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STOP AIDS IN PRISON ACT OF 2007, AND THE 

DRUG ENDANGERED CHILDREN ACT OF 2007 

HEARING 

BEFORE THE

SUBCOMMITTEE ON CRIME, TERRORISM, 

AND HOMELAND SECURITY 

OF THE

COMMITTEE ON THE JUDICIARY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

ON

H.R. 1943 and H.R. 1199 

MAY 22, 2007 

Serial No. 110–118 

Printed for the use of the Committee on the Judiciary 

( 

Available via the World Wide Web: http://judiciary.house.gov 

(II) 

COMMITTEE ON THE JUDICIARY 

JOHN CONYERS, JR., Michigan, Chairman 

HOWARD L. BERMAN, California 

RICK BOUCHER, Virginia 

JERROLD NADLER, New York 

ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia 

MELVIN L. WATT, North Carolina 

ZOE LOFGREN, California 

SHEILA JACKSON LEE, Texas 

MAXINE WATERS, California 

MARTIN T. MEEHAN, Massachusetts 

WILLIAM D. DELAHUNT, Massachusetts 

ROBERT WEXLER, Florida 

LINDA T. SA ́ NCHEZ, California 

STEVE COHEN, Tennessee 

HANK JOHNSON, Georgia 

LUIS V. GUTIERREZ, Illinois 

BRAD SHERMAN, California 

TAMMY BALDWIN, Wisconsin 

ANTHONY D. WEINER, New York 

ADAM B. SCHIFF, California 

ARTUR DAVIS, Alabama 

DEBBIE WASSERMAN SCHULTZ, Florida 

KEITH ELLISON, Minnesota 

LAMAR SMITH, Texas 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

HOWARD COBLE, North Carolina 

ELTON GALLEGLY, California 

BOB GOODLATTE, Virginia 

STEVE CHABOT, Ohio 

DANIEL E. LUNGREN, California 

CHRIS CANNON, Utah 

RIC KELLER, Florida 

DARRELL ISSA, California 

MIKE PENCE, Indiana 

J. RANDY FORBES, Virginia 

STEVE KING, Iowa 

TOM FEENEY, Florida 

TRENT FRANKS, Arizona 

LOUIE GOHMERT, Texas 

JIM JORDAN, Ohio 

PERRY APELBAUM, Staff Director and Chief Counsel 

JOSEPH GIBSON, Minority Chief Counsel 

SUBCOMMITTEE ON CRIME, TERRORISM, AND HOMELAND SECURITY

ROBERT C. SCOTT, Virginia, Chairman 

MAXINE WATERS, California 

WILLIAM D. DELAHUNT, Massachusetts 

JERROLD NADLER, New York 

HANK JOHNSON, Georgia 

ANTHONY D. WEINER, New York 

SHEILA JACKSON LEE, Texas 

MARTIN T. MEEHAN, Massachusetts 

ARTUR DAVIS, Alabama 

TAMMY BALDWIN, Wisconsin 

J. RANDY FORBES, Virginia 

LOUIE GOHMERT, Texas 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

HOWARD COBLE, North Carolina 

STEVE CHABOT, Ohio 

DANIEL E. LUNGREN, California 

BOBBY VASSAR, Chief Counsel 

MICHAEL VOLKOV, Minority Counsel 

(III) 

C O N T E N T S 

MAY 22, 2007 

Page 

THE BILLS 

H.R. 1199, the ‘‘Drug Endangered Children Act of 2007’’ .................................... 74 

H.R. 1943, the ‘‘Stop AIDS in Prison Act of 2007’’ ................................................ 76 

OPENING STATEMENTS 

The Honorable Robert C. ‘‘Bobby’’ Scott, a Representative in Congress from 

the State of Virginia, and Chairman, Subcommittee on Crime, Terrorism, 

and Homeland Security ....................................................................................... 1 

The Honorable J. Randy Forbes, a Representative in Congress from the 

State of Virginia, and Ranking Member, Subcommittee on Crime, Terrorism, and Homeland Security .......................................................................... 3 

The Honorable Lamar Smith, a Representative in Congress from the State 

of Texas, and Ranking Member, Committee on the Judiciary ......................... 4 

The Honorable Maxine Waters, a Representative in Congress from the State 

of California, and Member, Subcommittee on Crime, Terrorism, and Homeland Security ........................................................................................................ 5 

WITNESSES 

The Honorable Dennis Cardoza, a Representative in Congress from the State 

of California ..........................................................................................................

Oral Testimony ..................................................................................................... 7 

Prepared Statement ............................................................................................. 9 

Mr. Willie Mitchell, Chairman of the Board, San Antonio Fighting Back, 

San Antonio, TX ...................................................................................................

Oral Testimony ..................................................................................................... 12 

Prepared Statement ............................................................................................. 14 

Mr. Devon Brown, Director, Department of Corrections for the District of 

Columbia, Washington, DC .................................................................................

Oral Testimony ..................................................................................................... 41 

Prepared Statement ............................................................................................. 43 

Mr. Vincent Jones, Executive Director, Center for Health Justice, West Hollywood, CA ...............................................................................................................

Oral Testimony ..................................................................................................... 44 

Prepared Statement ............................................................................................. 46 

Mr. Philip Fornaci, Director, D.C. Prisoners’ Project, Washington Lawyers’ 

Committee for Civil Rights and Urban Affairs, Washington, DC ....................

Oral Testimony ..................................................................................................... 51 

Prepared Statement ............................................................................................. 53 

Rear Admiral Newton E. Kendig, M.D., Assistant Director, Health Services 

Division, Federal Bureau of Prisons, U.S. Department of Justice, Washington, DC .............................................................................................................

Oral Testimony ..................................................................................................... 55 

Prepared Statement ............................................................................................. 58 

APPENDIX 

Material Submitted for the Hearing Record .......................................................... 73 

(1) 

STOP AIDS IN PRISON ACT OF 2007, AND THE 

DRUG ENDANGERED CHILDREN ACT OF 2007 

TUESDAY, MAY 22, 2007 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON CRIME, TERRORISM, AND HOMELAND SECURITY

COMMITTEE ON THE JUDICIARY, Washington, DC. 

The Subcommittee met, pursuant to notice, at 12:39 p.m., in 

Room 2226, Rayburn House Office Building, the Honorable Robert 

C. ‘‘Bobby’’ Scott (Chairman of the Subcommittee) presiding. 

Present: Representatives Scott, Waters, Johnson, Forbes, and 

Coble. 

Staff present: Bobby Vassar, Subcommittee Chief Counsel; Rachel King, Majority Counsel; Veronica Eligan, Professional Staff 

Member; and Michael Volkov, Minority Counsel. 

Mr. SCOTT. The Subcommittee will come to order. 

I am pleased to welcome you today to the hearing before the Subcommittee on Crime, Terrorism, and Homeland Security on H.R. 

1199, the ‘‘Drug Endangered Children Act of 2007,’’ and H.R. 1943, 

the ‘‘Stop AIDS in Prison Act of 2007.’’ 

We will first take up H.R. 1199, the ‘‘Drug Endangered Children 

Act of 2007.’’ Congressman Cardoza is the primary sponsor of the 

bill, which would extend funding for the Drug Endangered Children Grant Program through fiscal year 2008 and 2009. 

This grant program was first authorized in title 7 of the USA Patriot Improvement and Reauthorization Act of 2005, which authorizes up to $20 million a year for grants to address this problem. 

One of the most troubling aspects of drug use is its impact on 

children. According to the Drug Enforcement Agency, over 15,000 

children were found at methamphetamine labs from 2000 to 2004. 

The problem is not limited to methamphetamine use. A Health and 

Human Services study found that over 1.6 million children live in 

homes where a variety of illicit drugs are used. 

These drug-infested conditions stretch child welfare agencies beyond their capacity because of increased violence and neglect. 

On February 6 of this year, the Subcommittee held a hearing on 

H.R. 545, the ‘‘Native American Methamphetamine Enforcement 

and Treatment Act of 2007,’’ which was passed out of this Subcommittee and out of the full Judiciary Committee. 

A central provision of H.R. 545 extends eligibility for Drug Endangered Children grants to Native American tribes. However, unless this bill passes the authorization for Drug Endangered ChilVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
2 

dren grants will expire this year, negating the efforts to help Native American children. 

After we take that bill up, we will take up H.R. 1943, the ‘‘Stop 

AIDS in Prison Act.’’ The gentlelady from California, Ms. Waters, 

introduced H.R. 1943, a bill similar to H.R. 1638, which she introduced in September of 2006. 

The bill would create comprehensive HIV/AIDS programs in Federal prisons that would educate, diagnose and treat prisoners who 

are infected with HIV/AIDS and prevent those who are not infected 

from becoming infected. Yet the HIV/AIDS epidemic is spreading at 

an alarming rate, especially in minority communities. 

According to the Centers for Disease Control and Prevention, the 

CDC 2005 statistic states racial and ethnic minorities comprise 69 

percent of all new HIV/AIDS cases. Furthermore, 41 percent of all 

prisoners in Federal prisons at the end of 2004 were African-American. 

These statistics show a clear need to educate prisoners about 

HIV/AIDS prevention, to detect existing cases and to treat those infected. Education, detection and treatment will not only protect 

prisoners, it will protect the prison personnel. Additionally, the 

treatment and education that the prisoners receive while incarcerated should help decrease the spread of the disease to the community upon their release. 

H.R. 1943 seeks to provide an effective HIV/AIDS program in 

Federal prisons for educating, detecting and treating HIV and 

AIDS. Under the bill, all inmates would have access to scientifically accurate education and prevention programs which may be 

provided by community-based organizations, local health departments or inmate peer educators. The information would be expressed in a culturally sensitive way, including the availability of 

a variety of languages and an audio format for those with low literacy skills. 

Detection, the second portion of the program’s approach, would 

begin upon a person’s entry to the prison system. All people entering the system would be detected unless declined by the prisoner 

and would continue throughout the prisoner’s incarceration, including annual testing available to all prisoners upon request and mandatory testing to prisoners who have been involuntarily exposed to 

the virus or to prisoners who become pregnant while incarcerated. 

Finally, the treatment portion of the program would ensure that 

infected persons receive timely comprehensive medical treatment 

consistent with the current Department of Health and Human 

Services guidelines and standard medical practice. Treatment options, confidentiality, counseling and access to medications would 

all be available to prisoners and medical personnel would help develop and implement procedures to safeguard confidentiality. 

Before re-entry into the community, HIV-infected prisoners 

would receive referrals to appropriate health care providers, additional education about protecting their family members and others 

in their community and a 30-day supply of medications to hold 

them over until they can connect with services in the community. 

It is now my pleasure to recognize the esteemed Ranking Member of the Subcommittee, my friend and colleague from Virginia, 

the Honorable Randy Forbes, for his comments. 

3 

Mr. FORBES. Thank you, Chairman Scott. And I appreciate, as always, your holding this legislative hearing on H.R. 1943, the Stop 

AIDS in Prison Act of 2007, and H.R. 1199, the Drug Endangered 

Children Act. 

I want to acknowledge the dedicated work of representative Maxine Waters, who has been a tireless advocate on the issue of HIV 

and AIDS in prison. I am proud to be an original cosponsor of H.R. 

