC had adopted the general principle

that virally suppressed individuals are highly unlikely

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57

to transmit HIV sexually, whether the sexual act is

between people of different sexes or of the same sex.

None of the ADOC’s experts disputed the proposition that

viral suppression dramatically reduces a person’s ability

to transmit HIV through sexual activity: The ADOC's

expert witness, Dr. Steven Scheibel, stated that:

“[S]omeone's not infectious in terms of sex if they have

an undetectable viral load .... If ... people ... are on

antiretroviral medication and the virus level is

suppressed, they are ... very unlikely to transmit.” 

There has also been no completed randomized

controlled trial studying the risk of transmission among

virally suppressed individuals who share needles

(although one such study is currently underway). Early

indicators suggest that antiretroviral drugs have a

similarly preventative effect when it comes to

transmission through needle sharing. This outcome would

be logical because, after all, regardless the means of

transmission, so long as a person is adherent to

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58

antiretrovirals, the virus will be only have a minimal

presence in the blood and body fluids. Based on the

current state of medical knowledge, Dr. Altice found it

probable that viral suppression reduces risk of

transmission via needle sharing: “[C]ohort studies and

community types of studies ... suggest[] that this

treatment as prevention paradigm works for all groups.

However, he conceded that “the jury's not in 100 percent”

in that regard. Dr. Scheibel was more skeptical: “[T]he

bottom line is that we do not know how transmission may

occur when people are sharing needles and when people are

tattooing in terms of HIV transmission.” Despite Dr.

Altice's optimism and indicators showing that virallysuppressed HIV-positive persons pose a drastically

reduced risk of transmission when sharing needles,

“‘[l]aw lags science; it does not lead it.’” McClain v.

Metabolife Int'l, Inc., 401 F.3d 1233, 1247 (11th Cir.

2005) (quoting Rosen v. Ciba-Geigy Corp., 78 F.3d 316,

319 (7th Cir. 1996)). Therefore, at this time, the court

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59

cannot conclusively find that virally suppressed HIVpositive individuals who share needles pose no, or only

a nominal, risk of transmission.

In addition to individuals who obtain viral

suppression through medication, there is another very

small group called “elite suppressors” who often have

undetectable viral loads without the aid any HIV

medications. The risk of elite suppressors spreading the

virus is similar to that of persons who have obtained

viral suppression throughout treatment. Dr. Scheibel’s

chart review of HIV-positive prisoners at Limestone

reveals that the vast majority of prisoners on

antiretroviral medications have acheived viral

suppression. He also identified one elite suppressor

among those who are not on HIV medication. 

Based on this evidence, it is clear that at least

some, if not a majority, of HIV-positive prisoners at

Limestone present a very low risk of transmitting the

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22. Despite the power of antiretrovirals to reduce

the odds of transmission, adherence is key to the

medications’ success. People infected with HIV who are

virally suppressed can quickly become infectious again if

they cease to take their medicines.

60

virus.22 Prisoners who have achieved viral suppression

pose an infintesimal risk if they abstain from sharing

needles, regardless of whether they have sexual

intercourse with other prisoners.

The understanding that some people with HIV are very

unlikely to transmit the disease is shared by ADOC

Commissioner Thomas. In the context of addressing the

criteria the department uses to determine whether HIVpositive prisoners are eligible for work release, he

explained that “the medical criteria allows ... a person

[for] who[m] the risk of transmission is almost zero to

have access to a work-release program.” Implicit in that

testimony is that Commissioner Thomas not only believes

that individuals exist within the system who are not

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23. Since HIV-positive prisoners are not segregated

at work release, but are housed alongside HIV-negative

prisoners, Commissioner Thomas’s statement also relates

confidence that the department can safely house at least

some HIV-positive individuals with prisoners who are HIVnegative.

61

infectious, but he also that believes that the ADOC is

able to identify those individuals.23

The level of risk is somewhat different for prisoners

who were not previously diagnosed with HIV (but had been

unknowingly living with the disease) before entering the

ADOC's custody. This group is, generally speaking, very

infectious until medication takes effect. As the

medication takes effect and the viral load lowers, the

risk of transmission decreases accordingly. Thus, for

these prisoners, the probability of transmission will

depend on the length of time over which they are adherent

to medication and their behavior. Should they engage in

high-risk behavior (including both sex and needlesharing) before achieving viral suppression, the risk of

transmission is high. On the other hand, if these

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62

prisoners abstain from voluntarily participating in

behavior that risks transmission, the risk is minimal.

However, even in the absence of high-risk behavior,

involuntary occurrences (such as rape) create some risk.

Nevertheless, on balance, the probability of transmission

posed by even a quite infectious person who does not

voluntarily engage in high-risk behavior is generally

low, and it will reduce drastically as treatment takes

effect.

There may exist a small minority of prisoners who,

for various reasons, will never achieve viral suppression

(barring further advances in science or changes in

behavior). For example, some people with HIV who have

poorly adhered to antiretroviral medications develop

strains of the virus that are resistant to treatment.

Others may, for various reasons, be unwilling to take

medications altogether. For these prisoners, the risk

and probability of transmission are largely a function of

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63

behavior (though this risk will be higher than that posed

by prisoners who have achieved viral suppression), and

the duration of the risk is indefinite. Essentially, the

risk posed by this group is the same as that posed by all

HIV-positive prisoners before the advent of

antiretroviral treatment.

The ADOC’s argument that integrating HIV-positive

prisoners would increase the number of transmissions

stems from the indisputable fact that integration would

increase opportunities for high-risk behavior. However,

the picture is more complex than the department suggests.

HIV-positive and HIV-negative prisoners at Limestone

already have ample opportunity to interact with one

another and engage in high-risk activity in areas of the

prison other than their housing units. As Dr. James

Austin, a nationally renowned expert in prison and jail

classification and risk assessment, explained, “sexual

contact between prisoners occurs in virtually all areas

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24. The low transmission rate is particularly notable

because in the earlier litigation challenging the more

stringent version of this policy, the ADOC argued, and

the district court agreed, that “the transmission risk

[was] significant in all programs.” Onishea, 171 F.3d at

1295. In spite of this finding, no transmissions in fact

occurred when programs were integrated. 

64

of prisons except where prisoners are in permanent

isolation.” Austin Report, Pls.’ Ex. 108, at 15.

Segregation also does not reduce opportunities for

transmission through sexual activity between staff and

prisoners, nor from prisoners who are transferred to

county jails or work-release facilities (where they are

not segregated) and then back to prison. Meanwhile, the

transmission rate for HIV within the ADOC is exceedingly

low: at or approaching zero.24 In light of the

substantial opportunities for interaction between HIVpositive and HIV-negative prisoners, the virtual

nonexistence of transmissions within the ADOC casts

serious doubt on the department’s assumption that further

integration would increase the transmission rate. It

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65

instead appears that so long as integration is handled

responsibly, it is unlikely to meaningfully increase

transmissions, if at all. 

Further still, it is possible that eliminating the

segregation policy could deter high-risk behavior in some

instances. Dr. Altice opined that, among HIV-negative

prisoners prone to risky behavior, segregation could

create a false sense of security. Believing that no one

in their midst had HIV, they may be more willing to

engage in high-risk behavior than they would otherwise.

This could place them at risk for contracting HIV from

highly infectious HIV-positive prisoners who were not

segregated because they were tested during the “window

period” (and for countless other sexually transmitted

infections). Thus, perversely, it is at least, arguably,

possible that the segregation policy could lead to

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25. Deputy Commissioner Emmitt Sparkman of the

Mississippi Department of Corrections testified that he

was not concerned about transmissions when that

department integrated HIV-positive prisoners in 2010

because he felt the segregation policy simply created a

false sense of security that encouraged high-risk

behavior.

66

transmissions that would not occur if the prisoners were

integrated.25

There is a small risk of transmission that exists

under the current policy: this cannot be eliminated so

long as human beings interact. There is no evidence that

integrating HIV-positive prisoners in housing would

meaningfully increase the probability of transmissions.

Although integration would certainly create more

opportunities for high risk behavior, such opportunities

exist now and have not resulted in any transmissions.

The link between the department’s lack of transmissions

and the segregation policy thus merely amounts to post

hoc ergo propter hoc. 

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67

Regardess of the likelihood of transmissions, the

significance of transmission for the person who becomes

infected with the virus should not be understated. There

is no cure for HIV at this time. Therefore, should a

prisoner in the custody of the ADOC become HIV-positive

while incarcerated, he will remain so for the rest of his

life (barring scientific advances). Accordingly, he

would be burdened with a lifelong responsibility to

maintain access and adhere to antiretroviral treatment,

a failure to do so likely resulting in a dramatically

shortened lifespan. For the disproportionately poor

prisoners in the ADOC, this responsibility (which is

literally a matter of life or death) is no small thing.

On the other hand, the consequences of being HIV-positive

are not nearly as severe today as they were during an

earlier time. As has been discussed, the vast majority

of people with HIV enjoy near-normal lifespans. They can

typically be treated with a simple one-pill-a-day regimen

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68

free of crippling side-effects. And, because of

antiretrovirals, they can also engage in ordinary sexual

behavior without reasonable fear of transmitting HIV to

their partners. With appropriate treatment, they can

have lives nearly identical to those of people who do not

have HIV (that is, aside from having to take

medications).

Balancing these factors and weighing “the odds that

transmission will occur” against “the severity of the

consequences,” Onishea, 126 F.3d at 1297, it is obvious

that, given the life-changing advances in HIV treatment,

ceasing the housing, categorically, of all HIV-positive

prisoners exclusively in Limestone's Special Unit would

not create “a direct threat to the health or safety of

other individuals” within the meaning of the ADA.

Onishea, 171 F.3d at 1296-97. A very low risk would be

created if the ADOC integrated HIV-positive prisoners on

an individual-by-individual basis, based, for example, on

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26. Integrating such persons could, in certain

circumstances, amount to a violation of the Eighth

Amendment’s prohibition of cruel and unusual punishment.

See, e.g., Gates v. Collier, 501 F.2d 1291, 1300 (5th

Cir. 1974) (finding an Eighth Amendment violation where

inadequate medical care resulted in, among other things,

“inmates with serious contagious diseases [being] allowed

to mingle with the general prison population”); Clark v.

James, 794 F.2d 595, 596 (11th Cir. 1986) (requiring

“reconsideration of appellant’s claim that by assigning

him to prison duties requiring exposure to contagious

diseases, prison officials violated his eighth ...

amendment rights”); Billman v. Ind. Dept. of Corr., 56

(continued...)

69

whether their viral levels are suppressed and whether

they have a demonstrated history of medication adherence

and abstinence from high-risk behavior. That description

could fit many prisoners currently incarcerated in the

Special Unit; segregating them thus violates the ADA. On

the other end of the spectrum, a threat could be created

if the ADOC integrated (without imposing additional

safeguards) HIV-positive prisoners with high viral loads

who refuse to take medication and who have a history of

risky behavior (for example, attempting to rape other

prisoners).26 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 69 of 153
26. (...continued)

F.3d 785, 788 (7th Cir. 1995) (upholding Eighth Amendment

claim alleging that “employees of the prison system,

knowing that [a prisoner] had a history of raping his

cellmates and was HIV-positive, nevertheless placed [the

plaintiff] in the same cell without warning him of the

danger he faced, and that they did nothing to interrupt

the rape while it was in progress”). However, even with

these prisoners, the court can discern no reason why the

ADOC would need to treat them differently from other

prisoners who have shown sexually predatory behavior and

have serious infectious diseases other than HIV. 

