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[House Report 110-342]
[From the U.S. Government Publishing Office]

110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    110-342

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                    STOP AIDS IN PRISON ACT OF 2007

                                _______
                                

 September 24, 2007.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Conyers, from the Committee on the Judiciary, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1943]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on the Judiciary, to whom was referred the bill 
(H.R. 1943) to provide for an effective HIV/AIDS program in 
Federal prisons, having considered the same, reports favorably 
thereon without amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for the Legislation..........................     2
Hearings.........................................................     2
Committee Consideration..........................................     2
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
New Budget Authority and Tax Expenditures........................     3
Congressional Budget Office Cost Estimate........................     3
Performance Goals and Objectives.................................     5
Constitutional Authority Statement...............................     6
Advisory on Earmarks.............................................     6
Section-by-Section Analysis......................................     6
Changes in Existing Law Made by the Bill, as Reported............     7

                          Purpose and Summary

    H.R. 1943 directs the Bureau of Prisons (BOP) to develop a 
comprehensive policy to provide HIV testing, treatment, and 
prevention for inmates during incarceration in Federal prisons 
and immediately before reentry into the community, while 
protecting confidentiality of prisoners and allowing them to 
refuse routine HIV testing.

                Background and Need for the Legislation

    HIV/AIDS in prison poses a threat not only to prison 
inmates and prison employees, but ultimately to the community 
at large. Prisoners who are unaware of their condition or who 
do not know how to keep others safe from the infection can 
unwittingly infect fellow prisoners. Prison workers, including 
corrections officers, healthcare workers, and administrators, 
are also at risk from exposure incidents resulting from close 
interaction with the prison population. The threat to the 
community at large comes from infected prisoners being released 
without having had the proper screening, education, and 
treatment, thereby exposing friends and loved ones to the 
disease.
    The Stop AIDS in Prison Act would require initial testing 
and counseling of inmates upon entry into the prison system, 
and then make ongoing testing available up to once a year upon 
the request of the inmate, or sooner if an inmate is exposed to 
the HIV/AIDS virus or becomes pregnant. The bill requires that 
the BOP make HIV/AIDS counseling and treatment available to 
prisoners, and give testing and treatment referrals to 
prisoners prior to their reentering the outside community.
    The bill may have a particularly beneficial effect on 
minority communities. According to the Centers for Disease 
Control and Prevention, racial minorities comprise 69% of all 
new HIV/AIDS cases in the nation. Since African Americans are 
disproportionately represented in the inmate population--41 
percent of all inmates in the prison system at the end of 2004, 
according to the Bureau of Justice Statistics--the risks 
associated with contracting HIV/AIDS in prison are one factor 
putting minority communities at higher risk of exposure. The 
Stop AIDS in Prison Act is therefore one way to begin reversing 
the high incidence of HIV/AIDS in minority communities.

                                Hearings

    The Committee's Subcommittee on Crime, Terrorism, and 
Homeland Security held 1 day of hearings on May 22, 2007. 
Testimony was received and heard from Mr. Devon Brown, Director 
of the Department of Corrections for the District of Columbia; 
Mr. Vincent Jones, Executive Director of the Center for Health 
Justice in West Hollywood California; Mr. Philip Fornaci, 
Director of the D.C. Prisoner's Project for the Washington 
Lawyer's Committee for Civil Rights and Urban Affairs; RADM 
Newton E. Kendig, M.D. the Assistant Director of the Health 
Services Division for the Federal Bureau of Prisons; and Mr. 
Willie Mitchell, Chairman of the Board for San Antonio Fighting 
Back.

                        Committee Consideration

    On July 24, 2007, the Subcommittee on Crime, Terrorism and 
Homeland Security met in open session and ordered the bill 
H.R.1943 favorably reported by voice vote without amendment, a 
quorum being present. On July 25, 2007, the Committee met in 
open session and ordered the bill H.R. 1943 favorably reported 
without amendment by voice vote, a quorum being present.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that there 
were no recorded votes during the Committee's consideration of 
H.R. 1943

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of rule XIII of the Rules of the House of 
Representatives is inapplicable because this legislation does 
not provide new budgetary authority or increased tax 
expenditures.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill, H.R. 1943, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                 Washington, DC, September 7, 2007.
Hon. John Conyers, Jr., Chairman,
Committee on the Judiciary,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1943, the Stop 
AIDS in Prison Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Leigh Angres, 
who can be reached at 226-2860.
            Sincerely,
                                           Peter R. Orszag,
                                                  Director.