1943, the Stop AIDS in Prison Act. 

I also want to acknowledge the commitment of Ranking Member 

Smith, who is a cosponsor of the same bill in the last Congress and 

a cosponsor of this year’s version. 

It is certainly great to see our friend Congressman Cardoza here 

today to testify and also a true superstar, Mr. Mitchell, who is here 

with us today. And we look forward to the very distinguish panel 

to testify. 

In 2006, the Department of Justice reported that approximately 

1.9 percent of State prison inmates and 1.1 percent of Federal inmates were known to be infected with HIV. The rate of confirmed 

AIDS cases is three times higher among prison inmates than the 

United States general population. 

These statistics, however, may understate the problem, because 

the Bureau of Prisons is responsible for housing all Federal inmates, and almost all States do not test all inmates for HIV. 

The need for testing at the Federal and State level is readily apparent. There are approximately 170,000 inmates in Federal prison. BOP tests inmates who requested tests, fall within a high-risk 

group, have clinical indications of HIV related or are involved in 

an incident when HIV transmission may have occurred. Forty-eight 

States test inmates if they have HIV-related symptoms or if the inmates request the test. Only 18 States test all incoming inmates. 

Only three States test inmates upon release. 

H.R. 1943 requires routine HIV testing for all Federal prison inmates upon entry and prior to release from Federal Bureau of Prison facilities. Under the proposal for existing inmates, the Bureau 

of Prisons has 6 months from enactment to offer HIV/AIDS testing 

from inmates. The bill also requires HIV/AIDS awareness education for all inmates and comprehensive treatment for those inmates who test positive. 

While H.R. 1943 addresses the problem in the Federal system, 

I hope that we can also examine the need for testing, education 

and prevention in State prisons. If we truly care about successful 

rehabilitation and re-entry of prisoners, we must address this problem at the State level as well. 

I also want to indicate my support for H.R. 1199, the Drug Endangered Children Act, which is also a subject of today’s hearing. 

The bill extends the authorization for the current grant program to 

address the problem of drug endangered children. 

It is a sad consequence of our Nation’s drug problem that drug 

traffickers have such a devastating impact on innocent children 

who happen to reside in a house used to facilitate the production 

and distribution of illegal drugs. 

We owe it to our Nation’s children to do all that we can to protect 

them and provide them the services needed to allow them to grow 

and develop in a health, loving home. 

4 

I look forward to hearing from today’s witnesses. 

Mr. Chairman, I yield back. 

Mr. SCOTT. Thank you. Thank the gentleman. 

We have with us the Ranking Member of the full Committee, and 

I will ask him if he has any comments. 

Mr. SMITH. Thank you, Mr. Chair. I do have a statement I would 

like to make. 

On the way to that statement, let me say to you, though, that 

this is the first time I have attended a meeting of the Crime Subcommittee this year and have gotten to be here while you are serving as Chairman. Not too many years ago, I was Chairman of this 

Subcommittee and you were the Ranking Member, so we have 

worked together for a long time on this and similar issues. 

But it is good to be here today. Let me thank you for holding a 

hearing today on these two important legislative items. 

And I also want to thank my colleague, Congresswoman Waters, 

for her leadership and her collaboration on H.R. 1943, the Stop 

AIDS in Prison Act of 2007. I introduced a similar bill in the last 

Congress, and I am pleased to be a cosponsor again with Representative Waters in this Congress. 

The problem of HIV and AIDS in Federal and State prisons is 

difficult to measure because inmates are not routinely tested. 

There are 170,000 prisoners in the Federal system. In a 2006 report, the Justice Department estimated that almost 2 percent of 

State prison inmates and over 1 percent of Federal inmates were 

known to be infected with HIV. 

As a percentage, this puts the occurrence of HIV and AIDS 

among inmates in Federal prison three times higher than within 

the general population of the United States. The cost of an HIV screening is between $6 and $15 per test. So 

requiring that Federal inmates be tested when they enter prison 

and when they leave prison is just good, common, practical sense. 

H.R. 1943 requires HIV testing for all Federal prison inmates 

upon entry and prior to release and for all existing inmates within 

6 months of enactment. Identifying inmates who are infected allows prison officials to take the precautionary measures necessary 

to protect the health and safety of prison employees and other inmates. This also ensure that medical treatment can be administered to inmates suffering from the disease. 

Finally, both the inmates themselves and the community they rejoin upon release will obviously benefit from the inmate knowing 

his status. 

I look forward to our hearing today. 

Mr. Chairman, before I stop I want to tell a quick story, and I 

mean this as a compliment to Maxine Waters, the congresswoman 

from California. 

Mr. SCOTT. You have to explain that it is a compliment? It may 

not sound like a compliment, but here we go. [Laughter.] 

Mr. SMITH. I will certainly yield to her when I am finished, but 

I think that she will corroborate the story. 

And that is, in the last Congress and frankly in the last revision 

that occurred in Texas, I picked up the east side of San Antonio, 

which is a predominantly Black community. And I started listening 

to what I was hearing and trying to respond to the suggestions 

5 

that I was getting and the needs that I was witnessing and hearing 

about as well. 

And so I looked around and saw that a bill such as the one that 

we are considering today had been considered, and I explored it 

some more. And I went to someone who is a personal friend as well 

as a colleague, Maxine Waters, and we decided to introduce this 

bill ourselves in the last Congress. We were the two primary cosponsors. 

Little did I know that things were going to change so dramatically in the election, but it is an indication of I think Ms. Waters’ 

sincerity and hopefully my cooperation that regardless of who is in 

the majority, we thought the issue was so important and needed 

to be addressed, that we would continue to do so and approach the 

subject in a bipartisan way, which in fact has occurred. 

So I want to thank her, both for her help in the last Congress 

and for her instrumental help in this Congress as well, trying to 

achieve what we want to achieve. 

And, Mr. Chairman, I will yield the balance of my time, such as 

it is, to the congresswoman from California. 

Mr. SCOTT. With a comment like that, we will give the gentlelady 

from California equal time. [Laughter.] 

Ms. WATERS. Mr. Chairman, just let me take a moment to thank 

you for holding this hearing today and our Ranking Member, Mr. 

Randy Forbes. 

And, of course, I want you to know that not only is Mr. Lamar 

Smith one of the original cosponsors of my legislation—along with 

John Conyers, yourself, Mr. Forbes, Ms. Lee and Donna 

Christensen—every time I see him in the hall, he asks me, ‘‘When 

is our bill coming up?’’ And so, today you have answered the question that has been asked of me time and time again. He has been 

anxious to get on with this legislation, and I appreciate his interest 

and his passion about this subject. 

And I just look forward to hearing from our witnesses today. 

And while I have the microphone, let me just say that in addition 

to my bill, the Drug Endangered Children Act of 2007 is extremely 

important. 

We have a Member who is here today who is going to talk about 

his passion related to this issue, the children that are endangered 

by methamphetamine, and I think that he has a compelling story 

to tell about what he knows about the subject. And so, I am anxious also to hear from him today, and I just thank him for the time 

that he has been putting in. 

Thank you, Congressman Cardoza, for taking time to provide 

leadership on this issue. 

And I yield back the balance of my time. 

Mr. SCOTT. Thank you. 

And, without objection, if the others will submit their statements 

for the record, we have a distinguished panel with us today to consider important issues that are currently before us. 

The first will be Representative Dennis Cardoza, who will testify 

on H.R. 1199. 

Representative Cardoza is in his third term representing the 

18th Congressional District of California. He is the Chairman of 

the Agriculture Committee Subcommittee on Horticulture and OrVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
6 

ganic Agriculture. In 2007 he joined the Rules Committee, and he 

also serves on the Democratic Steering and Policy Committee. 

Before coming to Washington, he served a term on the Atwater 

City Council and was later appointed to the Merced City Council, 

where his duties provided invaluable experience in dealing with a 

wide range of important local and county issues. 

The remainder of the witnesses will be testifying on H.R. 1943. 

Our first witness on the bill will be Mr. Devon Brown, who is the 

director for the District of Columbia Department of Corrections. He 

has more than three decades of experience in the congressional 

field. He recently returned to D.C. government from the state of 

New Jersey, where he was the commissioner of corrections from 

April 2002 to January 2006. Before his tenure as commissioner for 

the New Jersey Corrections, he served as deputy trustee of the Office of Corrections for the District of Columbia. During that time, 

he also served as interim director for the Department of Corrections for 6 months. 

The next panel member will be Mr. Vincent Jones. Mr. Jones has 

been the executive director of the Center for Health Justice since 

December of 2006. In his role, he oversees programmatic development, manages development activities and oversees the agencies 

capacity to fulfill its mission to empower more people affected by 

HIV and incarceration. He has more than 15 years’ experience in 

strategic planning, fundraising, organizational positioning, programmatic development and management teams. 

Our third panel member is Philip Fornaci. He, in August 2003, 

became the director of the D.C. Prisoners Legal Services Project. In 

2006 that project was merged with the Washington Lawyers Committee for Civil Rights and Urban Affairs, where he took over as 

director of the new organization. He litigates on behalf of prisoners 

in both D.C. jails and Federal institutions while also managing the 

project’s public affairs efforts, with a particular interest in civil 

rights of ex-offenders and the treatment of people with disabilities 

within the criminal justice system. 

Our fourth panel member is Rear Admiral Newton Kendig, M.D. 

He is the assistant director of Health Services Division, U.S. Bureau of Prisons, since August of 2006. He is a fifth-generation graduate of Jefferson Medical College in Philadelphia. He completed his 

residency in internal medicine at the University of Rochester and 

subspecialty training in infectious diseases at Johns Hopkins in 

1991, where he later joined the faculty. He subsequently served as 

medical director of the Maryland Department of Corrections and 

Public Safety for 5 years. 

Our final panel member is going to be introduced by the gentleman from Texas. 

Mr. SMITH. Mr. Chairman, thank you for another opportunity 

today to go out of order. It is appreciated. 

I am honored to introduce Willie Mitchell, chairman of San Antonio Fighting Back, who is from our hometown of San Antonio, 

Texas. 

Mr. Mitchell has had a distinguished career in business, community service and politics. He currently serves as chair of San Antonio Fighting Back, Inc., sits on the United Way of San Antonio and 

Barrett County Board of Trustees and on the San Antonio Water 

7 

Board, as well as many other committees and boards, including the 

Community Anti-Drug Coalition and the America Greenhouse Coalition. 

Mr. Mitchell ran for the San Antonio City Council in 1979. He 

has served as an active member of the Texas Council on Crime and 

Delinquency and has appeared on the ‘‘Today’’ show, representing 

the Center for Educational Development, teaming the athletic peer 

group. He has also appeared on ‘‘Texas Epidemic’’ in San Antonio, 

Texas, and is a recipient of the San Antonio Distinguished Citizen 

Award. 

Mr. Mitchell attended Tennessee A&I State University in Nashville, Tennessee, and upon graduation was drafted by the Kansas 

City Chiefs, National Football League, in 1964. Mr. Mitchell played 

in the first Super Bowl in 1966 and was a member of the Kansas 

City Chiefs team that won the 1969 Super Bowl. 