70

What is critical here is that, despite this range of

risk, the ADOC maintains a blanket policy of precluding

all HIV-positive prisoners at Limestone from integrated

housing, regardless of their individual circumstances.

That policy denies plaintiffs the individualized

determinations to which they are entitled under the ADA,

see Arline, 480 U.S. at 287, and unjustifiably treats all

HIV-positive prisoners identically, despite the fact that

their circumstances are materially different, not

identical. See Kapche v. City of San Antonio, 304 F.3d

493, 499 (5th Cir. 2002) (describing Supreme Court

precedent interpreting the ADA as “consistently

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71

point[ing] to an individualized assessment mandated by

[the act],” and “further not[ing] that [the court is]

unaware of any decision from [its] sister Circuits

abrogating the requirement of an individualized

assessment in favor of a per se exclusion under the

ADA.”). For this reason, the ADOC is currently violating

the rights of the HIV-positive prisoners within its

custody by categorically segregating them because of

their HIV status and excluding them from the integrated

housing for which they may be qualified.

The court witnessed the impact of the segregation

policy when it toured Limestone and the Special Unit with

both legal teams during the trial. The court recognizes

that the prisoners in the Special Unit were locked down

during the visit out of consideration for the court's

safety. Even discounting the effect of the lockdown,

the Special Unit evoked the feeling of a place abandoned.

The prisoners there displayed a striking uniformity of

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72

disposition. They peered, sullen, from their cells. The

quiet, which the ADOC touted at trial as an asset of the

unit, seemed instead to accent the dormitories' isolation

from the lively general-population dorms, communicating

these prisoners’ exclusion. The imposing cage around the

residential treatment unit, where mentally ill prisoners

with HIV are kept, allows any observer to see the

activity within. The effect of a severely mentally ill

man isolated within the cage, which juts into the common

area where the prisoners eat and watch television, would

surely be disturbing to those both within it and without.

It is evident that, while the ADOC’s categorical

segregation policy has been an unnecessary tool for

preventing the transmission of HIV, it has been an

effective one for humiliating and isolating prisoners

living with the disease. 

 As for the precise circumstances that would render

a prisoner qualified or unqualified for integrated

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73

housing at Limestone, the court need not draw such lines

now, at the liability stage. This case is a class action

including as plaintiffs all present and future HIVpositive prisoners within the custody of the ADOC. See

Henderson v. Thomas, 2012 WL 3777146 (M.D. Ala. Aug. 30,

2012) (Thompson, J.) (certifying class). Consequently,

for the ADOC to escape liability, there must be not a

single HIV-positive prisoner who is or could be qualified

for, and thus has the right to, integrated housing. That

is clearly not the case. For now, it is sufficient to

say that, pursuant to binding Supreme Court and Eleventh

Circuit case law, the ADOC is in violation of the ADA

with respect to the plaintiff class.

The only barrier to integrated housing for qualified

prisoners at Limestone is the ADOC’s medical

classification system, which treats all HIV-positive

prisoners identically and precludes them from being

integrated. As such, the sole accommodation necessary

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74

for qualified plaintiffs is that the ADOC modify its

classification system to afford the plaintiffs the

individualized determinations to which they are entitled

instead of treating HIV status as a dispositive criterion

regardless of viral load, history of high-risk behavior,

physical and mental health, or any other individual

aspects of the prisoner. 

The facts (and common sense) compel the conclusion

that making such a modification to the ADOC’s policies is

a reasonable accommodation that would not impose “undue

financial and administrative burdens” or require “a

fundamental alteration in the nature of” ADOC operations.

Harris, 941 F.2d at 1527 n.48 (citations omitted).

First, the ADOC has the ability to measure prisoners’

viral loads; the ADOC already does so. Second, the

department is capable of differentiating among prisoners

on the basis of their behavior, since the ADOC already

does this in the context of security classification.

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27. The ADOC asserts a fundamental-alteration defense

to these accommodations. If accommodations amount to a

fundamental alteration, the defendants need not make

them. “[A] proposed accommodation amounts to a

‘fundamental alteration’ if it would eliminate an

‘essential’ aspect of the relevant activity.” Schwarz v.

City of Treasure Island, 544 F.3d 1201, 1220 (11th Cir.

2008) (citations omitted). For example, in PGA Tour,

Inc. v. Martin, 532 U.S. 661, 682-83 (2001), the Supreme

Court listed as examples of hypothetical fundamental

alterations of a golf tournament, “changing the diameter

of the hole from three to six inches,” which would “alter

an essential aspect of the game,” or a change that “might

(continued...)

75

Third, the department is likewise able to distinguish

among HIV-positive prisoners based on their medical

needs, as evidenced by the medical coding chart it

already uses. Fourth, there is no evidence that

modifying its classification policies would require

unreasonable cost expenditures. See Onishea, 171 F.3d at

1303 (holding that cost is relevant for assessing whether

an accommodation imposes an undue burden). In short,

requiring the ADOC to modify its classification system in

order to effectuate integrated housing at Limestone would

be reasonable.27

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27. (...continued)

... give a disabled player ... an advantage over others,”

thus “fundamentally alter[ing] the character of the

competition.” Here, the ADOC contends that, because its

current treatment of HIV-positive prisoners was shaped in

part by prior litigation (in particular, the consent

decree in, Leatherwood v. Campbell, No. CV–02–BE–2812–W

(N.D. Ala. Apr. 24, 2004) (Bowdre, J.)), any change from

the status quo would constitute a fundamental alteration.

This contention is without merit. The fundamentalalteration defense is not intended to serve the purpose

of foreclosing successive litigation on related (albeit

not identical) issues. Moreover, despite what the ADOC

may imply, the Leatherwood court did not order the ADOC

to segregate HIV-positive prisoners from the general

prison population; it merely addressed the

unconstitutionally inadequate conditions of confinement

that HIV-positive prisoners faced at Limestone at the

time, namely, inadequate medical care. The court sees no

tension between Leatherwood and its decision today.

76

 For those prisoners who are not currently qualified

(perhaps because they are highly infectious), the law

requires the ADOC to make reasonable accommodations that

would render them qualified. See Bircoll, 480 F.3d at

1081-82 (citing 28 C.F.R. § 35.130(b)(7), which requires

that “[a] public entity ... make reasonable modifications

in policies, practices, or procedures when the

modifications are necessary to avoid discrimination on

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77

the basis of disability, unless the public entity can

demonstrate that making the modifications would

fundamentally alter the nature of the service, program,

or activity.”).

The plaintiffs have shown that reasonable

accommodations exist that would reduce (and even

eliminate) most of these individuals’ odds of

transmitting the disease. Principally, Dr. Altice

explained that, “From a public health and clinical

perspective, the rational way to reduce the risk of HIV

transmission in prison is not through housing segregation

but through effective HIV treatment.” Altice Report,

Pls.’ Ex., at 6. Under this approach, antiretroviral

medication is offered to every HIV-positive person who is

ready and willing to take it so that it will suppress the

virus and reduce or eliminate the chances of

transmission. Taking this step could eliminate many

prisoners’ likelihood of transmitting HIV. Thorough

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78

education would also play a preventative role. These

methods are reasonable ways to reduce the risk of

transmission. 

The court emphasizes that, in affording HIV-positive

prisoners the individualized determinations to which they

are entitled, the ADA grants the ADOC discretion in

choosing how best to do so. See, e.g., Frame v. City of

Arlington, 657 F.3d 215, 246 (5th Cir. 2011) (“Indeed, a

municipality is granted the discretion to choose how best

to make its services accessible.”), cert. denied, 132 S.

Ct. 1561 (2012). This court is “sensitive to ... the

need for deference to experienced and expert prison

administrators faced with the difficult and dangerous

task of housing large numbers of” prisoners. Brown v.

Plata, 131 S. Ct. 1910, 1928 (2011); see also Turner v.

Safley, 482 U.S. 78, 85 (1987) (“[F]ederal courts have

... reason to accord deference to the appropriate prison

authorities.”). In making determinations as to

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79

particular prisoners’ qualifications for integration, the

ADOC is entitled to rely on the reasonable judgments of

its medical professionals. See Olmstead, 527 U.S. at 602

(“Consistent with [the ADA’s prohibition of unnecessary

segregation], the State generally may rely on the

reasonable assessments of its own professionals in

determining whether an individual ‘meets the essential

eligibility requirements’ for habilitation in a

community-based program.”); Arline, 480 U.S. at 288

(“[C]ourts normally should defer to the reasonable

medical judgments of public health officials.”). 

However, while the law grants the ADOC deference in

choosing how to satisfy its responsibilities, the

department is of course obligated to act in good faith as

it works to ensure that no prisoner in its custody

remains unnecessarily segregated because of his HIV

status. Cf. Griffin v. United Parcel Serv., Inc., 661

F.3d 216, 224 (5th Cir. 2011) (“[W]hen an employer's

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80

unwillingness to engage in a good faith interactive

process leads to a failure to reasonably accommodate an

employee, the employer violates [Title I of] the ADA.”)

(citation omitted).

A final aspect of the ADOC’s housing policy at

Limestone warrants brief discussion: the practices in

Dorm E. That dormitory houses both HIV-positive and HIVnegative prisoners who have been placed in administrative

or disciplinary isolation. As was noted above, before

the end of trial, the ADOC conceded this aspect of the

plaintiffs’ challenge and assured the court that its

practices would change. Now, the ADOC urges the court to

disregard the issue, arguing that it has been mooted.

The court, however, finds good cause for resolving the

matter. For the reasons given earlier, the court has not

been deprived of its power to determine the legality of

this challenged conduct simply because the ADOC says it

has voluntarily ceased that conduct during the course of

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81

litigation. See Nat'l Ass'n of Bds. of Pharmacy, 633

F.3d at 1309. Moreover, the ADOC’s conceded practices

have evidentiary relevance; they speak to the credibility

of the department with regard to other justifications,

and they provide evidence of the department’s intentional

discrimination against individuals with HIV. 

Unlike prisoners housed in other parts of Limestone,

prisoners in Dorm E are restricted to their closed (and

locked) cells (each of which holds only a single

prisoner) for almost the entire day. They leave their

cells only when handcuffed and escorted by ADOC staff.

Because of this intensive monitoring, they have no

physical contact with one another at any time, and

consequently, transmission of HIV between an HIV-positive

and HIV-negative prisoner in isolation is not remotely

possible. Nevertheless, the HIV-positive and HIVnegative prisoners in Dorm E are segregated: HIV-positive

prisoners are clustered together separately from the HIVCase 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 81 of 153
82

negative prisoners. Because the size of each group will

differ depending on isolation needs at the time, the dorm

features a “floating gate” that the ADOC uses to

demarcate the border where the HIV-positive cluster ends

and the cells housing HIV-negative prisoners begin.