Enclosure

cc:
        Honorable Lamar S. Smith.
        Ranking Member
H.R. 1943--Stop AIDS in Prison Act of 2007.

                                SUMMARY

    H.R. 1943 would amend current law to require the Bureau of 
Prisons (BOP) to test all incoming and outgoing inmates for the 
human immunodeficiency virus (HIV). The legislation would offer 
an opt-out provision to most inmates. Presently, BOP performs 
HIV testing on those inmates who are sentenced to six months or 
more in prison if they are determined to be at risk for HIV. 
CBO estimates that implementing H.R. 1943 would cost about $3 
million in fiscal year 2008 and $12 million over the 2008-2012 
period, assuming appropriation of the necessary funds. Enacting 
H.R. 1943 would not affect direct spending or revenues.
    H.R. 1943 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on State, local, or tribal 
governments.

                ESTIMATED COST TO THE FEDERAL GOVERNMENT

    The estimated budgetary impact of H.R. 1943 is shown in the 
following table. The costs of this legislation fall within 
budget function 750 (administration of justice).

                 By Fiscal Year, in Millions of Dollars
------------------------------------------------------------------------
                                        2008   2009   2010   2011   2012
------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
HIV Testing and Services for BOP
 Inmates
  Estimated Authorization Level            3      2      2      2      2
  Estimated Outlays                        3      2      2      2      2

Reporting Requirements
  Estimated Authorization Level            *      1      *      *      *
  Estimated Outlays                        *      1      *      *      *

  Total Changes
    Estimated Authorization Level          3      3      2      2      2
    Estimated Outlays                      3      3      2      2      2
------------------------------------------------------------------------
Note: HIV = Human Immunodeficiency Virus; BOP = Bureau of Prisons; * =
  less than $500,000.

                           BASIS OF ESTIMATE

    For this estimate, CBO assumes that H.R. 1943 will be 
enacted near the start of fiscal year 2008 and that the amounts 
estimated to be necessary will be appropriated for each fiscal 
year.
Current HIV Testing Procedures in Bureau of Prisons' Facilities
    Under current law, BOP performs HIV testing on those 
inmates sentenced to six months or more in prison who are 
determined to be at risk for HIV--about 25,000 tests a year. 
Inmates can also request an HIV test once a year or when an 
inmate believes that he or she has been exposed to the virus. 
BOP also has the right to mandate testing for any inmate that 
it believes has intentionally or unintentionally transmitted 
the virus. For those who receive a test, BOP provides pre- and 
post-testing counseling, regardless of the diagnosis. Inmates 
who test positive for the virus--about 1 percent of the nearly 
200,000 incarcerated by BOP a year--also receive treatment 
during their incarceration and a 30-day supply of medication 
upon their release.
New Testing Procedures under H.R. 1943
    CBO estimates that implementing the expanded testing, 
medical treatment, and associated services under H.R. 1943 
would cost $11 million over the 2008-2012 period, subject to 
appropriation of the necessary amounts. H.R. 1943 would require 
BOP to test all incoming and outgoing inmates but would allow 
inmates to opt out of such testing. As under current law, if 
BOP believes that an inmate intentionally or unintentionally 
transmitted the virus, the inmate would be subject to mandatory 
testing. For inmates admitted prior to the effective date of 
the new policy, a test would be required within six months.
    Based on information from BOP, CBO expects that 
comprehensive HIV testing would likely be incorporated into the 
current medical examination system at an average cost of $10 
per inmate. We estimate that the cost of additional HIV testing 
on about 200,000 additional inmates in fiscal year 2008 under 
H.R. 1943 would be about $2 million, subject to the 
availability of appropriated funds. That first-year total would 
include tests for all inmates admitted prior to implementation 
of the new policy near the middle of fiscal year 2008. We 
anticipate that for years after 2008, BOP would conduct about 
110,000 additional tests a year (assuming that few inmates 
would opt out of testing), at a cost of about $1 million 
annually, also subject to the availability of appropriated 
funds.
    Testing of entering and exiting inmates may result in the 
diagnosis of some new HIV cases. CBO estimates that the cost of 
providing additional medical services for newly diagnosed 
inmates would be nearly $1 million a year. We estimate that the 
cost of HIV education and counseling programs would be less 
than $500,000.
Reporting Requirements
    CBO estimates that BOP would spend about $1 million over 
the 2008-2012 period to prepare two reports required by the 
bill, assuming the availability of appropriated funds. The 
first report would delineate BOP procedures for testing, 
treating, and preventing hepatitis and other infections 
diseases. The second report would provide the Congress with 
statistics on HIV test results.

              INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

    H.R. 1943 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would impose no costs on State, 
local, or tribal governments.

                         ESTIMATE PREPARED BY:

Federal Costs: Leigh Angres (226-2860)
Impact on State, Local, and Tribal Governments: Melissa Merrell 
    (225-3220)
Impact on the Private Sector: Paige Piper-Bach (226-2940)

                         ESTIMATE APPROVED BY:

Peter H. Fontaine
Assistant Director for Budget Analysis

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
1943 will help stem the spread of HIV/AIDS in the prison inmate 
population and in the community at large.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in Article I, Section 8 of the Constitution.

                          Advisory on Earmarks

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 1943 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of Rule XXI.

                      Section-by-Section Analysis

                          SEC. 1. SHORT TITLE.

    This section sets forth the short title of the bill as the 
``Stop AIDS in Prison Act of 2007.''

                 SEC. 2. COMPREHENSIVE HIV/AIDS POLICY.

    This section requires the Bureau of Prisons to develop a 
comprehensive HIV testing, treatment and prevention policy to 
stop the spread of HIV/AIDS among inmates, protect prison 
guards, provide medical treatment to affected prisoners and to 
provide comprehensive AIDS education, within 1 year of 
enactment. All inmates who test positive shall be provided 
confidential pre-release counseling and referrals to 
appropriate health care providers, and a 30-day supply of 
medications the prisoner is currently receiving

                    SEC. 3. REQUIREMENTS FOR POLICY.

    This section requires the BOP to administer a routing HIV 
test upon intake of all prisoners regardless of how long they 
will be in prison. The BOP must administer the test within 6 
months of the date of enactment to prisoners who are already 
incarcerated. Prisoners shall be provided with pre-test and 
post-test counseling. Prisoners have the right to ``opt out'' 
and choose not to be tested.
    Besides the testing upon admission, prisoners may obtain 
HIV tests upon request up to once a year. If a prisoner is 
involved in an ``exposure incident,'' the BOP may perform 
testing without the prisoners consent. Medical personnel shall 
notify prisoners of the test results and all results shall be 
confidential.

                    SEC. 4. CHANGES IN EXISTING LAW.

    This section amends existing law to incorporate HIV test 
results from this Act including amending Title 18 sec 4014(d) 
so that all test results from this Act will be inadmissible in 
criminal or civil proceedings.

                    SEC. 5. REPORTING REQUIREMENTS.

    This section requires the BOP to provide Congress a report 
on the policies and procedures to provide testing, treatment 
and prevention education programs for Hepatitis and other 
diseases transmitted through sexual activity and intravenous 
drug use with in a year of enactment. This section also 
requires the BOP to report to Congress on the incidence of 
diseases transmitted through sexual activity and intravenous 
drug use within 2 years of enactment. The report will also 
contain information about the incidence of HIV/AIDS in prison.

                       SECTION 6. APPROPRIATIONS.

    This section authorizes the appropriation of such sums as 
necessary to carry out this Act.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

                      TITLE 18, UNITED STATES CODE

           *       *       *       *       *       *       *
PART III--PRISONS AND PRISONERS

           *       *       *       *       *       *       *

CHAPTER 301--GENERAL PROVISIONS

           *       *       *       *       *       *       *

Sec. 4014. Testing for human immunodeficiency virus

    (a) The Attorney General shall cause each individual 
convicted of a Federal offense who is sentenced to 
incarceration [for a period of 6 months or more] to be tested 
for the presence of the human immunodeficiency virus[, as 
appropriate,] after the commencement of that incarceration, [if 
such individual is determined to be at risk for infection with 
such virus in accordance with the guidelines issued by the 
Bureau of Prisons relating to infectious disease management] 
unless the individual declines. The Attorney General shall also 
cause such individual to be so tested before release unless the 
individual declines..

           *       *       *       *       *       *       *

    (d) The results of a test under this section or under the 
Stop AIDS in Prison Act of 2007 are inadmissible against the 
person tested in any Federal or State civil or criminal case or 
proceeding.
    (e) Not later than 1 year after the date of the enactment 
of this section, the Attorney General shall issue rules to 
implement this section. Such rules shall require that the 
results of any test are communicated only to the person tested, 
and, if the results of the test indicate the presence of the 
virus, to correctional facility personnel consistent with 
guidelines issued by the Bureau of Prisons. Such rules shall 
also provide for procedures designed to protect the privacy of 
a person requesting that the test be performed and the privacy 
of the person tested. Such rules shall also provide that the 
initial test under this section be performed as part of the 
routine health screening conducted at intake.

                                  
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