Mr. Chairman, I just want to say about Willie Mitchell, beyond 

what I just said and beyond the organizations that he is a member 

of, he is literally a hero to many of us in San Antonio. He is known 

throughout the community for his good works, for his good words, 

for his talks that inspire so many young people across the board. 

And it is just nice that he was able to make the time and come up 

from San Antonio today to be able to testify before our Committee. 

As I say, there aren’t many genuine heroes we have these days, 

particularly those who are living among us, but Willie Mitchell is 

one of those in San Antonio. 

Thank you, Mr. Chairman. 

Mr. SCOTT. Thank you. Thank you, Mr. Smith. 

Each of the witnesses’ written testimony will be made part of the 

record in its entirety, and I would like each of the witnesses to 

summarize his or her testimony in 5 minutes or less. 

I think the timer is working. If it is working, the green light will 

come on. When 1 minute is left, the yellow light will come on. And 

when the red light comes on, that indicates that your time has 

pretty much expired. 

We are going to begin with Congressman Cardoza at this time. 

And we can take your testimony and then if there are any questions, and then the rest of the hearing will be on the other bill. 

Mr. Cardoza? 

TESTIMONY OF THE HONORABLE DENNIS CARDOZA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. CARDOZA. Thank you, Mr. Chairman. Thank you for inviting 

me here today. 

You and your Committee have accomplished a great deal for the 

American people in the short time since you have taken over as 

Chair, and I admire your commitment to making our Nation’s communities safer. 

Thank you for your interest in my bill. I appreciate all the comments of Mr. Forbes and Mr. Smith and Ms. Waters. 

I come here today to testify about an issue that is very close to 

my heart: drug endangered children. 

Drug trafficking and addiction have had a harrowing effect on 

children across this country, contributing to domestic violence, 

8 

abuse, and neglect. According to a recent Health and Human Services study, over 1.6 million children live in a home where at least 

one parent abuses illicit drugs, including cocaine, methamphetamine, heroin, and prescription drugs. 

I am especially concerned about the impact drug abuse is having 

on the foster care system. Seven years ago, my wife Kathy and I 

adopted two foster children, Joey and Elena. It is a little difficult 

for me at this time to refer to them as foster children, because after 

7 years of being in our home and being part of our family, they are 

our children, not foster children. But in any case, they were at one 

time foster children. 

It was truly an eye-opening experience for both Kathy and I, and 

I was inspired to become an advocate for improving the lives of foster kids. It breaks my heart that in communities across this country drugs like methamphetamine are harming innocent children 

and over-burdening the foster care system. 

Methamphetamine is particularly dangerous for children because 

parents set up meth labs in their homes. These labs are highly 

toxic and susceptible to fires and explosions. Tragically, according 

to the Drug Enforcement Administration, children are found in 

over 20 percent of all meth labs seized. 

It is well-documented that children exposed to drug abuse are 

more emotionally traumatized than other foster children and often 

have serious drug-related health problems. For these reasons, drug 

endangered children present unique challenges to the system. In 

fact, according to a National Association of Counties study, 69 percent of county social service agencies are working to develop special 

training procedures and protocols to help children with methamphetamine-addicted parents. 

I recently introduced the Drug Endangered Children Act of 2007 

to address the challenges nationwide. The legislation would reauthorize the Department of Justice to make $20 million grants for 

drug endangered children for fiscal years 2008 and 2009. The Drug 

Endangered Children program was originally authored as part of 

the Patriot Act reauthorization, but money was never appropriated. 

Last June during the consideration of the Science, State, Justice 

and Commerce appropriations bill, I offered an amendment to provide $5 million for the program for fiscal year 2007. The amendment passed with bipartisan support, but the funding was not included in the continuing resolution adopted this year when the underlying bill from last year didn’t pass through the Committee 

process. 

The Drug Endangered Children’s grants are designed to improve 

coordination among law enforcement, prosecutors and child protection services to help transition drug endangered children into a residential environment and as-safe-as-possible custody as soon as 

possible. 

The Byrne JAG and COPS programs have proven that grants to 

local law enforcement, other government agencies are extremely effective in taking public policy and tackling public safety problems. 

The Drug Endangered Children program would operate in a similar 

manner to these highly successful Justice Department programs by 

funding coordination across jurisdictions to address the needs of 

drug endangered children. In addition, these grants would leverage 

9 

1Department of Health and Human Services, Office of Applied Studies. ‘‘The National Survey 

on Drug Use and Health.’’ 2004. 2Swetlow, Karen. ‘‘Children of Clandestine Methamphetamine Labs: Helping Meth’s Youngest 

Victims.’’ 2003: p. 3. 

the Federal Government’s investment by offering an incentive for 

local governments to invest their own money to confront this growing epidemic. 

I want to again thank you, Mr. Chairman, for the opportunity to 

present my testimony today. I strongly believe that the Drug Endangered Children Act would improve the lives of the more than 

1.6 million children across the country impacted by parental drug 

abuse. I urge the Subcommittee to support this legislation. 

And as you mentioned earlier, Mr. Chairman, you have already 

supported legislation that would build on this in the Native American Meth Act, and without this underlying legislation, the legislation you passed earlier this year wouldn’t have any impact. 

[The prepared statement of Mr. Cardoza follows:] 

PREPARED STATEMENT OF THE HONORABLE DENNIS CARDOZA, A REPRESENTATIVE IN

CONGRESS FROM THE STATE OF CALIFORNIA

Thank you, Mr. Chairman for inviting me here today. You and your committee 

have accomplished a great deal for the American people in the short time since you 

have taken over as Chairman of the Subcommittee on Crime, Terrorism, and Homeland Security, and I admire your commitment to making our nation’s communities 

safer. 

I am here today to testify about an issue that is close to my heart: drug endangered children. Drug trafficking and abuse have had a harrowing effect on children 

across our country, contributing to domestic violence, abuse, and neglect. According 

to a recent Health and Human Services study, over 1.6 million children live in a 

home where at least one parent abuses illicit drugs, including cocaine, methamphetamine, heroin, and prescription drugs.1

In my district in the Central Valley of California, I have seen the devastating impact of methamphetamine on children’s lives. While visiting schools in my area, I 

have been told by teachers and administrators that a significant proportion of students have a parent or relative who abuses meth. I am positive that similar stories 

can be told in other parts of the country where drug abuse is rampant. 

I am especially concerned about the impact drug abuse is having on the foster 

care system. Seven years ago, my wife Kathy and I adopted two foster children— 

Joey and Elena. It was truly an eye-opening experience for both of us, and I was 

inspired to become an advocate for improving the lives of foster kids. This year I 

introduced legislation to provide Medicaid coverage for foster kids with mental 

health problems who age out of the foster care program. Also, I am planning on introducing legislation to guarantee that every foster child has a Court Appointed 

Special Advocate (CASA)—a vital step to improving outcomes for children in foster 

care. Without a doubt, one of the most serious challenges facing the foster care system is parental drug abuse. In communities like mine across the country, drugs like 

methamphetamine are affecting innocent children and overburdening the foster care 

system. 

Meth is extremely dangerous for children not only because meth addicts are more 

likely to abuse and abandon their children, but also because meth-addicted parents 

often set up meth labs in their homes. These labs are highly toxic and susceptible 

to fires and explosions and therefore place innocent children in physical danger. In 

my district, children have been found at labs with burns from spilled ingredients 

from the methamphetamine production process. In addition, there is a high risk of 

lasting health damage from toxic fume inhalation. Tragically, according to the Drug 

Enforcement Administration (DEA), children are found at 20 percent of all meth lab 

seizures.2

*ERR13*Drug endangered children present unique challenges for law enforcement 

agencies, prosecutors, child protective services, social service agencies, health care 

providers, and other government entities. These children are often traumatized and 

abused, and they require special attention and care to transition into a safe and 

healthy residential environment. According to a survey released by the National Association of Counties, 69 percent of responding officials from county social service 

10 

3 National Association of Counties. ‘‘The Meth Epidemic in America: The Impact of Meth on 

Children.’’ July 5, 2005: p. 10. Available at http://www.naco.org/Template.cfm?Section=Meth— 

Action—Clearinghouse&template=/ContentManagement/ContentDisplay.cfm&ContentID=17216. 

agencies indicate that their counties have had to provide specialized training for 

their welfare system workers and have had to develop special protocols for workers 

to address the special needs of children displaced by parental meth abuse.3

I recently introduced the Drug Endangered Children Act of 2007 (H.R. 1199) to 

address the challenges facing children abandoned, neglected, or abused by parents 

addicted to illicit drugs. The legislation would authorize the Department of Justice 

to make $20 million in grants for drug endangered children for Fiscal Years 2008 

and 2009. The grants are designed to improve coordination among law enforcement, 

prosecutors, children protection services, social service agencies, and health care 

providers to help transition drug endangered children into safe residential environments. 

Grants to local law enforcement and other local government agencies are extremely effective in tackling public safety problems in communities across the country. The Community Oriented Policing Services (COPS) program has been critical 

in reducing crime across the country. The Edward Byrne Memorial Justice Assistant 

Grant program is another example of a program that empowers state and local governments to fight crime and respond to emerging public safety threats. 

The Drug Endangered Children (DEC) program would operate in a similar manner to these highly successful Justice Department programs. By funding coordination across jurisdictions and among several different types of government agencies, 

the DEC program would foster cooperative efforts to address the needs of children 

affected by drug abuse. These grants would leverage the federal government’s investment by offering an incentive for local government to invest their own money 

in confronting this important problem. 

This legislation renews the authorization for the Drug Endangered Children program originally included as part of the USA PATRIOT Improvement and Reauthorization Act of 2005 (P.L. 109–177). Last June during the consideration of the Departments of Commerce and Justice, Science, and Related Agencies Act of 2006 

(H.R. 5672), I offered an amendment to provide $5 million for the program in Fiscal 

Year 2007. The amendment passed by voice vote, but the funding was not included 

in the Continuing Resolution adopted earlier this year. 

The Drug Endangered Children Act of 2007 represents a continuation of the work 

of the Subcommittee on Crime, Terrorism, and Homeland Security this year. On 

February 6, 2007, the Subcommittee reported out the Native American Methamphetamine Enforcement and Treatment Act of 2007. A central provision of this 

legislation is to extend Drug Endangered Children grants to tribes and territories. 

This provision is irrelevant without the reauthorization of the DEC program itself. 

H.R. 1199 builds on the prior work of the Subcommittee to help Native American 

communities devastated by the methamphetamine epidemic. 

Thank you, Mr. Chairman, for the opportunity to present my testimony to the 

Subcommittee on Crime, Terrorism, and Homeland Security. I strongly believe that 

the Drug Endangered Children Act of 2007 would improve the lives of the more 

than 1.6 million children across the country impacted by parental drug abuse. I urge 

the Subcommittee to support this legislation. 

Mr. SCOTT. Thank you very much. 

Are there any questions for Mr. Cardoza? 

Mr. Forbes? 

Ms. Waters? 

Ms. WATERS. Mr. Chairman and Members, I certainly support 

this legislation, and I thank Congressman Cardoza again for his 

leadership on this issue. 

We have all heard many stories about the unfortunate situations 

where children find themselves in homes sometimes with both parents using meth or—— 

Mr. SCOTT. If the gentlelady would yield for just a minute? 