Because ending segregation in Dorm E would present

absolutely no risk of harm, it is clear that the ADOC’s

policy of separating HIV-positive prisoners and HIVnegative prisoners in the dormitory and using the

physical infrastructure of the building to indicate which

prisoners have HIV, is, and has always been, wholly

unnecessary and promotes no legitimate purpose. As such,

it serves only to discriminate for the sake of

discrimination. That is precisely the sort of

“irrational disability discrimination” that the ADA

“seeks to [prohibit].” Tennessee v. Lane, 541 U.S. 509,

522 (2004); see also Bledsoe v. Palm Beach Cnty. Soil and

Water Conservation Dist., 133 F.3d 816 821-22 (1998)

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 82 of 153
83

(holding that the ADA prohibits “all discrimination by a

public entity” regardless of the form it takes).

The ADOC’s practices in Dorm E are most relevant in

that they illuminate the intent underlying the

department’s treatment of HIV-positive prisoners. In

order to accommodate assumed and actual anti-HIV

prejudice among its staff and prisoners in its custody,

and to some extent due to prejudice that stems from

department decision-makers, the ADOC has sought to

segregate HIV-positive prisoners from the general

population in all possible contexts regardless of whether

any legitimate purpose is served by doing so. Moreover,

the ADOC has been uninterested in reexamining seemingly

irrational policies. Only at the eleventh hour, during

the last days of trial, after the ADOC was at a loss for

words in mustering a justification for its practices in

Dorm E, did the department seek to assure the court that

these practices would change. See Defs.’ Resp. to

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84

Judicial Request (Doc. No. 240) at 1-2 (responding to a

judicial inquiry about the purpose of the Dorm E

practices by referencing unspecified prior “conflicting

statements,” but not attempting to put forth any actual

purported purpose).

In addition to Dorm E, certain other unnecessary

features remain in place at Limestone. One standard

operating procedure, which remains on the books (though

purportedly unenforced), warns that, “Routine physical

contact with Special Unit inmates should be kept at a

minimum at all times.” Joint Ex. 7, at 3. “Any staff

member who enters the cell of a Special Unit inmate may

wear ... 1) plastic or latex gloves; 2) Face mask; 3)

Goggles; 4) Protective Rainwear.” Id. A barbed-wire

fence surrounds the two Special Unit dorms. Originally,

that fence separated HIV-positive prisoners from generalpopulation prisoners in the common yard. The gate to

the fence is kept open now, but the fence is no less

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 84 of 153
28. The fence's purpose (enforcing segregation) is

obvious in the layout of the prison. Much of Limestone's

grounds are symmetrical. After entering the prison's

front entrance, to the left is the "A-Side" of the

facility, and to the right is the "B-Side." Each side is

made up of five separate dormitories (all of which are

identical) that are laid out in a circle with a common

yard in the middle. Two of A-Side's dormitories, Dorms

B and C, make up the Special Unit. A-Side and B-Side are

completely identical in their physical appearance, except

that for the large, barbed-wire fence that cuts through

the middle of the common yard and around the two Special

Unit dormitories. Of course, no such fence exists on BSide (which is otherwise identical in all respects).

85

visible; it remains a stark reminder of the HIV-positive

prisoners’ separation.28 These relics of the department’s

earlier policies, unaltered despite having no current

purpose, suggest that other aspects of the policy are

likewise relics of a different era, retained by the

department due more to inertia than because they are

truly needed today.

Moreover, these other unnecessary features matter in

their own right, even if unused. They impress upon both

the prisoners and ADOC staff that HIV-positive prisoners

are different and dangerous. Despite the ADOC’s

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86

modifications to its policy in recent years, the symbolic

power of the segregation policy has not been diluted.

Like the fence with its unlocked gate, the barrier

between the prisoners with HIV and the rest of the prison

is more visible and more imposing than the narrow

doorways that allow them access.

b. Exclusively Housing HIV-positive Men at Limestone

and Decatur Work Release 

The ADOC has neither argued nor given the court any

reason to believe that the transmission risk posed by

housing HIV-positive prisoners in general-population

dorms at Limestone would differ in any meaningful way

from housing HIV-postive prisoners in general-population

dorms at other facilities throughout the State. Nor has

the ADOC argued or presented evidence that housing HIVpositive prisoners at a work-release facility other than

Decatur would pose any additional risk of transmission.

Therefore, the court may answer the “otherwise qualified”

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87

question with the same analysis under Arline articulated

with respect to housing within Limestone. In terms of

the Arline analysis, to the extent that HIV-positive

prisoners are qualified for integrated housing within

Limestone, they are, to the same extent, qualified for

integrated housing at any other facility. Similarly, the

same accommodations that the court has already found

reasonable (modifying the ADOC’s classification system

and various prevention measures) would suffice to

consider HIV-positive men for prisons other than

Limestone. Since HIV-positive prisoners are already

housed in an integrated setting at Decatur Work Release,

the court finds that no concerns about transmission

justify a blanket bar on housing HIV-positive prisoners

at other work-release facilities. 

The question, instead, is whether housing prisoners

at facilities other than Limestone and Decatur would

impose an undue burden on the State. In essence, the

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29. As context for its argument, at trial the ADOC

emphasized the significant advances in HIV care that the

department made pursuant to its settlement with a class

of male HIV-positive prisoners incarcerated at Limestone

in Leatherwood v. Campbell, No. CV02-BE-2812-W (N.D. Ala.

Nov. 18, 2002) (Bowdre, J.). In that case, the

plaintiffs challeged the inadequate medical treatment and

(continued...)

88

ADOC argues that its current system of providing HIV care

at Limestone is effective, and that housing HIV-positive

prisoners at other facilities would inevitably denigrate

the quality of care. Likewise, the department explains

that HIV-positive prisoners in the work-release program

are housed exclusively at Decatur because it is close to

Limestone, which allows prisoners at Decatur ready access

to Limestone’s medical facilities. The ADOC states that

housing prisoners at other facilities would force it to

alter its current system of providing medical care to

prisoners who have HIV. This, they attest, would

drastically diminish quality of care for HIV-positive

prisoners and would be cost the State more money than it

has to spend.29

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29. (...continued)

substandard housing provided to HIV-positive prisoners.

In the 2004 settlement, the ADOC agreed to significant

changes to its housing and standard of medical care for

prisoners with HIV. In 2006, the consent decree expired.

However, the ADOC has continued to adhere to its terms.

Experts on both sides agree that the current level of

care is good, and the ADOC has shown that it may well

exceed the level of care typically provided in the

community. 

30. The ADOC argues that the plaintiffs can find no

relief here because the ADOC's prisoners, regardless of

any diseases they may have, do not have a right to be

transferred to the facility of their choice and,

therefore, this court cannot "allow[] HIV-positive

inmates greater access or rights to the benefits of

(continued...)

89

The court first considers what accommodations would

be necessary in order to house HIV-positive prisoners at

other facilities. In doing so, the court will not assume

that the ADOC would have to house prisoners with the most

dire medical needs at every facility in the State.

Instead, the court will simply evaluate what would be

required to end the ADOC’s current policy of

categorically housing all HIV-positive prisoners in one

prison and one work-release facility.30 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 89 of 153
30. (...continued)

services and programs afforded to all inmates." Defs.’

Pretrial Br. (Doc. No. 211) at 31. The ADOC misconstrues

the plaintiffs' claim. The plaintiffs do not request a

right to transfer to the facility of their choosing; the

plaintiffs ask only not to be segregated on account of

their HIV status. Cf. United States v. Jefferson Cnty.

Bd. of Educ., 380 F.2d 385, 390 (5th Cir. 1967) (school

children have the right to desegregated education despite

the fact that “a schoolchild has no inalienable right to

choose his school”).

90

The court first observes that care for HIV-positive

individuals can be highly variable, ranging from

profoundly complex care to a regime that is relatively

simple. In assessing the ADOC’s claims, the question is

not whether every facility or even whether any additional

facility could provide adequate care for the most ill

prisoners, but rather whether any facility could provide

HIV care for any of the system’s HIV-positive prisoners.

One critical component of the ADOC’s current system

of care is the availability of an HIV specialist to meet

with prisoners at Limestone. The parties dispute how

often and to what extent a specialist must be involved in

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91

care. Dr. Altice opined that, while it is appropriate

for HIV patients initially to be monitored quarterly by

a specialist, patients who become stabilized and virally

suppressed do not require such frequent consultation with

a specialist: instead, they can be monitored by a

specialist as little as twice a year. Dr. Altice found

that, for a stable patient, a specialist may also

evaluate laboratory results without even seeing the

patient. The ADOC’s experts contested Dr. Altice’s view.

Dr. Lyrene noted that some very sick patients must see a

specialist every day. Dr. Schiebel stated that, while

biannual appointments with a specialist may be

appropriate for a stabilized and adherent patient, a more

conservative approach is appropriate in the prison

environment, where adherence to medication is a

challenge. Dr. Scheibel also emphasized the value of a

specialist’s opinion in evaluating lab results,

addressing drug interaction concerns, and treating

comorbitities. 

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92

 It is clear that every person infected with HIV will

require access to a specialist at certain points.

However, the degree to which this is required varies both

from patient to patient and from one time to another as

a patient’s disease progresses. No expert has testified

that every person with HIV requires daily or even weekly

treatment from a specialist. Moreover, no expert

disputed that, for at least some patients, quarterly or

even biannual meetings with a specialist are adequate to

manage their HIV (although Dr. Scheibel expressed

skepticism as to whether any prisoner within the ADOC

falls into this category). Dr. Lyrene testified that the

HIV-positive prisoners at Limestone are generally

healthy. Dr. Scheibel found, through a chart review,

that most have acheived viral suppression. Therefore,

the court concludes that, for at least some of the HIVpositive prisoners, daily or weekly access to an HIV

specialist is not necessary for their care. 

The court also finds that, to the extent that

specialty care is needed, reasonable accommodations are

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31. The court finds it clear the telemedicine is an

adequate means of providing access to specialty care.

However, the debate over its merits at trial warrants

some discussion. Dr. Altice testified that telemedicine

has been effectively used for the provision of HIV

specialty care in a number of other prison systems. Dr.

Scheibel suggested that telemedicine is less than ideal

because the primary care physician may lack experience

with HIV and may not report back to the specialist.

However, he also reported that most patients he had

consulted via telemedicine had good outcomes, although

several experienced nonadherence problems, which he

attributed to unknowledgable primary care physicians.

Dr. Lyrene expressed concern about practical matters,

such as the handling of patient files. The court finds

that these concerns can be addressed through simple

planning and training, particularly since telemedicine

has been effectively implemented elsewhere. Further,

while the ADOC’s experts identified concerns about

telemedicine, neither suggested that it is an inadequate

means of providing HIV care. 

93

available that could make HIV specialty care available at

multiple facilities. One means of doing so, much debated

at trial, is telemedicine, whereby an HIV specialist

would virtually consult with primary care providers in

other locations.31 The ADOC’s primary argument against

telemedicine is based on cost. To that end, the

department presented Hal White, the director of an

information technology consultancy. White conducted a

thorough evaluation of the costs of implementing

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94

telemedicine within the ADOC and visited various

facilities to assess potential challenges. He estimated

that the total cost of installing the necessary

technological equipment for all ADOC prison sites for

five years would be $ 2,026,619.53. While the ADOC

emphasized this larger number at trial, the cost for each

individual facility was estimated at $ 21,184 for

equipment with an additional $ 8,217.53 to install

special equipment at Limestone, from which it is presumed

the HIV-specialist would operate. The facilities would

then have highly variable maintenance costs, ranging from

a total of $ 8,000 per facility over a five-year period

to $ 49,250 per facility. The General Fund Appropriation

for the ADOC for fiscal year 2012 is $ 377,900,000; the

total cost of adding telemedicine at one facility for

five years at even the most expensive facilities

therefore amounts to .02 % of the ADOC’s budget. At the

least expensive facilities (of which there are 13,

according to White’s expert report), the cost would

amount to less than .01 % of the budget. Given this,

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95

while the court stops short of deciding whether

telemedicine is the best or even a good option for the

ADOC, the court concludes that it would not be

prohibitively costly to install telemedicine in at least

one additional facility (and, indeed, the plaintiffs do

not insist that it should be installed at every facility

in the system). 

Even if telemedicine were not possible, however, the

plaintiffs also make the plausible suggestion that an HIV

specialist could travel to different locations within the

system to see patients. Further, the plaintiffs

presented evidence that in certain other states, HIVpositive prisoners travel to a designated prison for HIV

specialty care. The court finds both of these options

particularly feasible since stable HIV patients require

care only quarterly or biannually. In sum, the court is

not convinced that the ADOC could not find a reasonable,

cost-effective way to provide HIV specialty care on an

as-needed basis in at least one facility other than

Limestone. 

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96

The ADOC similarly argues that the other members of

its medical staff, from doctors to pharmacists, cannot

provide adequate HIV care at any facility other than

Limestone. The department contends that it cannot train

staff at other facilities to provide adequate HIV care.

Further still, the ADOC claims that its staff cannot

adequately provide the routine monitoring necessary to

track the progress of HIV.

However, even if the court takes the ADOC’s experts

at their word when they say that the department's medical

staff is not currently equipped to handle even basic care

for HIV-positive prisoners, the court does not find it

credible that the ADOC cannot sufficiently train at least

some medical staff enough that they could provide the

most basic HIV care. The plaintiffs have shown that an

abundance of resources exist in Alabama from

organizations that specialize in the provision of HIV

care and are ready and willing to train ADOC staff for

free. For instance, Dr. James Raper, who directs the

1917 Clinic, a multispecialty HIV practice at the

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97

University of Alabama at Birmingham with vast experience

in the provision of HIV care (including to patients

exiting the correctional system) testified that he would

be open to having health care providers at his clinic

assist with the delivery of health care to HIV-positive

prisoners on a consulting basis. Madeleine LaMarre, a

nurse practitioner who served as nursing director and

clinical services manager for the Georgia Department of

Corrections and participated in a committee to oversee

that department’s transition from a segregated to

integrated system for HIV-positive prisoners, evaluated

the resources available in Alabama for HIV treatment and

concluded that these resources were adequate to train

ADOC staff at multiple facilities. Given LaMarre’s

experience overseeing Georgia’s transition from a

segregated to integrated system and her personal outreach

to HIV care professionals in Alabama, the court finds

that her testimony merits substantial weight.

Dr. Altice also presented evidence that effective

training has been possible in several state systems, many

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98

of which he consulted during that process. In Florida,

for instance, he helped create a mini-residency program

to train correctional medical staff throughout the state

in routine primary HIV care. On-site training helped to

“create[] de-facto treating experts where there had

previously been a complete void.” Moreover, this was all

achieved at a time when, unlike today, HIV care was

“really, really complex” across the board.

It is readily apparent that, if the ADOC wishes to

train medical staff at other facilities (at least enough

to equip them to address the basic needs of stabilized,

virally suppressed HIV-positive prisoners), it may do so.

Further, it may do so at minimal or no cost. 

The ADOC’s protestations do not alter the court’s

opinion. They do, however, expose a persistent pattern

in the ADOC of maintaining the status quo on the basis of

mere assumptions rather than actual investigation. For

instance, Assistant Commissioner of Health Services Ruth

Naglich admitted that she was unfamiliar with any of the

options that the plaintiffs offered for the provision of

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99

free training for medical staff in HIV care. Further

still, in making a determination that delivering HIV care

at facilities other than Limestone would raise costs, she

did not consult with a single community health-care

organization in Alabama. This would have been fruitless,

she assumed, because “community providers ... generally

do not wish to come into the confines of the prison. So

therefore, we would have to take our inmates out into the

community to receive care.” Based on the testimony of

the plaintiffs’ witnesses, her assumption was incorrect.

Dr. Scheibel testified that, even if training was

provided, the individuals trained would still not rise to

the level of expertise. This may well be. However, this

argument does nothing to disrupt the court’s conclusion

that medical staff could learn the basic HIV care needed

for at least some HIV-positive prisoners within the

system. 

The ADOC further argues that, if prisoners were

housed outside of Limestone, it could compromise their

adherence to HIV medications. The court takes very

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100

seriously the ADOC’s concerns about adherence. It is

evident that adherence to medications is both highly

important and a persistent problem in the provision of

HIV care. However, the court does not find that the ADOC

has provided any meaningful link between its segregation

policy and adherence. Dr. Scheibel’s testimony showed

that it would be possible for a prisoner to feel

embarassed by his medications or its side effects,

particularly diarrhea, when housed in general population,

and that this could result in nonadherence. However,

this argument is counter-weighed by Dr. Altice’s equally

convincing opinion that segregation can cause depression

and deprives prisoners of the mental-health and

substance-abuse services offered at other facilities,

which can lead to nonadherence. Moreover, while several

of the ADOC’s experts speculated that segregation could

create a community that encourages adherence, Dr. Altice

emphatically and credibly attested that no medical

literature supports the premise that involuntary

immersion in a community of people with HIV has any

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101

positive effect on adherence (or any therapeutic benefits

whatsoever). Indeed, the plaintiffs in this case

uniformly expressed only deep sadness at being

segregated, and the ADOC presented no prisoner witnesses

to contradict this testimony. Therefore, while the court

finds that adherence is of tantamount concern for HIV

patients, the court does not find that housing prisoners

in a segregated environment makes adherence more likely.

To the extent that the ADOC argues that adherence issues

are better addressed by professionals who are

knowledgable about HIV, the court finds that, given the

resources available, this concern can be addressed

through training. In any event, and perhaps most

importantly, the ADOC has also not shown why it could not

identify prisoners with an adherence problem and address

those prisoners’ behavior separately from adherent

patients; indeed, Dr. Scheibel was able to identify such

individuals in his chart review. In sum, adherence

should be addressed on an individual-by-individual basis,

as the ADA requires, rather than categorically. 

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102

The ADOC’s arguments about medical care are also

undermined by the wide variety of correctional systems

that have successfully provided care in more than one

facility. It is evident that there is no one-size-fitsall approach. Each system approaches this issue

differently based on its needs. Dr. Altice provided

several examples of systems in which he served as a

consultant. In California, for example, the largest

prison system in the country, facilities throughout the

State can manage HIV, but the State also maintains a

central unit where patients with complex medical needs

can go on a purely voluntary basis. In Texas, routine

HIV care is provided at prisons throughout the State,

often supplemented by specialty care provided via

telemedicine. Texas also maintains specialty centers for

more intensive treatment. Florida maintains six to eight

“centers of excellence” to manage complex HIV, but does

not require HIV-positive prisoners to remain at these

centers if their conditions are stable. In

Massachusetts, HIV patients are monitored on-site

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32. Dr. Altice also stopped short of prescribing

which system would work best for Alabama. This task is

impossible, he said, without serious discussion among the

key stakeholders. He described the process used in other

States, which he testified that Alabama should pursue:

“[Y]ou get the ... health professional leaders. You also

get the correctional ... staff involved. You draw up a

map ... and you put in a lot more information in terms of

which places have got medical facilities. Sometimes the

places will make some decisions about augmenting some of

their staffing, or they may move staffing around. But

it’s a process. It’s not something that you can just go

in in five minutes and say, ‘here’s the fix.’”

103

throughout the entire system, and specialty services are

provided as needed from the central office. LaMarre

testified to the success of the integration program in

Georgia, which relies on its medical prison for complex

HIV care but does not require HIV-positive prisoners to

be housed there when stable. While Alabama is different

from each of these States, each of these States is

equally different from every other. Therefore, while

this court does not go so far as to prescribe which of

these systems might suit Alabama,32 the court does not

find it credible that Alabama is uniquely unable to

provide HIV at even one additional facility.

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104

The ADOC’s current mechanisms for assessing the needs

of prisoners with other serious diseases casts further

doubt on its contention that it cannot change its current

system. The department’s own medical coding guide

provides a powerful example. While the ADOC does

medically cluster inviduals with certain conditions, in

the case of other chronic diseases, it does so by

assessing the actual medical needs of the prisoner, not

diagnosis alone. For instance, a chronic-care clinic

patient, such as a person suffering from hepatitis C, who

has been diagnosed for at least three months, is stable,

and requires provider follow-up no less than every 120

days, can be placed at any institution within the system.

However, a person with hepatitis C who requires

chemotherapy may only be housed at four institutions: St.

Clair, Tutwiler, Donaldson, and Limestone. Even adopting

Dr. Scheibel’s more conservative estimate that a stable,

virally suppressed person with HIV must see a specialist

every three months, under the medical coding guide as it

is applied to all other prisoners, that person would be

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33. The guide also indicates that HIV-positive

prisoners may be housed at Kilby, which is the

classification prison for men. HIV-positive prisoners

are housed in isolation cells during the classification

process at Kilby before being transferred to Limestone.

34. For example, Hepatitis B, a viral infection that

is transmitted in the same way as HIV, is two to two-anda-half times more prevalent in prisons nationwide than

HIV and is 20 times more infectious than HIV. Hepatitis

C is 10 to 15 times more prevalent in prisons nationwide

and is 30 % more infectious than HIV. Since 2007, the

mortality rate for Hepatitis C has exceeded that for HIV.

105

eligible for any institution in the ADOC. However,

instead of providing any sort of scale for HIV-positive

prisoners with different needs, the guide instead limits

them to Limestone and Tutwiler alone.33

Testimony at trial revealed that other diseases

routinely managed by the department are as, or more,

challenging to manage than HIV.34 The ADOC’s ability to

place them based on their actual medical needs and

provide them with adequate care deeply discredits its

arguments that it cannot do the same for HIV. The only

plausible differences that the ADOC’s experts identified

between HIV and these diseases are that medication

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106

adherence is more important for HIV patients and that HIV

has no cure. The former distinction can be easily

dismissed: good adherence can, and should be addressed on

an individual-by-individual basis. The second

distinction is irrelevant to the feasibility of providing

care. 