We want to recognize the presence of the gentleman from North 

Carolina, Mr. Coble, and the gentleman from Georgia, Mr. Johnson, who are also present with us today. 

You can continue. Sorry. 

11 

Ms. WATERS. That is all right. 

We have heard these horror stories about children who are abandoned or children who are placed at great risk because they are unfortunate enough to end up in these situations. And even though 

it is not well-known among the Members of even Congress and perhaps the public, I know that Congressman Cardoza has a special 

experience with this situation of children who were at risk because 

of their parents having been on methamphetamine. 

And I would just like to ask you if the children that you have 

knowledge of are safely being cared for now? 

Mr. CARDOZA. Well, it varies, Ms. Waters. And thank you for 

your recognition. 

When we got our children from the foster care system, they had 

been abandoned by their mother, who was a methamphetamine addict. They were in foster care, being somewhat abused for a second 

time, and a CASA volunteer saved our kids, a kindergarten teacher 

that recognized that my son was under severe stress and could see 

it in the classroom. 

We were lucky and our children were lucky. We were lucky to 

get them. They are wonderful kids. They will be great adults if we 

don’t—I often joke, if we let them live that long, they will be great 

adults. Like any kids, they are persnickety and get into mischief. 

But we love them deeply, and they are in a great situation now. 

But the impact from the years that they were in a bad situation 

still affects their lives, even though they are 13 and 10 now. That 

impact continues. Even though they have got a nurturing mother 

and a father that take care of them and love them, there are impacts that reside inside them that affect them to this day. 

I am personally aware of two children that were taken out of a 

meth lab about a mile from my home. When they removed these 

children, they were covered in red phosphorus and their teddy 

bears literally had to be considered hazardous materials and were 

taken away in Hazmat bags by men in white suits, because they 

were so contaminated and dangerous. The children were literally 

little toxins. They were taken to the hospital to be decontaminated. 

And when you see those kinds of experiences, you know the effect 

of methamphetamine on parents causes parents to simply abandon 

the kids. And especially if they have been taken the drugs during 

pregnancy, while the drug can have an effect on the child physically, the emotional lack of attachment that the parent has, because they oftentimes abandon newborns and things, is something 

that early child development practitioners will tell you has a lifelong effect on this young people that were abandoned. 

That is why the counties are having such trouble dealing with 

some of the after-effects of this, and I really appreciate your question. I am very passionate about this subject, and I know the 

money will be well-spent if we can direct it this way. 

Ms. WATERS. Thank you very much. 

Mr. SCOTT. Thank you. 

Mr. Smith? 

Mr. Johnson? 

Mr. JOHNSON. I wish to commend you, Representative Cardoza, for this measure to extend this act, which would provide $20 million per year for children who have been adversely impacted by 

12 

their drug environments. If we don’t pay now, we will certainly pay 

later. And $20 million compared to $97 billion is a small amount 

when it goes toward helping children. So you are to be commended. 

I have only talked with you a couple of times since I have been 

in Congress, and my idea of you is of someone who is very stern 

and focused and that kind of thing. But to hear you and your wife 

have taken in foster children who were challenged gives me a different perspective on your character. So I look forward to getting 

to know you better and thank you so much for your service to your 

country in that regard. 

Mr. CARDOZA. Thank you, Mr. Johnson. 

Mr. SCOTT. Does the gentleman want equal time? [Laughter.] 

Mr. CARDOZA. I will do some soul searching about my sternness. 

The reality is there are a great deal of young people that are 

put—you know, 1.6 million people are affected in some way; 

500,000 children are in foster care at any given time in the United 

States; 118,000 are up for adoption. 

There is a disproportionate number of children in the AfricanAmerican community vis-a-vis the population. They comprise about 

15 percent of the population and 39 percent of those waiting for 

adoption. 

We have a lot of work to do on this issue, but the counties and 

the locales that are dealing with this, in some cases cities, really 

need to help in developing special protocols. These are special kids 

with special needs, and I think that this money will go to developing those programs that can be used disseminated throughout 

the country to solve the problem. 

I thank the Chairman. 

Mr. SCOTT. Thank you. 

If there are no other questions, thank you, Mr. Cardoza, and we 

will excuse you at this point. 

Thank you for introducing this bill. The children you are talking 

about are at the highest risk of getting in trouble, and any investments we can make before they get in trouble will go a long way, 

as the gentleman from Georgia has indicated. 

As you have heard, we have got several votes, at least eight 

votes. So it is going to be some time. We will get back as soon as 

we can, but it will be at least a half an hour before we can get 

back. So we will get back as soon as we can and continue with the 

hearing. 

We are in recess. 

[Recess.] 

Mr. SCOTT. The Committee will come back to order. 

Representative Forbes is detained but specifically asked me to 

continue, so we will continue with the hearing. 

And I understand that the witnesses have been informed that 

Mr. Mitchell is on a time crunch. And we would ask him to testify 

at this point. 

Mr. Mitchell, you are recognized for 5 minutes. 

TESTIMONY OF WILLIE MITCHELL, CHAIRMAN OF THE BOARD, 

SAN ANTONIO FIGHTING BACK, SAN ANTONIO, TX 

Mr. MITCHELL. Thank you, Mr. Chairman. 

13 

Let me say first of all, I am clearly elated to be here, and I appreciate the opportunity to come before you and your Committee to 

give some impact to the problem with HIV/AIDS to those who have 

been incarcerated and to those who are being incarcerated. 

From my perspective, I have worked with the Three Rivers Federal Penal Institution in Three Rivers, Texas, and the thing that 

I think is so unique is that this bill that you have designed and 

put together, I think everything that I know, as a practitioner and 

out in the community, everything is being addressed. 

The one thing that I know is beneficial is that those who come 

from those communities that really have the AIDS virus or have 

the potential of getting the AIDS virus and going into the penal institution, I think if tested before, that will help to serve and make 

sure that the finances to make sure that the people who have AIDS 

going in get the treatment that is necessary and reduce the problem with those who are incarcerated to where there are more people coming in with that same virus. 

And for those that are inside the prison, if they are not tested 

to see, then it just continues to spread and it will be widely known 

as they come out. If they are coming out with the virus and haven’t 

been tested, that is not good for the community either, because the 

community is going to have to suffer and pay for that type of testing and the medicine that is needed. So the bill will certainly help 

those who are incarcerated, those who are not incarcerated. 

And from my perspective, I have a grant right now that is from 

the Center for Substance Abuse and Mental Health Service Administration, SAMHSA, and the Center for Substance Abuse Prevention, CSAP, and right now just what you are talking about we want 

to see being done for them, I am doing it already for the public. 

So if we can do it, and SAMHSA has the need to show that it 

is needed and necessary for the general public, why shouldn’t we 

do it for those who have been incarcerated? That is one of the 

issues that I think makes it so unique and special. 

And we are doing free testing. So why wouldn’t the Federal Government want to test these people before they enter the penal institution? 

That is why I am so strong and I feel so good about it, is because 

I am there, I am in the community. 

And within the penal institution you must realize that there will 

be some type of sexual activity going on among these men. If you 

don’t test to make sure and then give them the information that 

is needed so that if I know what the possibilities are and the information is being given to me or we will looking at it, then we have 

a better chance of preventing it. 

But if we do the laymen thing and act as though it is not going 

to happen and say, well, we will deal with that later, then the 

penal institutions have the problems with the medical part of it, 

and then as they come out to the public, there is another problem. 

So I think the bill will serve not only the penal system, but it 

will serve the community to let them know that we are doing this 

testing to make sure that if a person has this virus, at least we 

will test to find out, so that we will have some indication of what 

is going in and what is going out. 

14 

1Disease Profile of Texas Prison Inmates Pg. 4–5, Baillargeon, Jacques Ph.D., Black, Sandra 

A. Ph.D., Dunn, Kim M.D., and Pulvino, John P.A. 2 Ibid Pg. 7 

3 Ibid Pg. 10 

And then I have transitional housing, where I have transitional 

housing for those that come out of the penal institution. So when 

we talk about jobs and opportunities for them, the first thing they 

want to know, well, do they have any ailments, do they have any 

sicknesses, have they been tested for this. That is the first thing 

the employer wants to know. So if you do that and test them before 

they come out, then that means that also we save again, because 

they may have a better opportunity to get a job. 

So I am much in favor of it, and I appreciate the fact of being 

able to come and at least make the testimony before you, because 

I know that this is an important step in trying to make sure that 

we address this issue. 

That is basically about all I have to say about it. It is just that 

it is something that is needed. I appreciate the fact that you all are 

taking the initiative to put forth this bill. And I hope that anything 

that we can do and say in our community will help you. 

[The prepared statement of Mr. Mitchell follows:] 

PREPARED STATEMENT OF WILLIE MITCHELL

In 2006, the HIV/AIDS virus pandemic reached a milestone our world hoped it 

never would; 25 years of existence. The HIV/AIDS virus is one that has touched 

lives from all backgrounds regardless of class, race, gender, or geographic location. 

While there are many factors which contribute to the number of men and women 

infected with HIV/AIDS virus, those individuals who are or have been incarcerated 

are not to be excluded. According to an unpublished report done by the U.S. Department of Justice in a report done in 2002 titled Disease Profile of Texas Prison Inmates; ‘‘. . . study shows that for a number of conditions, the prison population exhibited prevalence rates that were substantially higher than those reported for the 

general population.’’ 1 Upon entry into the Texas Department of Criminal Justice 

(TDCJ) system for any duration of time, all inmates receive a medical and mental 

health examination; however it does not currently include testing for the HIV/AIDS 

virus. 

Therefore it would only be prudent for the state to do so in order to take a 

proactive approach and reduce the number of individuals infected along with the potential of infecting others with the HIV/AIDS virus. ‘‘. . . infection with HIV was 

more common among black females than among either white or Hispanic females.’’ 2

The need for testing before and after incarceration is not only a social injustice; 

however it also has the potential to be an economic injustice. Social in the sense 

that individuals infected with the virus who are from low income backgrounds can 

only create future financial responsibilities to the state in addition to the country. 

Economic in the sense that it costs the state thousands of dollars each year to provide health care, medications, housing, along with other welfare benefits; all at the 

expense of both the state and the country. The federal government cannot wait for 

individuals to become infected with this virus; it must act now and address the 

issues with a proactive mentality. The report further indicates that, ‘‘the high rates 

of HIV among prison populations are attributable to high-risk behaviors in which 

a number of criminals reportedly engage prior to incarceration. For example, 40 to 

80 percent of prison inmates are reported to have used intravenous drugs.’’ ‘‘Eleven 

percent of incarcerated men are reported to have had sex with a prostitute, while 

between two and group percent are reported to have engaged in bisexual or homosexual relationships.’’ 3 The lack of mandatory HIV/AIDS screening process in place 

within the TDCJ system during the study period may likely contribute to the underestimation of the actual cases that exist. The absence of a clear understanding of 

the number of cases is a danger not only to the individual who is infected, the community at large, and the many correctional facility professionals whose lives are at 

risk if an individual does not know their status. Furthermore, ‘‘research indicates 

the following factors may contribute to prisoners’ excess disease prior to incarceration: low socioeconomic status, poor access to health care in their home commuVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00018 Fmt 6633 Sfmt 6621 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
15 

4 Ibid Pg. 12 

nities, and high risk behaviors. Following incarceration, a number of environmental 

factors including crowded living conditions, lack of temperature control, poor sanitation, and increase psychological stress may further contribute to excess disease 

among inmates.’’ 4

Testing inmates for the HIV/AIDS virus is one of many that is needed to ensure 

the health and wellness of the incarcerated population and correction facility professionals who serve them everyday. The Hepatitis virus is another fatal illness that 

is often associated with high risk populations of which many incarcerated men and 

women are. The report also made reference to the increase rates of the transmittal 

of the Hepatitis virus through risky behavior such as multiple partners, male to 

male sex, and intravenous drugs. Currently in the state of Texas, it is a challenge 

to receive testing and aftercare in the event an individual becomes infected; this 

virus equally deserves the attention of our state and national government. 

16 

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Mr. SCOTT. Thank you very much, Mr. Mitchell. 

Let me just ask you one quick question; we usually defer questions until the end. But in your experience and education, how do 

you make sure that inmates actually learn the material, particularly when you consider that it has to be presented in a culturally 

sensitive manner? 

Mr. MITCHELL. Well, the culturally sensitive manner, I don’t 

have a problem with that, because I think with the virus as deadly 

as it is, if we don’t do it, then we are not serving the community. 

I don’t think that you can make this an easy thing to say. I don’t 

think there is a special way to do it. 

I think that because they have been incarcerated and for what 

the problems are while you are incarcerated, I think you have to 

have more education in terms of educating the inmates to it and 

putting out or disseminating information that they can read, such 

as pamphlets. They have a lot of down time, where at night they 

could read the pamphlets about the AIDS virus and what it causes. 

So I think if there is some information given to them, that they 

can readily read—on bulletin boards. We all know the best way to 

get a product sold is through advertising, so if we want to sell this 

product, why don’t we advertise it within the penal institution? 

And I think that is just a good business principle, that if you want 

to have some results, advertise it within the penal institution so 

that they will know what the cause and effects are. 

Mr. SCOTT. Thank you. 

Ms. Waters, do you have any questions for Mr. Mitchell? He has 

a plane to catch. He will be leaving. 

Ms. WATERS. No. I want to thank Mr. Mitchell very much. I did 

have an opportunity to talk with him a little bit earlier when I was 

here. You were over there, and I should have been over there too. 

However, I do thank you for being here today, and I certainly appreciate the work that you are doing and for your particular knowledge about what is going on in our prisons. 

You are there. You see the inmates. You have a sense of how information is disseminated. You have enough knowledge about this 

to know that they can benefit from this program that we are trying 

to institute to save lives and to save the lives of mates on the outside. 

So I just thank you for being here today and coming from so far 

to share this testimony with us. Thank you. 

Mr. MITCHELL. Ms. Waters, I appreciate that. 

It is one thing to know that within our community, within the 

African-American community, this virus has escalated, and the fact 

of the matter is that we need to make sure that there is an awareness brought about, and if we don’t do that, then the virus continues to happen. Nobody will take the fact that we need to do 

something. 

And I think this is one step in saying that within the penal system, we are going to do something. And I think from the Federal 

level, it says a lot about you all as Members of the Committee who 

are trying to allocate money for it. The States may have a difficult 

time, but I think from a Federal standpoint you all are doing an 

exciting job in doing this. 

41 

And I would just ask all of you, go visit a Federal penal institution, and it will help you to make some good choices on what is 

going on there. It may be a system that we have to house people 

that have committed certain crimes, but they do a tremendous job 

in trying to rehabilitate those people and give them an opportunity 

for other jobs as they come out so that they can become productive 

citizens. It is a wonderful system, and I wish the States would 

adopt some of the things that we do in the Federal institutions. 

Ms. WATERS. Thank you very much. 

Mr. SCOTT. Thank you. 

Visit the prisons is on our agenda. Mr. Forbes and I are looking 

for prisons to visit right now, and we expect there to be more than 

one. So thank you for that recommendation. 

Mr. MITCHELL. Thank you, Mr. Chairman. 

Mr. SCOTT. Mr. Brown, you are recognized for 5 minutes. 

TESTIMONY OF DEVON BROWN, DIRECTOR, DEPARTMENT OF 

CORRECTIONS FOR THE DISTRICT OF COLUMBIA, WASHINGTON, DC 

Mr. BROWN. Good afternoon, Mr. Chairman and Members of the 

Subcommittee. I am Devon Brown, director of the District of Columbia Department of Corrections. 

I appear before you today as a 33-year correctional executive 

whose experience includes leadership at both the State and local 

levels within Maryland, New Jersey and the District of Columbia 

correctional systems. I do so in firm support of House Resolution 

1943. 

Having spent the entirety of my career as a public servant in the 

proud membership of the correctional profession, I am acutely 

aware of the many challenges and demands of its operations and 

gravity of responsibilities. 

Having functioned as the director of the Montgomery County Department of Corrections and Rehabilitation in Maryland, warden of 

two of Maryland’s maximum security institutions and as a forensic 

psychologist, I have faced many concerns and issues existing within 

prison walls but ultimately having impact upon all of society. None 

are more important than those addressed by H.R. 1943 as it recognizes the growing interface between public safety and public 

health. 

This bill, like similar ones enacted throughout the country, recognizes the critical significance of diagnosing, educating and treating, 

where appropriate, all inmates for HIV/AIDS as they enter, reside 

within and leave prison gates. 

The proposed legislation understands that, as we speak, over 2.2 

million prisoners are currently incarcerated within our country’s 

prisons and jails with over 600,000 of them returning to our communities each year. These individuals will be re-establishing themselves in our villages, our hamlets and neighborhoods, with many 

securing employment in fields requiring routine and close interaction with the public. 

Of acute concern is the realization that approximately 3 to 5 percent of them will be released from confinement with HIV and 

AIDS, a statistic which is five times the rate of prevalence in the 

general population. 

42 

These individuals will return to their families, resituate themselves and resume their lives infected with a highly pernicious, destructive and contagious disease. Many will be unaware that they 

are the host of this acutely devastating virus, nor will they know 

that their disorder has the potential of being innocently passed on 

to unsuspecting others both within and outside of prison gates. 

H.R. 1943 endeavors to promote public health for all of the country by ensuring that inmates are automatically tested for HIV and 

AIDS upon commitment to Federal custody, educated about the disease and treated. Moreover, they are again tested upon completing 

their term of incarceration. 

These provisions are consistent with the Centers for Disease 

Control recommendations and those of several other jurisdictions, 

among them the District of Columbia. As a means to offset the fiscal resources necessary to implement this legislation, funding is 

available through SAMHSA with guidance provided by the CDC. 

As correctional systems take on an increasing and more vital role 

in promoting the vibrancy of our communities, their efforts must 

include doing more to contain the spread of HIV and AIDS. Inasmuch as 90 percent of all HIV-positive cases detected in prisons reportedly involve those who have contracted the infection prior to incarceration, the proposed legislation will also play an important 

role in protecting the health of the brave men and women who 

serve the people of this country each day through their employment 

within correctional facilities. 

By diagnosing, educating and treating the inmate population 

who possess the disorder, it is less likely to be spread to prison 

staff as well. House Resolution 1943 recognizes this necessity. Its 

enactment is in the best interest of our correctional systems and 

the public they serve. 

In recognition of this reality, last June the District of Columbia 

Department of Corrections became the first municipal detention facility in the United States to comprehensively expand its existing 

inmate health care services to address the HIV pandemic by integrating automatic HIV testing into its routine medical intake operations and release procedures. 

As most correctional systems test for HIV under limited, voluntary conditions, our approach in automatically testing all detainees at the front and back end of incarceration is highly congruent 

if not identical with the elements of H.R. 1943 and stands as indisputable evidence of the feasibility as well as success of these procedures. 

Our condom distribution program, implemented during the early 

1990’s, was likewise one of the first initiatives of its kind in the 

Nation and complements our automatic HIV testing strategy by 

contributing to the deterrence of the disease’s transmission. The 

condom distribution initiative began at a time when only a handful 

of correctional systems supported such a response to controlling 

HIV in correctional settings. 

It is important to note that while our departmental policy strictly 

prohibits sexual activity among inmates, the HIV/AIDS issue is 

considered more insidious than the consequences resulting from inmates committing consensual sex-related infractions. 

43 

In conclusion, I leave you with these observations made in 1929 

by the National Society for Penal Information, as conveyed in a 

publication entitled, ‘‘Health and Medical Service in American Prisons and Reformatories,’’ by F.L. Rector. And I quote: ‘‘Viewed from 

whatever angle, whether social, economic, administrative or moral, 

it is seen that adequate provision for health supervision of the inmates of penal institutions is an obligation which the State cannot 

overlook without serious consequences to both the inmates and the 

community at large.’’ 

These resounding words are as true today as when related over 

7 decades ago. As it relates to HIV/AIDS transmission, the health 

of our Nation shall be greatly influenced by the manner in which 

we address our prisons. 

House Resolution 1943 affirms this truth. Recognizing the profound importance that this bill will have in furthering the health 

of all citizens, I enthusiastically support its passage. 

Mr. Chairman, this concludes my testimony. 

[The prepared statement of Mr. Brown follows:] 

PREPARED STATEMENT OF DEVON BROWN

Good Morning Mr. Chairman and members of the Judiciary Committee, I am 

Devon Brown, Director of the District of Columbia Department of Corrections. I appear before you today as a 33-year correctional executive whose experience includes 

leadership at both the State and local levels within Maryland, New Jersey State, 

and the District of Columbia correctional systems. I do so in firm support of House 

Resolution 1943. 

Having spent the entirety of my career as a public servant in the proud membership of the correctional profession, I am acutely aware of the many challenges and 

demands of its operations and gravity of responsibilities. Having functioned as the 

Director of the Montgomery County Department of Corrections and Rehabilitation, 

warden of two of Maryland’s Maximum Security institutions and as a forensic psychologist, I have faced many concerns and issues existing within prison walls but 

ultimately having impact upon all of society. None are more important than those 

addressed by H.R. 1943 as it recognizes the growing interface between public safety 

and public health. 

This bill, like similar ones enacted throughout the country, recognizes the critical 

significance of diagnosing, educating, and treating, where appropriate, all inmates 

for HIV/AIDS as they enter, reside within, and leave prison gates. The proposed legislation understands that as we speak, over 2.2 million prisoners are currently incarcerated within our country’s prisons and jails with over 600,000 of them returning to our communities each year. These individuals will be re-establishing themselves in our villages, hamlets, and neighborhoods, with many securing employment 

in fields requiring routine and close interaction with the public. Of acute concern 

is the realization that approximately 4–5% of them will be released from confinement with HIV/AIDS, a statistic which is five times the rate of prevalence in the 

general population. These individuals will return to their families, resituate themselves and resume their lives infected with a highly pernicious, destructive, and contagious disease. Many will be unaware that they are the host of this acutely devastating virus, nor will they know that their disorder has the potential of being innocently passed on to unsuspecting others both within and outside of prison gates. 