 The plaintiffs have also presented evidence that the

ADOC’s HIV-segregation policy may actually undermine the

level of care provided to HIV-positive prisoners in

certain respects. First, the policy of automatically

sending HIV-positive prisoners to Limestone necessarily

bars those prisoners from other facilities, some of which

provide care that is not available at Limestone. A key

example is Bullock, where prisoners with complex mentalhealth problems are treated. Dr. Altice testified that,

“[O]ftentimes, HIV is the least of [a prisoner’s]

worries.... [F]or individuals who don’t have access to

the kind of full array of treatment that is going to be

most optimal and important to them, it can actually

detract from HIV treatment outcomes.” Further, because

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107

HIV-positive prisoners are barred from the residential

aspect of the substance-abuse treatment program within

Limestone and cannot participate in the much more robust

therapeutic-community program at St. Clair, they are

denied the best treatment for their substance-abuse

needs. This is significant because HIV is commonly

comorbid with substance abuse. Dr. Altice found in a

study that HIV patients whose substance-abuse needs are

met are five times more likely to adhere to their HIV

medications.

In sum, the ADOC has failed to show that it is

necessary to categorically house all HIV-positive males

only at Limestone (and Decatur Work Release) in order to

provide adequate care. Indeed, it is possible that the

policy actually worsens treatment outcomes, particularly

for patients with other severe needs that cannot be

adequately addressed at Limestone. 

In reaching these conclusions, the court does not

speculate as to how many institutions could feasibly

provide HIV care or how many HIV-positive prisoners could

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108

be removed from Limestone and housed elsewhere. Instead,

the court simply concludes that the ADOC’s current

assumption, that no HIV-positive prisoner could receive

adequate care at any other institution within the system,

lacks credence. The ADOC’s own expert, Dr. Scheibel,

perhaps expressed the court’s impression best: “HIV is a

complex disease, and we have to ... examine it patient by

patient.” (emphasis added.) When determining the medical

needs of people with HIV, “[y]ou can't group all patients

together.”

In addition to its contentions that the required

accommodations would impose an undue burden, the ADOC

contends that housing HIV-positive prisoners at

additional facilities would constitute a fundamental

alteration of its system for providing medical care. A

fundamental alteration exists where a proposed

accommodation would “elimininate an ‘essential’ aspect of

the relevant activity.” Schwarz, 544 F.3d at 1220. The

basic purpose of a prison medical system is to provide

care to its prisoners. See id. at 1221 (considering the

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109

“basic purpose” of zoning in order to determine whether

a proposed change amounted to a fundamental alteration).

Thus, while a fundamental alteration may exist if the

plaintiffs requested that the ADOC fire all of its

doctors or eliminate its pharmacies, the accommodations

necessary to house HIV-positive prisoners at additional

facilities do not amount to such a drastic change,

particularly because this step may be taken without

compromising the quality of medical care given to

prisoners (and, indeed, it must not be compromised). See

Henderson, 2012 WL 3777146, at *6 (“Notwithstanding any

relief that may be ordered in this case and the

expiration of the Leatherwood consent decree, the

defendants are still obliged to provide HIV+ inmates a

constitutionally adequate level of care. The Eighth

Amendment and federal anti-discrimination statutes are

not mutually exclusive.”).

In evaluating a State’s fundamental-alteration

defense, a district court must also be attentive to the

cost of the proposed changes to the system in light of

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110

both the resources at the State’s disposal and the

State’s other responsibilities. See Olmstead, 527 U.S.

at 597. The ADOC vigorously argued that enacting any of

the changes proposed by the plaintiffs would be

prohibitively costly. It emphasized the dire state of

the department’s finances: Steve Brown, the Associate

Commissioner for Administrative Services in the ADOC,

testified that the department is facing a $ 15 million

budget shortfall and is operating on a severely

constrained budget. 

The court does not doubt that the ADOC suffers from

severe shortages of funding. However, the court is not

convinced that dismantling its segregation policy would

add any significant costs to the department’s budget.

The ADOC has presented evidence that an increase in

transmissions within the prison would cost the department

a substantial amount of money because it would then have

to treat the infected prisoners’ HIV. However, the court

is not convinced that the transmission rate would rise

upon integration.

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111

The department also argued that the cost of providing

medical care at facilities other than Limestone would be

cripplingly high. The evidence showed, however, that

medical-training resources are available to the ADOC at

low cost or cost-free. Moreover, the options for

specialty care, which could range from telemedicine to

the specialist traveling to select facilities to

prisoners traveling to meet the specialist, present a

number of cost-effective options from which the ADOC may

choose. 

 The ADOC might even save costs by dismantling its

segregation policy. Indeed, Emmitt Sparkman, Deputy

Commissioner of the Mississippi Department of

Corrections, testified that ending the HIV-segregation

policy actually saved his department money on the whole.

He explained: “[W]henever you have a specialized

population it’s more costly, because they can only be

housed in one location.” This limits the department’s

flexibility in placing and moving prisoners. As an

example, Sparkman explained that, if a prison maintains

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35. Special measures (and, by basic inference,

additional resources) are required for prisoners in close

custody: they must be housed in a single cell, and, when

outside of the housing area, restrained and accompanied

by armed correctional personnel.

112

a housing unit with 50 beds in the HIV unit, but only 20

HIV-positive prisoners, the prison still must staff that

unit for 50 beds, which wastes resources. Sparkman’s

analysis can be easily applied to the ADOC. For

instance, while Limestone is not designed to house close

custody prisoners, it must do so within the Special Unit

because all HIV-positive prisoners are assigned there.35

Therefore, the court finds it likely that the expenses

that the ADOC incurs in changing its policy will be at

least somewhat offset by the money it saves by having a

more flexible system. In sum, then, the court does not

find that ending the HIV-segregation policy would be

prohibitively costly for the ADOC. Therefore, the

department’s cost-based fundamental alteration defense

must fail. 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 112 of 153
113

 The court concludes that the ADOC’s current policy of

categorically housing HIV-positive prisoners within

Limestone and Decatur Work Release violates the ADA. The

court need not decide now how far the ADOC must go to act

within the confines of the law, and this holding should

not be interpreted to mean that integrating HIV-positive

prisoners at every facility in the state is necessary nor

that integrating them at only one additional facility is

enough. It sufficient at this stage to find that the

current categorical policy violates the law. 

c. The HIV-Segregation Policy for Women at Tutwiler and

Montgomery Women's Facility

The court now turns to the female plaintiffs’ claims.

The female plaintiffs challenge the ADOC’s policy of

requiring all HIV-positive women to be housed in Dorm E

at Tutwiler, which precludes them from integrated housing

in the general-population dormitories, and also from

housing alongside HIV-negative prisoners in the infirmary

and mental-health unit. They also challenge the fact

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 113 of 153
36. The one patient who had not yet achieved it had

recently begun the medication, and so there had not been

enough time for her virus to become undetectable.

114

that they are eligible to be housed only at Montgomery

Women’s Facility when they participate in the workrelease program. The court will first address the

segregation policy at Tutwiler. 

While it is clear that some men at Limestone could be

provided integrated housing without posing a meaningful

risk, it is even more obvious that this is true for the

women at Tutwiler. The vast majority of women (four out

of five) within the ADOC who are taking antiretroviral

medication have acheived viral suppression, which

dramatically reduces the probability of transmission.36

In addition, the transmission risk among women is

significantly lower than it is among men because women

cannot transmit the virus through sexual activity. As

the court has already stated, there has never been a

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37. The department argued that transmission is

possible when women use sexual devices (“toys”) and

presented thin evidence that such devices have been used

at Tutwiler. However, even accepting this fact as true,

it is obvious that the chances of transmission through

sexual activity between women are significantly lower

than the chances of transmission through sexual activity

between men.

115

documented case of HIV that was sexually transmitted from

one woman to another.37

Further, as is the case with male prisoners, the

opportunities for high-risk behavior that already exist

have not yielded any transmissions. Women are integrated

in programs at Tutwiler and thus have the opportunity to

engage in high-risk behavior in places other than their

dorms. Sexual conduct with staff (including staff-onprisoner sexual assault) and travel between county jails

and work-release centers present further opportunities

for high-risk behavior. Nevertheless, the transmission

rate among female prisoners within the ADOC is at or

approaching zero. Moreover, there is no evidence that

the transmission rate is any higher in other prison

systems where female prisoners with HIV are integrated.

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 115 of 153
38. This incident occurred in 2007 before Tutwiler

had integrated its programs.

116

The evidence also casts doubt on the ADOC’s

characterization of its policy as a practical necessity

divorced from any discriminatory intent. The court

gained the impression that animus against HIV-positive

prisoners has emanated from the top at Tutwiler,

particularly from its warden, Frank Albright. Dana

Harley described Warden Albright’s reaction when, in

preparation for a legal challenge, she and the other

women in Dorm E began filing requests for access to

various programs from which they were excluded because of

their HIV-positive status.38 A week after they filed the

requests, Warden Albright “[s]tormed in” with a captain,

a lieutenant, and the entire classification team, and

said: “[T]he next request you write, write it to me so I

can deny it personally. Because when you file the

lawsuit, I want it to say ‘Albright’ with one ‘L.’ ...

Y’all will not walk my halls and spread HIV.” At trial,

Warden Albright demonstrated willful ignorance about HIV:

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 116 of 153
39. Disclosure of HIV-positive status is an

inevitable byproduct of segregation at Tutwiler just as

it is as Limestone. The HIV-positive women at Tutwiler

do not wear white armbands; however, because they are

housed together in the small facility, it is abundantly

clear who they are. Dana Harley echoed male prisoners’

feelings about forced disclosure: “It doesn’t bother me

for people to know my status if I choose to disclose it,”

she said, but she did not want “to be labeled in the HIV

dorm.”

117

he testified that he did not know, and did not need to

know, whether HIV can be transmitted through food

preparation. Harley also reported that correctional

officers at Tutwiler commonly refer to Dorm E as the

“AIDS dorm.”39 From the attitude exhibited by Albright

and his staff, it is plainly apparent that prejudice, at

least, infects the way that the HIV-segregation policy is

implemented. 

 The court’s impression of the atmosphere at Tutwiler

is powerfully informed by the court’s tour of the prison

during the trial. During the tour, part of Dorm E was

under construction, but this did not influence the court.

Only four HIV-positive women are currently housed in

Tutwiler, and, when the court visited, only three were

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118

present in Dorm E. The court struggles to convey the

depression in that room, so thick it felt possible to

reach out and touch it. While the other dorms in

Tutwiler were vibrant, Dorm E was nearly empty. Vacant

bunk beds lined the room, stripped of sheets and

mattresses. It resembled an isolation cell more than it

did a dorm. 

Balancing the relevant factors and weighing “the odds

that transmission will occur” against “the severity of

the consequences,” Onishea, 171 F.3d at 1297, it is

obvious that HIV-positive female prisoners in the custody

of the ADOC are not categorically unqualified for

integrated housing. Requiring the ADOC to modify its

procedures to make individualized determinations is at

least as reasonable for female prisoners as it is for

men. Given that there are usually hundreds of HIVpositive male prisoners and under ten HIV-positive female

prisoners in the ADOC’s custody at any given time, the

burden imposed on the ADOC in making individualized

determinations for female prisoners is far lighter.