H.R. 1943 endeavors to promote public health for all of the country by ensuring 

that inmates are automatically tested for HIV/AIDS upon commitment to federal 

custody, educated about the disease and treated where warranted. Moreover, they 

are again tested upon completing their term of incarceration. These provisions are 

consistent with the Centers for Disease Control (CDC) recommendations and those 

of several other jurisdictions among them the District of Columbia. As a means to 

offset the fiscal resources necessary to implement this legislation, funding is available through the U.S. Department of Health Department with guidance provided by 

the CDC. 

As correctional systems take on an increasing and more vital role in promoting 

the vibrancy of our communities, their efforts must include doing more to contain 

the spread of HIV/AIDS. Inasmuch as 90% of all HIV positive cases detected in prisons reportedly involve those who have contracted the infection prior to incarcerVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6621 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
44 

ation, the proposed legislation will also play an important role in protecting the 

health of the brave men and women who serve the people of this country each day 

through their employment within correctional facilities. By diagnosing, educating, 

and treating the inmate population who possess the disorder, it is less likely to be 

spread to prison staff as well. House Resolution 1943 recognizes this necessity. Its 

enactment is in the best interest of our correctional systems and the public they 

serve. 

In recognition of this reality, last June the District of Columbia Department of 

Corrections became the first municipal detention facility in the United States to 

comprehensively expand its existing inmate health care services to address the HIV 

pandemic by integrating automatic HIV testing into its routine medical intake and 

release procedures. As most correctional systems test for HIV under limited, voluntary conditions, our approach in automatically testing all detainees at the front 

and back end of incarceration is highly congruent with the elements of H.R. 1943 

and stands as indisputable evidence of the feasibility as well as success of these procedures. Our condom distribution program, implemented during the early 1990’s, 

was likewise one of the first initiatives of its kind in the nation and complements 

our automatic HIV testing strategy by contributing to the deterrence of the disease’s 

transmission. The condom distribution initiative began at a time when only a handful of correctional systems supported such a response to controlling HIV in correctional settings. It is important to note that while our departmental policy strictly 

prohibits sexual activity among inmates, the HIV/AIDS issue is considered more insidious than the consequences resulting from inmates committing consensual sex related infractions. 

In conclusion, I leave you with these observations made in 1929 by the ‘‘National 

Society for Penal Information’’ as conveyed in a publication entitled, Health and 

Medical Service in American Prisons and Reformatories, by F.L. Rector: 

‘‘Viewed from whatever angle, whether social, economic, administrative, or 

moral, it is seen that adequate provision for health supervision of the inmates 

of penal institutions is an obligation which the state cannot overlook without 

serious consequences to both the inmates and the community at large.’’ 

These resounding words are as true today as when related over 7 decades ago. 

As it relates to HIV/AIDS transmission, the health of our nation shall be greatly 

influenced by the manner in which we address our prisons. House Resolution 1943 

affirms this truth. Recognizing the profound importance that this bill will have in 

furthering the health of all citizens, I enthusiastically support its passage. 

Mr. Chairman, this concludes my testimony. I would be pleased to respond to any 

questions that you may have of me at this time. Thank you. 

Mr. SCOTT. Thank you, Mr. Brown. 

Mr. Jones? 

TESTIMONY OF VINCENT JONES, EXECUTIVE DIRECTOR, 

CENTER FOR HEALTH JUSTICE, WEST HOLLYWOOD, CA 

Mr. JONES. Good afternoon, Mr. Chairman and Members of the 

Committee. My name is Vincent Jones. I am the executive director 

of the Center for Health Justice. 

The Center for Health Justice is the Nation’s only nonprofit organization solely focused on HIV prevention and treatment education 

for incarcerated populations. Our mission is to empower people affected by HIV in incarceration to make healthier choices and to advocate for the elimination of disparities between prisoner health 

and public health. 

More specifically, we provide treatment adherence education to 

positive inmates, prevention education to incarcerated women and 

men at high-risk for HIV infection, and supportive services to positive parolees upon release. 

We are the Nation’s largest provider of condoms inside correctional facilities, and run a nationwide toll-free prevention and 

treatment hotline for inmates. We also have an active policy and 

advocacy team. 

45 

The Center for Health Justice was founded in 2000 by advocates 

with over 20 years’ experience in the field to focus treatment, advocacy and prevention efforts for the incarcerated population, an 

often-forgotten subset of Americans. 

Our work is guided by the principle that prevention and treatment in correction facilities should be equal to that of the general 

public. We call this health justice. 

In general, positive people in the community have access to quality medical care, medications, treatment education and advocacy 

and support services, and so should positive prisoners. Positive and 

at-risk folks in the community have access to education, condoms 

and hotlines. So should prisoners. 

Our staff and board have examined H.R. 1943, the Stop AIDS in 

Prison Act, through the lens of Health Justice and decided to support this bill. We applaud Congresswoman Maxine Waters for recognizing the intersection of HIV and correctional facilities and 

thank her for her leadership on this very important issue. 

Before I tell you why we support the Stop AIDS in Prison Act, 

let me share some facts. 

In the United States, one in four people with HIV pass through 

a jail or prison each year; 26 years into the epidemic, a quarter of 

those with HIV are undiagnosed. Women, especially women of 

color, constitute an increasingly large proportion of new infections. 

And this might come as a surprise to some, but over 90 percent 

of people in prison or jail return to their communities in a matter 

of months, bringing back to their communities the effects of poor 

HIV medical treatment and prevention efforts inside. 

But there is a silver lining. The simplest and most cost-effective 

way to address the HIV pandemic is through education and primary care providers, but incarcerated populations generally lack 

formal schooling and adequate health care. Hence, in-custody programs often mark their first and only opportunity for HIV prevention and treatment education and the best teachable moment, 

when they are sober, contemplative and in a single-sex environment. 

The Stop AIDS in Prison Act recognizes those facts and takes advantage of this public health opportunity incarceration presents 

without taking advantage of prisoners and their decreased capacity 

to decline or meaningfully consent to participation and intervention. 

It also encourages routine HIV testing in a manner that mirrors 

testing in the general public and approaches treatment holistically 

and also updates the formulary rules in a manner that will enhance confidentiality and help extend the lives of Americans living 

with HIV. 

Now for a few statistics. Controlling the epidemic begins with 

more people knowing their status. HIV testing upon request is the 

norm in the general public and should be the case inside correction 

facilities. We are delighted that H.R. 1943 stipulates that an inmate’s request for a test cannot be used against her or him in a 

punitive manner. The fewer disincentives to testing that exist, the 

greater likelihood that an individual would choose to be tested and 

begin to make healthier choices upon learning their HIV status. 

46 

While we believe it is important for more people to know their 

status, we know that inmates are more likely to make healthier 

choices after learning their status if they choose to take the test 

themselves rather than have that choice imposed upon them. For 

that reason, we are happy that this bill provides a clear opt-out 

provision for inmates. 

The bill further requires that testing be offered upon entry and 

release and contrasts legislation proposed from other jurisdictions 

requiring testing only upon exit. Testing upon entry and release is 

preferable because it allows an individual receiving a positive diagnosis to do so in an environment where he or she can receive required care rather than just a diagnosis upon departure. 

We also like the strong pre-test and post-test counseling as it 

helps inmates to understand the ramifications of a positive or a 

negative result. 

We are also pleased that this bill calls for comprehensive treatment. Not only is comprehensive treatment the goal in the general 

public, but it is a more effective approach to reducing reinfection 

and prolonging lives. 

Providing for a formulary that will contain all the FDA-approved 

medications necessary to treat HIV and AIDS and providing for 

automatic renewal systems for medications and requiring that 

medical and pharmacy personnel provide timely and confidential 

access to medication are all essential to providing quality care in 

prison. And we are happy that these issues are addressed in the 

bill and reflect the authors’ comprehensive understanding of the 

challenges of HIV care in incarcerated settings. 

At the Center for Health Justice, we assist inmates in developing 

pre-release plans that take their health into consideration and 

know the effectiveness of these types of tools. We are also happy 

that this bill provides a similar planning. 

Finally, the exposure incident provision in this bill is one in 

which we look forward to working with the author to improve. It 

could be argued that this provision makes prisoners living with 

HIV the subject of scrutiny rather than members of our community 

to be supported with increased counseling and testing and educational resources. We agree with the goal of reducing intramural 

HIV transmissions, including to staff, but we believe this can be 

done in a different manner. 

In closing, I cannot thank you enough for the opportunity to provide our expertise to those whose goals are consistent with our mission. The passage of this bill will help plug a huge gap in our Nation’s plan to reduce the spread of HIV and extend the lives of 

Americans living with the virus. 

I welcome the opportunity to show any of you how our programs 

work in real incarcerated settings, as that can help you understand 

why we believe that the bill is so essential. 

Thank you. 

[The prepared statement of Mr. Jones follows:] 

PREPARED STATEMENT OF VINCENT JONES

Good morning. My name is Vincent Jones. I am the Executive Director of the Center for Health Justice, an organization based in Los Angeles. The Center for Health 

Justice empowers people affected by HIV and incarceration to make healthier 

47 

choices and advocates for the elimination of disparities between prisoner health and 

public health. 

More specifically, Center for Health Justice provides treatment adherence education to HIV+ inmates, HIV prevention education to incarcerated women and men 

at high-risk for HIV infection, and supportive services to HIV+ parolees upon release. We are also the nation’s largest provider of condoms inside correctional facilities, and provide prisoners access to condoms in the Los Angeles and San Francisco 

County Jail systems. Finally we run a nationwide HIV prevention hotline that prisoners may call collect while incarcerated. 

The Center for Health Justice was founded in 2000 by HIV advocates with over 

20 years experience in the field to focus HIV treatment advocacy and prevention efforts on incarcerated populations, an often forgotten subset of the HIV community. 

But ignoring this population is the detriment of us all. 

Here are the facts: In the US one in four people with HIV pass through a jail 

or prison each year; 26 years into the epidemic a quarter of those with HIV are 

undiagnosed. Women, especially women of color, constitute an increasingly large 

proportion of new infections. And this might come to a surprise to some but over 

90% of people in prison or jail return to their communities in a short period of time, 

bringing back to their communities the effects of poor HIV medical treatment and 

prevention efforts inside. 

The fundamental tenet of our organization is the principle that HIV prevention 

and treatment in correctional facilities should be equal to that of the general public. 

We call this health justice. In general, HIV+ folks in the community have access 

to quality medical care, HIV medications, treatment education and advocacy and 

support services: HIV+ prisoners should also. HIV+ and at-risk folks in the community have access to prevention education, condoms and HIV hotlines that provide 

information to reduce the risk of transmission: HIV+ and at-risk prisoners should 

to. 

Applying principle of Health Justice to the real world is not only the right thing 

to do but it is also good policy. 

Today, I am here to tell you that our staff and board have examined HR 1943, 

the STOP AIDS in Prison Act of 2007 through the lens of Health Justice and decided to support this legislation. We applaud Congresswoman Maxine Waters for 

recognizing the intersection of HIV and correctional facilities and thank her for her 

leadership on this very important issue. 