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119

Further, the department’s cost-based defense is even

weaker in the context of Tutwiler than it is for men.

Indeed, it is almost certain that the department is in

fact wasting valuable resources by maintaining the

segregation policy: Dorm E at Tutwiler--a large space

filled with empty beds--is being used to house only a few

women. Therefore, requiring the ADOC to dismantle its

policy of segregating HIV-positive women would neither

impose “undue financial and administrative burdens” nor

require “a fundamental alteration in the nature of” ADOC

operations. Harris, 941 F.2d at 1572 n.48 (citations

omitted). 

The court now turns to the ADOC's practice of housing

HIV-positive women exclusively at Montgomery Women’s

Facility. The ADOC justifies this policy on the same

basis that it justifies housing HIV-positive men

exclusively at Decatur: Montgomery Women’s Facility is

close to Tutwiler, allowing women in the work-release

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40. HIV-positive women already reside in integrated

housing at Montgomery Women’s Facility, and the ADOC has

not suggested that there are any differences in the

transmission risks at its other work-release facility for

women. Therefore, the court easily concludes that no

concerns about transmission justify this policy. 

120

program access to the medical services at the prison.40

For the same reasons that this court concluded that the

ADOC can provide (at a minimum) basic HIV care for men in

at least one additional facility, the court finds that

the department can do so in this context as well. This

is particularly feasible since the ADOC operates only one

work-release facility for women other than Montgomery

Women’s Facility. Thus, for the same reasons expressed

above, ceasing to place women categorically at Montgomery

will not impose an undue burden on the State or cause it

to fundamentally alter its system of providing medical

care. 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 120 of 153
121

d. Food-Service Jobs

 The court now turns to two policies that impact both

male and female prisoners: the exclusion of HIV-positive

prisoners from kitchen jobs within Limestone and Tutwiler

and from holding food-service jobs in the work-release

program. The ADOC committed to changing these policies

at the end of trial and no longer attempts to defend

them. Although the ADOC argues that the issues are moot,

the court, for reasons already given, disagrees. See

Nat'l Ass'n of Bds. of Pharmacy, 633 F.3d at 1309. 

The challenged policies are obviously irrational. As

both parties agreed, the science is unanimous: there is

no risk of HIV spreading through food. Therefore, there

is no plausible argument (and the ADOC did not attempt to

make one) that barring HIV-positive prisoners from foodservice jobs within the prisons and at work release

prevents the transmission of HIV. However, before the

ADOC conceded these issues at the end of trial, it first

attempted to put forth other justifications. For one,

the ADOC argued that, if it allowed HIV-positive

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 121 of 153
41. The ADOC also argued that a primary motivation

for excluding HIV-positive prisoners from food-service

jobs within prisons is the threat that HIV-negative

prisoners would react with violence. The ADOC used this

justification for several of its policies and presented

evidence about this risk generally, rather than how this

risk would manifest with regard to specific policy

changes. The court addresses this argument later in this

opinion. 

122

prisoners to take food-service jobs on work release,

employers may withdraw from the program because of their

own anti-HIV prejudices. The ADOC wisely no longer

contends that accommodating assumed prejudice is a

legitimate justification for discriminating against the

plaintiffs in this way.41 

Moreover, despite the ADOC’s insistence that concern

about transmission risk played no role in the foodservice policy, the evidence suggests that many ADOC

staff members are unaware that HIV cannot be transmitted

through food preparation and that staff members acted on

their misconceptions. Plaintiff Knox testified that,

after he ate with the general-population prisoners that

were in SAP with him, prison officials disciplined him

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 122 of 153
123

for creating a health hazard and searched for the

utensils and plates that he had used to eat his meal

(presumably fearing that they were contaminated).

Further, as the court has already noted, the warden of

Tutwiler did not know that HIV could not be transmitted

through food. Therefore, despite the ADOC’s

protestations that its food-service policy is not based

on transmission risk, it is evident that false beliefs

about this risk, at the very least, have impacted the way

that this policy is implemented. 

 At this stage, the ADOC puts forth no further

justifications for this policy, and the court will not

search for one. Because the challenged policies

irrationally exclude the plaintiffs from programs to

which they are unquestionably qualified, those policies

violate the plaintiffs’ rights under the ADA. 

But, most importantly, the ADOC's adherence to its

food-service policy throughout most of this litigation,

(including the trial), its relucance to reexamine its

policy, and its seemingly deliberate indifference to the

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 123 of 153
124

unfounded prejudice that the policy reinforced, buttress

this court’s earlier conclusions that the ADOC's

arguments in support of its overall segregation policy

are based in large measure on a failure to reexamine that

policy in more detail in light of what other States have

done and in light of the resources that are available in

this State. 

2. Work Release

In addition to the integration mandate, the ADA

prohibits the unnecessary exclusion of disabled

individuals. The implementing regulations to the ADA

state: 

“A public entity shall not impose or

apply eligibility criteria that screen

out or tend to screen out an individual

with a disability or any class of

individuals with disabilities from fully

and equally enjoying any service,

program, or activity, unless such

criteria can be shown to be necessary

for the provision of the service,

program, or activity being offered.”

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 124 of 153
125

28 C.F.R. § 35.130(b)(8) (emphasis added).

“[L]egitimate safety requirements” may be imposed, but

only when they are “necessary for safe operation” and

“based on actual risks and not mere speculation,

stereotypes, or generalizations about individuals with

disabilities.” 28 C.F.R. § 36.301(b). 

The plaintiffs argue that the work-release criteria

that the ADOC imposes on HIV-positive prisoners

constitute unnecessary eligibility criteria and therefore

violate the ADA. It is evident that the eligibility

criteria at issue tend to screen out individuals with

HIV. Indeed, screening out at least some individuals

with the virus is precisely what the criteria were

designed to do. Of course, because the ADA’s protections

extend to only qualified individuals with disabilities,

the plaintiffs must also show that at least some of the

class members on whom the criteria were imposed are

otherwise qualified for work release. This, however, is

easily satisfied: the work-release criteria are imposed

upon (and therefore burden and diminish the chances of

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42. The plaintiffs also provide specific examples of

how the criteria have in fact screened out individuals

who are qualified. For instance, James Douglas was

denied medical clearance because of a “blip” that showed

a viral load measurement over the required threshold,

even though viral load returned to undetectable levels

after the blip. The ADOC argues that Douglas was denied

participation in work release because of his history of

escapes; however, this does nothing to change the fact

that eligibility criteria were imposed on him with regard

to his viral load despite the fact that they were

unnecessary. Moreover, plaintiffs who have not achieved

viral suppression but have consistently abstained from

any high-risk behavior may be qualified for work release;

the criteria categorically disallow any such individuals

to participate.

126

participation for) all HIV-positive prisoners who are

considered for work release. This includes those

prisoners who ultimately satisfy the work-release

criteria and are admitted into the work-release program

and therefore obviously are qualified for participation.42

However, under the current criteria, even these

individuals have a lower chance of being admitted and are

subjected to standards that prisoners who do not have HIV

are not. 

The ADOC therefore bears the heavy burden of showing

that the criteria are necessary. See Guckenberger v.

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127

Boston University, 974 F. Supp. 106, 139 (D. Mass. 1997)

(Saris, J.) (“[The defendant’s] burden is a heavy one

because it must show that the more stringent eligiblity

criterion is ‘necessary’ to achieve [the defendant’s]

goal.”). 

At trial, however, the ADOC sought to justify these

criteria under an incorrect standard. By the

department’s account, the standard for evaluating the

work-release criteria is the one the Supreme Court

identified in Turner v. Safely, 482 U.S. 78 (1987), in

which the Court held that, “when a prison regulation

impinges on inmates’ constitutional rights, the

regulation is valid if it is reasonably related to

legitimate penological interests.” Id. at 89. The ADOC

argues that the Turner doctrine applies to statutory

rights (including those afforded by the ADA) as well as

constitutional rights, and cites Onishea for support.

Thus, under Turner, the ADOC argues, the work-release

criteria must merely satisfy a “reasonableness” test.

Defs.' Br. (Doc. No. 247) at 7. 

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 127 of 153
43. While the Eleventh Circuit in Onishea noted that

penological interests are relevant in determining whether

the plaintiffs meet the essential eligibility criteria of

a program, the potential relevance of such concerns does

not, of course, absolve the ADOC of the obligation to

meet its burden under the ADA.

128

But Onishea rendered no such holding. Indeed, the

court explained that Turner “does not, by its terms,

apply to statutory rights.” Onishea, 171 F.3d at 1300;

see also Pope v. Hightower, 101 F.3d 1382, 1384 (11th

Cir. 1996) (referencing the Turner doctrine as balancing

judicial restraint against “the need to protect

constitutional rights”) (emphasis added); Al-Amin v.

Smith, 511 F.3d 1317, 1327 (11th Cir. 2008) (“Turner ...

adopted a ... test for determining whether prison

practices impermissibly burden inmates’ constitutional

rights”) (emphasis added).43 

Because the ADOC has applied the wrong standard, it

has neither argued nor presented evidence that the workrelease criteria are necessary. Therefore, the court has

not been adequately informed by the department, and must

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44. The ADOC argues that “a plaintiff cannot maintain

an ADA claim if the alleged exclusion does not pertain to

or involve a service program, or activity.” Defs.’

Pretrial Br. (Doc. No. 211) at 32 (quotations and

citations omitted). However, as the Eleventh Circuit’s

decision in Bledsoe, supra, reveals, the department is

incorrect. The department nevertheless runs with its

interpretation, citing, first, a Ninth Circuit case that,

by its terms, expressly disagreed with the Eleventh

Circuit’s opinion in Bledsoe, and, second, the district

court's decision in Bledsoe that was reversed on appeal.

See Defs.’ Pretrial Br. (Doc. No. 211) at 32-33 (relying

on Zimmerman v. Or. Dep’t of Justice, 170 F.3d 1169 (9th

Cir. 1999) and Bledsoe v. Palm Beach Soil and Water

Conservation Dist., 942 F. Supp. 1439 (S.D. Fla. 1996)).

As these arguments contradict Eleventh Circuit law, the

court easily dispenses with them. 

129

therefore reserve its decision on this issue to be

addressed at a later time. 

3. The White-Armband Policy

The ADA's prohibition on discrimination is not

limited to exclusion from “programs, services, or

activities.” Bledsoe, 133 F.3d at 821-22. Rather, the

ADA "prohibits all discrimination by a public entity,

regardless of the context.” Id. (emphasis added;

citation omitted).44

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130

The ADOC’s policy of requiring male HIV-positive

prisoners to wear white armbands implicates this broad

prohibition against discrimination. At trial, the ADOC

insisted that the sole purpose of the armbands policy at

Limestone is to allow correctional officers to identify

easily whether a prisoner is in a dormitory other than

the one to which he is assigned (which would implicate

legitimate safety concerns). That justification is not

credible. Cf. United States v. Virginia, 518 U.S. 515,

533 (1996) (“The justification must be genuine, not

hypothesized or invented post hoc in response to

litigation.”). Throughout Limestone, each dormitory has

its own assigned colored armbands. The sole exception is

that the two Special Unit dormitories are both assigned

white armbands. As a correctional officer frankly told

the court during its site visit, Limestone staff have no

way of knowing whether a prisoner assigned to Dorm B is

impermissibly present in Dorm C when he should not be,

and vice versa. The department’s justification for the

armband policy presents no evidence of its neutrality.

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 130 of 153
45. During the site visit of Limestone, the court

took notice that, in the HIV-negative areas of the

prison, large numbers of prisoners were not wearing any

armband at all. Prison officials explained that the HIVnegative prisoners are frequently moved from one dorm to

another and there is a time lag between the move and the

officials’ ability to obtain a new armband. This

substantial failure in effectiveness of the use of

armbands among HIV-negative prisoners would seem to

support the plaintiffs’ contention that armband use was

later expanded to HIV-negative prisoners as a cover for

the initial discriminatory purpose behind their use for

HIV-positive prisoners. See supra n.10. Regardless, the

court need not rely on this contention.

131

The justification (dorm identification) is pretextual,

for the white armbands do not identify which dorm (B or

C) a prisoner is from but rather identifies the prisoner

as HIV-positive.45 The policy, therefore, tellingly

portrays the ADOC’s willingness to discriminate against

HIV-positive prisoners and then dress naked

discrimination in the guise of neutral policy. Here, the

emperor has no clothes. The purpose of the white

armbands has been to identify the HIV-positive prisoners.

Indeed, when combined with the presence of the

Special Unit itself, the armbands make disclosure of the

prisoners’ HIV status all but inevitable. As Dr. Altice

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 131 of 153
46. Plaintiff Henderson testified, “I am comfortable

with who I am and what I’m dealing with. HIV doesn’t

define me .... But I still should have that right to be

able to disclose this to whoever I want to disclose it

to.” Plaintiff Knox said: “I think that should be our

choice and our choice alone who we should disclose [our

HIV status] to.”

132

explained: “If you have an HIV unit within your facility,

there just aren’t any secrets.... The notion that every

time you may be walking out into a yard or with visitors

walking by, that somebody may recognize ... that you’re

the person who’s wearing the white arm band,” amounts to

a constant outing of the prisoners’ HIV-positive status.

And, regardless of whether or not a person which HIV

wishes to disclose his status, voluntary dislosure is

different from forced disclosure.46

The white armbands are also profoundly stigmatizing.

Plaintiff Henderson said: “I feel like it’s a tag....

Just like you put a tag on cattles .... It’s branding

me. Everywhere I go ... it sticks out.” Henderson

communicated the cumulative effect of the ADOC’s

treatment of HIV-positive prisoners, from their

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133

segregation in the Special Unit to the requirement that

they wear white armbands: 

“In Limestone it’s like no matter what

you do, you just there .... It’s like

... putting a bunch of fishes in an

aquarium. And that’s it. They’re just

in this aquarium, just swimming around

in this aquarium 24/7, all day long, all

night, all year.... And ... to be

placed in this aquarium and have

individuals outside of this aquarium to

pass by ... it’s like a zoo ... or a

circus ... where people just pass by and

... look at you like you some kind of

exotic animal .... When the tours came,

it was like I was placed in that

aquarium, and these people came to the

museum to see exotic fishes. And the

guide ... would point their finger

inside the aquarium at the fishes....

[O]ne time ... I was outside working out

... and a tour came through with some

young kids .... And they couldn’t tell

whether or not I was HIV positive ...

[b]ecause I had a long sleeve shirt

[which hid the white armband]. They

stopped, and [the guard giving the tour]

was pointing towards the dorm, and he

told the tour, the kids, that this is

where we house our HIV/AIDS patients....

And they was like ... amazed, like they

was looking at some exotic stuff.... I

want to say something real bad, because

it touched me.... I am one of these

people that he’s talking about with this

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47. Henderson’s account recalls Frantz Fanon in his

essay, “The Fact of Blackness”: “I found that I was an

object in the midst of other objects.... [T]he

movements, the attitudes, the glances of the other fixed

me there, in the sense in which a chemical solution is

fixed by a dye.” Frantz Fanon, Black Skin, White Masks

109 (Charles Lam Markmann trans., Grove Press 1967)

(1952).

134

virus, you know, and it hurts. It

really did. It hurt[].”47

 Requiring all HIV-positive prisoners to wear white

armbands that disclose their HIV status does not serve a

legitimate purpose. This policy constitutes unlawful,

and, indeed, intentional, discrimination under the ADA.

Bledsoe, 133 F.3d at 821-22.

4. Penological Concerns

 The ADOC contends that, even if the plaintiffs show

a violation of the ADA, the department will face no

liability if it justifies its segregation policies on the

basis of legitimate penological concerns. The department

relies on the Supreme Court's holding in Turner v. Safley

that a regulation that impinges on constitutional rights

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135

is valid so long as it is “reasonably related to

legitimate penological interests.” 483 U.S. at 89.

However, as this court has already explained, Turner does

not apply to statutory rights. See Onishea, 171 F.3d at

1300 (noting that Turner “does not, by its terms, apply

to statutory rights”). 

This does not mean that the factors identified in

Turner have no relevance. In Onishea, the Eleventh

Circuit found that the lower court’s consideration of

Turner factors did not warrant vacatur, reasoning that it

“seems obvious ... that the requirements for

participation in prison programs are determined in part

by the same ‘legitimate penological interests’ that

Turner respects in the [constitutional rights] context.”

Onishea, 171 F.3d at 1300. Thus, because of the

substantial overlap between factors that must be

considered in both Turner analysis and ADA analysis, “the

district court could properly use factors such as

Turner's to determine whether the plaintiffs were

Case 2:11-cv-00224-MHT-WC Document 249 Filed 12/21/12 Page 135 of 153
48. In Pa. Dep't of Corr. v. Yeskey, 524 U.S. 206

(1998), the first Supreme Court case to affirm the ADA’s

application to state prisons, the Court provided entirely

no indication that Turner would apply (nor did the Court

cite Turner a single time), and that case was decided

eleven years after Turner. Additionally, the Religious

Land Use and Institutionalized Persons Act (RLUIPA)

provides a useful analogy for illustrating Turner's

application to constitutional rights only. Congress

enacted that statute to afford a greater right of

religious freedom to prisoners than is provided by the

Constitution. See Cutter v. Wilkinson, 544 U.S. 709,

714-15 (2005) (describing RLUIPA). Eighteen years after

the Turner decision, in Cutter v. Wilkinson, the Supreme

Court upheld RLUIPA’s validity. Id. at 719-20. If the

ADOC were correct that any state prison practice that

impinges statutory rights created by Congress is

nevertheless valid if merely reasonably related to

legitimate penological interests, the Court’s upholding

of RLUIPA’s heightened strict-scrutiny standard for

impignments on religious rights is difficult to square.

See Van Wyhe v. Reisch, 581 F.3d 639, 651 (8th Cir. 2009)

(rejecting the prison officials’ “argu[ment] that RLUIPA

violates the doctrine of the separation of powers because

the statute improperly overturns the more deferential

constitutional standard set forth by [Turner]”).

136

otherwise qualified to participate in the programs.” Id.

at 1301.

Neither Turner nor Onishea require this court to

treat penological interests as a trump on the plaintiffs’

statutory rights as the ADOC contends it must.48 But even

when the court gives full consideration to the ADOC’s

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137

purported penological justifications, the department

still cannot prevail. For example, the ADOC argues that

it has a “‘legitimate penological interest[]’ ... [in]

curtail[ing] the spread of HIV to the general population

inmates.” Defs.’ Pretrial Br. (Doc. No. 211) at 55.

That is undoubtedly true, but, as the court has

discussed, it is also true that the ADOC can in fact

effectuate the plaintiffs’ rights under the ADA while

simultaneously preventing HIV transmissions. Cost is

also a legitimate concern. See Onishea, 171 F.3d at

1300. However, the court has already found that none of

the accommodations necessary to dismantle the challenged

policies would be unreasonably costly. 

The ADOC also argues that its policies are supported

by its penological interests in safety and security

within the prison. Security is indeed a valid

penological concern, and, pursuant to the Eleventh

Circuit’s analysis in Onishea, it can go to whether an

individual is otherwise qualified under the ADA. Id.

(“Security is [a] legitimate interest.”). The department

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138

posits that dismantling the segregation policy in housing

and in food services would result in violence, placing

prisoners and correctional staff at risk. 

To support this claim, the department principally

relies on a survey conducted by Drs. Brent Maulden and

Jerry Ingram. The two administered their survey in July

2012 to 1,186 prisoners at different correctional

institutions throughout Alabama.

Among other results, the survey found that 52.2 % of

prisoners believe that acts of violence such as threats,

stabbings, and beatings will occur if HIV-positive

prisoners are integrated into the general population. In

addition, 39 % expressed agreement with the statement, “I

would use force to keep an inmate with HIV away from me.”

Other results suggest widespread discomfort born of

misinformation. For instance, 62.4 % of prisoners would

be concerned about transmission if HIV-positive inmates

prepared their food, and 38.5 % answered that it would

bother them if an HIV-positive prisoner worked in the

laundry and washed their clothes and bedsheets. 

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139

Drs. Maulden and Ingram also conducted a survey of

correctional officers, surveying 155 officers

representing 42 institutions in the ADOC. That survey’s

results suggest, above all, that many members of the ADOC

correctional staff lack basic understanding of HIV and

seem to harbor severe prejudice against those who have

it. Troublingly, 44.4 % responded that they would be

less likely to stop acts of violence in the prison if

prisoners with HIV were involved. 

The plaintiffs’ expert on polling, Dr. Faye Taxman,

found numerous faults with the survey. Among them were

that Drs. Maulden and Ingram did not follow basic

protocols for conducting research on human subjects, that

their sampling strategy was inadequate to guarantee a

representative sample, and that the questions in the

survey were too convoluted to merit confidence in the

accuracy of the responses. 

Further, Dr. Ingram conducted a nearly identical

survey in 1989 when HIV-positive prisoners challenged the

ADOC's policy. That survey predicted that violence would

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49. Dr. Ingram later corrected himself and said that

he meant to say that homosexual acts are high-risk, not

homosexual orientation. Dr. Ingram's deposition

transcript shows that when asked how he would respond to

the statement, “I would use force to keep a homosexual

away from me,” he stated, “I would.” According to the

transcript, Dr. Ingram answered the question this way in

two separate instances. At trial, Dr. Ingram said that

the transcript of the deposition was incorrect in both

places where this answer was shown, and that it should

have shown that his response was: “I would not.” The

court finds both Dr. Ingram's claim that the transcript

was incorrect and his post-hoc corrections of his

statements disingenuous. It was evident from both his

testimony and his demeanor in editing his own words that

Dr. Ingram harbors prejudice against homosexual people.

140

occur if programs were integrated: it did not. This

result casts doubt on Dr. Ingram's similar predictions in

this case.