As you know the purpose of the bill is to stop the spread of HIV and AIDS among 

prisoners, to protect staff from HIV infection, to provide comprehensive medical 

treatment to prisoners who are living with HIV, to promote HIV awareness and prevention among prisoners, to encourage prisoners to take responsibility for their own 

health and to reduce the transmission of HIV in prison. 

We like the fact that many elements of this legislation conforms with existing 

standards and practices employed outside of correctional facilities. More specifically: 

• Testing and Counseling upon intake is consistent with the provision of 

testing to individuals who are not incarcerated. The strong pre and post test 

counseling component of the legislation is critical because it helps inmates 

understand the potential ramifications of a positive OR a negative result. In 

either instance, it is incumbent upon them to make healthier choices and appropriate counseling and education makes that more likely. 

• Improved HIV Awareness through Education is critical. The simplest 

and most cost-effective way to address the HIV epidemic is through education 

and primary care providers, but incarcerated populations generally lack formal schooling and adequate healthcare. Hence, in-custody programs often 

mark their first and only opportunity for HIV prevention education and in the 

best teachable moment: when constituents are sober, contemplative, and in 

single sex environments. In our experience while education is available to 

some portion of prisoners at some times in some facilities, all programs could 

benefit from increased access by community service providers and health departments and prisoner peer educators to provide HIV education. We particularly support the provision of educational materials to be available at intervals during incarceration including at orientation, in medical clinics at regular educational programs and prior to release. In our experience education, 

particularly about a sensitive topic as HIV, is best reinforced frequently and 

provided repeatedly to individuals who at various points during their lives 

and incarceration may be more open to receiving such information. 

• Controlling the HIV epidemic begins with more people knowing their HIV status. HIV Testing upon request is the norm in the general public and 

should be the case inside correctional facilities as well. We are delighted that 

48 

the legislation stipulates that an inmate request for an HIV test can not be 

used against her or him in a punitive manner. The few obstacles to testing 

that exist the greater likelihood that an individual will choose to be test and 

begin to make healthier choices upon learning their HIV status. 

• The encouragement of HIV testing of pregnant women is also critical and is 

the norm in the general population. We know that we can stop the transmission of HIV from a mother to her child if the appropriate treatment is 

given at the right time. 

• By doing HIV prevention and treatment education in correctional facilities for 

the past seven years, we know that HIV is often one a myriad of issues that 

our clients face. For this reason, we apply a holistic approach to treatment. 

We are pleased that this bill calls for comprehensive treatment as well. Not 

only is comprehensive HIV treatment the goal in the general public but it is 

a more effective approach to reducing re-infection and prolonging lives. The 

confidential counseling and voluntary partner notification aspects of this legislation are important too because they help to create an environment in 

which HIV positive inmates will seek out and adhere to treatment. 

• Providing for a formulary that will contain all of the FDA-approved medication necessary to treat HIV/AIDS is essential. The science around HIV is constantly evolving and the disease affects people differently. One drug that does 

the trick for one person may not work at all for another. The provision of 

automatic renewal systems for medication is also essential and we’re glad it’s 

included in this bill. It is not uncommon for inmates to go without medications for weeks because their prescription expired after three months—but access to a physician to renew them took more than that time. We were able 

to resolve this issue with the Sheriff’s Department of Los Angeles County, 

and we are happy to see that this specific issue was addressed in this bill. 

It reflects the author’s comprehensive understanding of the challenges of HIV 

care in an incarcerated setting. 

• Requiring that medical and pharmacy personnel provide timely and confidential access to medications similarly reflects that the author of the legislation 

understands that in correctional settings it is difficult to provide medications 

in a way that protects confidentiality. In our experience, HIV+ prisoners’ confidentiality is often violated when medications are distributed to folks in long 

lines and without a way to conceal the type of medication being distributed. 

And as you know, one’s HIV positive status is a highly protected status in 

terms of confidentiality law in the general public and should be in incarcerated settings due to the many real negative implications that can and do result from being HIV positive in prison or jail. 

• We assist inmates in developing pre-release plans that take their health into 

consideration and know the effectiveness of these types of tools. We are happy 

that this bill provides for similar planning especially. Many inmates often 

lack access to adequate health care but can be helped to surmount the obstacle with the proper planning 

• To our knowledge, no population is required to take an HIV test. We are 

happy that this bill provides a clear opt-out provision for inmates. While we 

believe it is important for more people to know their status, we know that 

inmates are more likely to make healthier choices after learning their status 

if they choose to take the test themselves. 

• The bill further requires that testing be offered upon entry and release, in 

contrast to legislation proposed in various other jurisdictions requiring testing 

only upon exit. Testing upon entry and release is preferable because it allows 

an individual receiving a positive diagnosis to do so in an environment where 

he or she can receive required care, rather than just a diagnosis upon departure. 

• The exposure incident provision in the bill is one which we look forward to 

working with the author to improve. It could be argued that this provision 

making prisoners living with HIV the subject of scrutiny rather than members of our community to be supported with increased counseling and testing 

and educational resources. We agree with the goal of reducing intra-mural 

HIV transmission including to staff but we believe this could be done in a different manner. 

49 

IN CONCLUSION

We are pleased that the Congress of the United States has taken official notice 

of the issue of HIV among the incarcerated. We support efforts to increase HIV testing in a manner that mirrors HIV testing in the community, takes advantage of the 

public health opportunity incarceration presents without taking advantage of prisoners and their decreased capacity to decline or meaningfully consent to participation in interventions. 

Thank you for the opportunity to provide our expertise to those whose goals are 

consistent with our mission: to empower those affected by HIV and incarceration to 

make healthier choices. 

Thank you. 

50 

ATTACHMENT 


Jones.eps
51 

Ms. WATERS. Thank you. 

Mr. SCOTT. Thank you. 

Mr. Fornaci? 

TESTIMONY OF PHILIP FORNACI, DIRECTOR, D.C. PRISONERS’ 

PROJECT, WASHINGTON LAWYERS’ COMMITTEE FOR CIVIL 

RIGHTS AND URBAN AFFAIRS, WASHINGTON, DC 

Mr. FORNACI. Good afternoon. Thank you. My name is Phillip 

Fornaci. I am director of the D.C. Prisoners’ Project at the Washington Lawyers’ Committee for Civil Rights. 

In that capacity, we work with folks who are incarcerated here 

in D.C. And as probably most of you are familiar, in D.C., all folks 

who are convicted of felonies are sent into the Federal Bureau of 

Prisons. So we work very closely with folks who are held in the 

Federal Bureau of Prisons. 

I wanted to thank the Chairman for having this hearing and to 

especially thank Congresswoman Maxine Waters for her leadership 

on this bill. It is a very important step in curbing the spread of 

HIV, which has decimated so many communities in this country. 

We believe that testing combined with effective AIDS education 

efforts can help to prevent new HIV infections. This is really where 

we are going. 

About a dozen years ago, I used to run the largest legal organization in D.C. that was geared toward protecting people against discrimination based on HIV. A dozen years ago, things were a little 

bit different. It was very common to have landlords who would not 

rent to someone with HIV, employers who would not hire someone, 

doctors who would not even treat someone with HIV. And a lot of 

that has changed, in part because there has been such a massive 

public education effort that has gone on over the years and the 

awareness has grown. 

But I think we need to remember that in jails and prisons, it is 

different. They have not had that exposure, generally speaking, to 

those kinds of educational efforts. It has not reached them or in 

any case has not been received. It is not been clear I think to a 

lot of prisoners how HIV is spread, how it affects people who have 

it. And discrimination is rampant in the world of folks who are incarcerated, in a world that is marked by violence and desperation. 

We had a case a few years ago that we actually just settled last 

year involving someone in a jail facility who, because he had some 

dispute with a corrections officer, that corrections officer posted his 

medical records on a bulletin board that was in a common area of 

the jail. That inmate was subjected to physical violence, his bed 

was burned, and faced harassment for the rest of his stay in jail. 

So we want to be aware that those kinds of things do happen, 

and they will happen again in the future. We want to try to prevent it, but this is the culture into which we are dropping this bill, 

and I think it is important that we understand that. 

Some comments on the legislation specifically. 

We commend the idea of comprehensive HIV education and the 

testing protocol, and particularly we would also like to commend 

the inclusion of the opt-out provision. Testing in itself will do nothing unless people are willing to do something with the test results. 

We can’t force people to get tested and say, ‘‘Ha, ha, you are posiVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
52 

tive,’’ and expect for a result to come out of it. It needs to be a voluntary process, as Mr. Jones has already testified, to make that effective. 

So I would urge you to certainly preserve the voluntary nature 

of the testing program, which is so crucial, and consider adding a 

written informed consent that is some kind of a sign-off for the individual prisoner to say, ‘‘Yes, I have been told I can opt out of it; 

I have decided to get tested,’’ or, ‘‘No, I have not.’’ 

We just want to make sure that there is no coercion in this whole 

process, which is very, very likely to happen without some kind of 

a formalistic process of informed consent. 

I have one concern with regard to the bill, and it is not so much 

concern about the bill but the environment in which we are bringing it into, is the confidentiality provisions. They could potentially 

be strengthened in the bill. And I wanted to give a few suggestions, 

and you may do with them what you may. They are in my written 

testimony. I will elaborate slightly. 

One is that we want to require that no non-medical staff have 

access to medical records. This is a basic premise, and it is generally the rule in most penal institutions but not always, and very 

often it happens that people have non-medical staff have access to 

medical records. When they do, it causes a problem. 

The other thing is there need to be swift and certain consequences, including potential job dismissal, for staff who allow 

confidential medical information, including information about HIV, 

to be released to another prisoner. This is where problems result, 

when the information becomes widely known and people become 

known as HIV-positive within a prison setting. It will lead to violence, undoubtedly. 

We also want to ensure that there is adequate staffing patterns 

so that people are protected from violence, which again we know 

is more common than we would like to think in these facilities. And 

there will be more of it when we are dropping in a situation where 

many, many people will be tested for HIV and many people who 

didn’t know they were positive were find out they are positive. 

Finally, I want to raise the issue of the Prison Litigation Reform 

Act. Actually it creates a little bit of a barrier to enforcing the confidentiality provisions of this bill. If, for example, the instance that 

I brought up earlier of a person whose medical records are posted 

on the wall, there would be no remedy for that person because of 

the Prison Litigation reform Act. Because it did not cause a physical injury to them despite that it caused much humiliation and 

pain and suffering, they would not be entitled to any kind of litigation as a result of that confidentiality breach. 

Finally, I just want to make one statement with regard to the 

HIV testing on re-entry, which is a great idea and I commend you 

for including that in the bill. I would again, though, specifically include language that I have put in my written testimony, basically 

that a refusal to take an HIV test will not affect the program placement or the person’s eligibility for a halfway house placement. And 

there is a very strong possibility of discrimination against people 

who decide they don’t want to be tested for whatever reason and 

they need to get into a halfway house. 

53 

We had an incident a few years ago, we had a case where one 

of our clients was to be released on parole, and it became known 

to the parole authorities that she was HIV-positive. She actually 

told them because she had taken coursework in how to live with 

your HIV diagnosis. She was denied parole. We had to bring actually a habeas corpus suit in that situation to win her release, in 

part because people didn’t understand HIV in the parole process. 