However, the greatest damage to the credibility of

the survey was done by Dr. Ingram himself at trial. Dr.

Ingram testified, for example, that he included questions

about the prisoners’ attitudes about homosexuality

because, “Homosexuality is a high-risk behavior.”49

Dr. Ingram is incorrect to equate sexual orientation to

unprotected sexual activity, and his error exemplifies a

mutually reinforcing relationship between prejudice

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141

against HIV and homophobia. The court was disturbed by

his attitudes. More pertinently, because much of the

survey assessed attitudes about homosexuality, the court

is concerned that the study was tainted by Dr. Ingram's

own biases. Therefore, while the court considers the

results of the survey, it lends them only limited

credence. 

Even if the study were an exemplar of professional

integrity (and it is not), its results do not show that

violence would necessarily result if the ADOC changed its

policy. This conclusion can only be drawn when the

study’s results are coupled with the fatalistic

assumption that potential backlash cannot be prevented.

The evidence, however, reveals that this is not the

case. There was not significant unrest, for instance,

when the ADOC integrated HIV-positive prisoners into

various programs and activities, although department

officials, including Associate Commissioner DeLoach,

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50. Based largely on Dr. Ingram's survey, ADOC argued

that violent backlash would result from program

inegration in Onishea, interpreting the evidence to show

“that residential and program integration would be

equally objectionable to certain inmates.” Onishea, 171

F.3d at 1300. 

142

feared that violence would occur.50 Deputy Commissioner

Emmitt Sparkman attests to a similar result when the

Mississippi Department of Corrections integrated its HIVpositive prisoners in 2010: though violence was

anticipated, none, in fact, took place. Sparkman credits

this success to a robust education effort that the

Mississippi Department of Corrections conducted in

anticipation of integration. And indeed, since the

results of the prisoners’ survey revealed widespread

misinformation about how HIV is spread, it it imminently

possible that education would both dispel these

assumptions and reduce the fear (and the potential

violent backlash) that accompany them. 

The ADOC has an equally scant basis for assuming that

correctional officers could not be educated to better

address potential unrest. Moreover, the ADOC has a

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143

responsibility to ensure that its officers are informed

and would treat all prisoners equally. Therefore, if

correctional officers really would hesitate to break up

fights involving HIV-positive prisoners, then the

appropriate response is certainly not to accommodate it.

Indeed, rather than justifying the ADOC’s policy, the

correctional officers’ responses to the survey instead

provide strong evidence that prejudice against prisoners

who have HIV is prevalent within the department. And as

a general matter, the department’s arguments about the

results of the survey (which suggested that bias,

misinformation, and homophobia are persistent problems

within the ADOC) demonstrate the ADOC’s willingness to

defer to prejudiced viewpoints rather than correct them.

Associate Commissioner DeLoach’s testimony on the

potential threat of violence exemplifies this approach:

“DELOACH: Inmates still have this

mindset that HIV-positive offenders-–in

large part, they equate that to

homosexual activity. 

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144

“THE COURT: So the real animating trait

here is really not the HIV-positive

quality, but the gay quality.

“DELOACH: Yes, sir.”

Associate Commissioner DeLoach testified that this

impacted his assessment of whether HIV-positive inmates

could be safely housed in cells with prisoners who do not

have HIV. Thus, DeLoach demonstrated a willingness to

allow homophobia to drive the department’s policy with

regard to HIV-positive prisoners. 

Despite this, however, Associate Commissioner DeLoach

largely testified directly against the ADOC’s position on

security justifications for its policy. According to

DeLoach, today, there is no security reason that HIVpositive prisoners could not share open bay dormitories

with general-population prisoners at Limestone. He

testified that he now has no concerns about integrating

HIV-positive prisoners at Tutwiler. He is also concerned

about integration at facilities other than Limestone, but

believed that an incremental process accompanied by

education could allow the department to integrate

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145

successfully at those facilities as well. Integration

could be achieved, he said, as long as the process is

“slow and gradual.” That the very man responsible for

implementing the segregation policy (and a person who has

not shied away from accommodating prejudice) finds no

security justification today for maintaining it

discredits deeply the department’s insistence that its

approach is essential to the safety and good operation of

the prison system. DeLoach’s last-minute concessions

also deepen the court’s impression that the ADOC’s policy

has stood on stale assumptions. 

In sum, the ADOC has not demonstrated that intgrating

the plaintiffs in housing or including them in foodservice jobs would create a serious threat of disorder;

the court’s conclusion that the plaintiffs are not

categorically unqualified therefore remains in tact.

Even if the court were to apply Turner formally, it would

not find the ADOC’s current segregation policies

justified. To the extent that violence is a credible

concern, the “existence of ... ready alternative[s]”,

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146

such as education, renders segregation precisely the sort

of “‘exaggerated response’ to prison concerns” that the

Turner doctrine is not intended to shield. Turner, 482

U.S. at 90.

C. Res Judicata

The court now turns to a defense asserted by the ADOC

at early stages of this litigation. The court set this

issue aside for further factual development at trial.

See Henderson v. Thomas, ____ F. Supp. 2d ____, 2012 WL

3846439, at *6 (M.D. Ala. 2012) (Thompson, J.). The ADOC

contends that the plaintiffs’ claims under the ADA are

identical to those adjudicated in Onishea and Edwards,

and are thus precluded from relitigation in this case

under the doctrine of res judicata.

Res judicata bars a subsequent action where four

elements are satisfied: “(1) a final judgment on the

merits, (2) rendered by a court of competent

jurisdiction, (3) the parties, or those in privity with

them, must be identical in both suits, and (4) the same

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147

cause of action must be involved in both cases.” Hart v.

Yamaha-Parts Distribs., Inc., 787 F.2d 1468, 1470 (11th

Cir. 1986) (citations omitted). The plaintiffs concede

that the first three elements are met. However, they

contend that the fourth element is not satisfied because

the underlying facts have changed.

 In determining whether two causes of action are

identical for the purposes of res judicata, the court

must consider “not only whether the same legal claim is

asserted, but also whether the factual underpinnings of

the causes of action are constant.” Edwards, 81 F. Supp.

2d at 1249. Thus, “in determining whether to apply res

judicata, [the court] must look to the factual issues to

be resolved in the second cause of action, and compare

them with the issues explored in the first cause of

action. If there has been a modification of significant

facts creating new legal conditions, res judicata is no

defense.” Southeast Fla. Cable, Inc. v. Martin County,

173 F.3d 1332, 1336 (11th Cir. 1999) (punctuation marks

and citations omitted). 

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51. The district court in the Onishea litigation

“concluded that the transmission risk [was] significant

in all programs.” Onishea, 171 F.3d at 1295. 

148

 Here, the plaintiffs argue that the “central factual

premise of the Onishea decision--that HIV infection

inevitably progresses to AIDS and then to death-–is no

longer true.” Pls.’ Br. (Doc. No. 37) at 3. As the

court has already concluded, that is correct. HIV is no

longer inevitably fatal. Because the Onishea court’s

holding hinged on this fact, Onishea cannot preclude the

plaintiffs from litigating the case at issue here. 

 In addition, the ADOC has significantly changed its

policy with regard to HIV-positive prisoners since

Onishea was litigated. These changes include abandoning

policies that the ADOC argued in Onishea were necessary

to protect the safety of all prisoners within the

system.51 Therefore, the ADOC’s own actions are poweful

evidence that circumstances since Onishea have

significantly changed. 

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149

 It is clear, then, that the factual underpinnings of

this action are different from those in Onishea. In

Edwards, this court dismissed the lawsuit as an attempted

relitigation of the Onishea claims; thus, if this case is

not precluded because of Onishea, nor is it precluded

because of Edwards. Res judicata is therefore no bar to

this suit. 

III. RELIEF

 Having decided the ADOC’s liability, the court now

turns to the issue of appropriate relief. The Prison

Litigation Reform Act requires that the relief imposed

be “narrowly drawn, extend[] no further than necessary

..., and [be] the least intrusive means necessary to

correct the violation of the Federal right[s].” Brown,

131 S. Ct. at 1929 (quoting 18 U.S.C. § 3626(a)(1)(A)).

At the end of the trial in this case, the court promised

that, should it find in favor of the plaintiffs on

liability, it would afford the defendants an opportunity

to propose appropriate relief to the court and that this

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opportunity would include time for both sides to meet and

attempt to agree upon relief. The court will keep its

promise. Cf. Davoll v. Webb, 194 F.3d 1116, 1132 n.8

(10th Cir. 1999) (“The federal regulations implementing

[Title I of] the ADA envision an interactive process that

requires participation by both parties.... Both parties

thus have an obligation to interact in good faith to

determine how to reasonably accommodate the employee.”)

(quotation marks and citations omitted).

***

In conclusion, the court holds that, except as to the

work-release policy, the ADOC's HIV-segregation policy

violates the ADA. In reaching this holding, the court

will emphasize three points.

First, the court finds that the segregation policy is

based on outdated and unsupported assumptions about HIV

and the prison system's ability to deal with HIV-positive

prisoners. The policy is also infected, and the reasons

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the ADOC has proffered for its continued existence

undermined, by an intentional bias against HIV-positive

people, as reflected in a bias from those in charge (for

example, with the white-armband policy) and in a systemwide tolerance for a culture of bias, rooted in large

measure in ignorance about HIV, from among not only

prisoners but employees in general (for example, with the

food-service policy and the fear that guards will not

protect HIV-positive prisoners). More specifically, in

response to the question of why the ADOC continued to

exclude HIV-positive prisoners from food-service jobs in

the prison kitchens and in the work-release program when

it was clear that HIV was not transmitted by handling

food and when there had been no complaints from employers

about HIV-positive prisoners having food-service jobs,

Associate Commissioner DeLoach responded: “[W]e live in

Alabama, and there are a lot of prejudices.... [I]t

doesn’t sound nice. It doesn’t sound ... chic....

Prejudices ... die hard in Alabama.” Therefore, any

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remedy the defendants might propose to the court must be

based not only on a willingness to revisit assumptions

and to look to all reasonably available and untapped

resources; and must not only be uninfected by bias

against those with HIV, but it must also address the lack

of education and ignorance among both prisoners and

prison employees about HIV. "We live in Alabama" is not

an excuse.

Second, the court cannot overemphasize that it is not

holding that all HIV-positive prisoners are entitled to

be co-mingled with HIV-negative prisoners; indeed, the

court is not even holding that any particular HIVpositive prisoner is entitled to such. Rather, the court

is simply holding that how prisoners should be treated

based on their HIV-positive status must depend upon an

individual-by-individual assessment of these prisoners

that honors each prisoner's rights under the ADA, and the

court is convinced that resources are reasonably

available to do this. The essential thrust of this

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court's opinion today is simply that the ADOC must look

at each HIV-positive prisoner separately and individually

based upon that prisoner’s particular circumstances.

 Third and finally, the court will address later and

by a separate order how the parties are to proceed as to

the unresolved challenge to the ADOC's work-release

policy. 

An appropriate judgment will be entered.

DONE, this the 21st day of December, 2012.

 /s/ Myron H. Thompson 

UNITED STATES DISTRICT JUDGE

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