So I just wanted to raise some cautionary remarks. But again, 

I want to commend this Committee and particular Congresswoman 

Waters for bringing this. 

Thank you very much. 

[The prepared statement of Mr. Fornaci follows:] 

PREPARED STATEMENT OF PHILIP FORNACI

Thank you for this opportunity to provide testimony on H.R. 1943, the ‘‘Stop AIDS 

in Prison Act 0f 2007.’’ In particular, I would like to thank Representative Maxine 

Waters for her outstanding leadership on this issue, as well as the important roles 

played by Congressman Conyers, Congressman Smith, Congressman Scott, Congressman Forbes, Congresswoman Lee, and Congresswoman Christensen as co-sponsors. My name is Philip Fornaci. I am Director of the D.C. Prisoners’ Project, a section 

of the Washington Lawyers’ Committee for Civil Rights & Urban Affairs. Our organization represents D.C. prisoners held both locally in D.C. jail facilities as well as 

those held in the federal Bureau of Prisons (BOP), where those convicted of felonies 

in D.C. are sent. We advocate for appropriate medical care, protection from violence, 

and access to basic constitutional rights. 

Although D.C. prisoners are a small percentage of the overall BOP population, 

more than 7,000 D.C. prisoners are spread throughout 99 separate BOP institutions, 

and our organization receives correspondence from individuals living in as many as 

70 different facilities every year. Because we focus heavily on health care issues in 

the BOP, we have a great deal of experience with regard to medical care at a wide 

range of facilities. Additionally, because D.C. prisoners have a higher-than-average 

prevalence of HIV infection than other prisoners in the BOP, we have a broad perspective on issues facing people with HIV in these facilities. I appreciate the opportunity to comment on this legislation. 

The most significant aspect of the Stop AIDS in Prison Act is simply that it provides official recognition of the AIDS epidemic within the federal Bureau of Prisons 

(BOP). Because most prisoners in the BOP will eventually leave prison, BOP policies and procedures can have a strong impact on public health efforts to limit the 

spread of HIV outside of prison. Effective AIDS education programs, policies that 

encourage and support responsible behavior, and comprehensive medical treatment 

for people in BOP custody are therefore extremely important for all Americans. 

HIV TESTING

The centerpiece of the Stop AIDS in Prison Act is its mandate for routine HIV 

testing in all BOP facilities in the context of pre- and post-test counseling. I commend the bill’s sponsors for recognizing that ‘‘routine HIV testing’’ requires provisions to allow people to ‘‘opt out’’ of HIV testing if they choose to do so, while also 

giving prisoners an opportunity to receive this important information about their 

health. 

The opt-out provision is particularly important because, consistent with the goals 

of the legislation, it does not simply coerce prisoners into learning their HIV status. 

It recognizes that prisoners need to choose to be tested for the goals of the legislation to be achieved. Effective HIV prevention requires HIV education, along with 

testing, so that people can change their behaviors. The prisoner must enter the process voluntarily, be willing to learn about how to protect himself and others from infection, and use that information when he is released. A more coercive approach 

that does not allow a prisoner to decline testing is unlikely to be effective in achieving the educational purposes behind testing. HIV testing on its own does nothing 

to prevent the spread of HIV. What happens after testing is crucial. 

Recommendation: Written Informed Consent. To preserve the viability of the 

opt-out provision, and to ensure that all prisoners recognize that they have the ability to refuse testing, it is extremely important that the bill be amended to include 

provisions for written informed consent. Currently, there are no controls in place 

54 

that will ensure that prisoners have free choice to exercise their opt-out right, and 

there is significant room for coercion. Remedying this need not be complicated. In 

order to ensure that prisoners are aware that they have the right to be tested, and 

the right to refuse to be tested, the BOP can design a simple form to that effect, 

which would remain in the prisoner’s medical file. It would also ensure that, rather 

than simply telling prisoners that they have a free choice around testing, there are 

actual procedures in place documenting a prisoner’s exercise of that choice. 

HIV TREATMENT

Another important aspect of the bill is the requirement that prisoners testing 

positive for HIV receive comprehensive HIV treatment. Although the BOP is required to provide constitutionally-mandated levels of medical care, it is not always 

delivered in every BOP facility. We frequently receive reports from men and women 

who have been denied consistent HIV treatment while in the BOP, with frequent 

treatment interruptions. Some BOP facilities tend to provide only the most minimal 

treatment for HIV, changing medications in favor of the least-expensive treatments, 

regardless of their effectiveness. (This is particularly a problem in privately-owned 

facilities that contract with the BOP.) Other facilities have chaotic health care delivery systems that result in prisoners missing treatments or receiving the wrong 

medicines. 

It is important to recognize that treatment for HIV also requires that facilities 

provide adequate levels of general health care. People with HIV often also have hypertension, diabetes, or hepatitis. ‘‘Comprehensive medical treatment to inmates 

who are living with HIV/AIDS’’ (section 2(b)(1)) must also include treatment for nonHIV conditions for people who also have HIV. 

It is my hope that, with enactment of this legislation, the BOP will take this legislative mandate seriously, effectively monitoring its facilities to ensure that every 

prisoner’s serious medical needs are being met. At this point, no such effective monitoring process is in place. 

CONFIDENTIALITY CONCERNS

The bill contains language aimed at protecting the confidentiality of HIV-related 

medical information (section 3(7)), but this language is unfortunately inadequate for 

the important task at hand. Although stigma and prejudice associated with HIV infection have decreased to some extent in the broader society over the last twenty 

years, people with HIV still suffer from job and housing discrimination as a result 

of their HIV status. Despite many years of public education, huge segments of the 

U.S. population still retain false information about HIV and about the people who 

live with it. Unfortunately, HIV is not treated like other diseases. 

Within the walls of any BOP prison, however, the situation is far worse. HIV is 

not treated like diabetes or hypertension. People with HIV in jails and prisons 

across the U.S. are isolated and singled out for violent treatment. Outmoded beliefs 

about how HIV transmission occurs, as well as false stereotypes about people infected with HIV, are commonplace. It becomes fodder for homophobic attacks and 

physical violence. Ignorance about HIV runs rampant not only among prisoners but 

among correctional and even medical staff as well. In the prison setting, where violence (including sexual assault) is ever-present, persons with HIV must keep their 

HIV status private for their own protection. Identifying as a diabetic or even someone with mental illness does not place people at risk of violence; identifying as HIVpositive may cost a prisoner his life. 

One example may be instructive. Our organization represented a man who, for 

reasons that remain unknown, had apparently gotten into a dispute with a correctional officer. That officer posted the man’s HIV medical records on a bulletin board 

in a common area in the facility. As a result, our client was threatened repeatedly 

through anonymous notes and, when he was moved to another facility, the threats 

continued and his bed was burned. Although he survived, he lived the rest of his 

sentence in fear of further attacks, knowing that both staff and prisoners were potential assailants. 

However, unlike in our case, where we were able to bring litigation under local 

law, the federal Prison Litigation Reform Act (PLRA) will prevent any BOP prisoner 

whose confidentiality has been breached from enforcing this provision of the bill. 

There is no way for a prisoner to enforce the confidentiality provisions of this bill, 

nor is there any way to recover damages for the terror, mental anguish, and threats 

that would result from a confidentiality breach. 

Recommendation: Strengthen the confidentiality provisions of this bill. 

As in the case described here, corrections staff themselves sometimes use HIV information to manipulate and harass prisoners, just as some staff commonly use inforVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6621 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
55 

mation about a prisoner’s sexual orientation or alleged status as a ‘‘snitch’’ to enforce a code of behavior. Simply educating staff about the importance of confidentiality will do little to deter such actions. In the context of this bill, where thousands 

of people with HIV will be identified, it is imperative that the BOP adopt strict procedures to protect prisoners potentially stigmatized by their HIV status. Specifically, 

enhanced confidentiality protections should include: 

• A requirement that no non-medical staff have access to confidential prisoner 

medical information. There is no security-based reason why a corrections office would need to know any confidential medical information, whether HIV 

status, a mental illness diagnosis, or cancer. 

• The guarantee of swift and certain consequences, including job dismissal, for 

staff who allow confidential medical information (including information about 

HIV status) to be released to another prisoner. 

• Adequate staffing patterns and transparent institutional rules protecting prisoners against violence from other prisoners, regardless of the cause of the violence. 

• Include under this bill an exemption from the PLRA’s physical injury and exhaustion of administrative remedies requirements to allow prisoners to file individual lawsuits to enforce this provision when corrections staff fail to protect their confidential medical information. 

HIV TESTING AND PAROLE

The requirement that prisoners be tested prior to release is a useful opportunity, 

and probably the most appropriate time for HIV testing. However, individuals may 

have their own reasons for not wanting to be tested while incarcerated and wish 

to exercise their opt-out rights. 

A few years ago, our organization represented a woman whose parole was denied 

because parole authorities found out she was HIV-positive. They discovered this because the woman revealed this fact herself, citing as proof of her educational 

achievements that she had completed a course in ‘‘Dealing with Your HIV Diagnosis.’’ The parole authorities, expressing a level of ignorance not uncommon in 

some parts of the broader community, decided that she would be a risk to the community. We had to file a habeas corpus petition to secure her release on parole, 

which was successful largely because the case generated some media attention. 

There are many other reasons why prisoners may not want to be tested prior to 

release, both practical and psychological. Their rights to refuse should not be taken 

lightly. 

Recommendation: Explicitly endorse the right to opt-out of testing prior 

to reentry. Although the bill refers back to the opt-out provision, that provision 

does not address issues like release to halfway house or other pre-release issues. 

Section 3(9) should also add language similar to: ‘‘However, the inmate’s refusal 

shall not be considered a violation of prison rules, result in disciplinary action, or 

affect program placement, including eligibility for halfway house placement. 

Thank you for this opportunity to provide comments on this important piece of 

legislation. I am available to answer any questions you may have. 

Mr. SCOTT. Thank you. 

Admiral Kendig? 

TESTIMONY OF REAR ADMIRAL NEWTON E. KENDIG, M.D., ASSISTANT DIRECTOR, HEALTH SERVICES DIVISION, FEDERAL 

BUREAU OF PRISONS, U.S. DEPARTMENT OF JUSTICE, WASHINGTON, DC 

Admiral KENDIG. Good afternoon, Chairman Scott, Ranking 

Member Forbes and Members of the Subcommittee. Thank you for 

the opportunity to discuss the Bureau of Prisons’ Infectious Disease 

Management Programs and the Stop AIDS in Prison Act of 2007. 

My name is Newton Kendig, and I serve as the medical director 

for the Federal Bureau of Prisons. Prior to my current position, I 

served as the Bureau of Prisons’ chief of infectious diseases. Previously I was medical director for the Maryland Department of CorVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00059 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
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rection and Public Safety and, prior to that, infectious disease fellow at Johns Hopkins University. 

I am board-certified in infectious diseases and internal medicine. 

I am also on faculty at Johns Hopkins University, where I provide 

care to patients with HIV infections and AIDS in a clinic at the 

university hospital. 

I believe the Stop AIDS in Prison Act of 2007 addresses an issue 

that is of great significance and importance to all of us who work 

in corrections and particularly to physicians who provide care to 

patients who are infected with HIV. 

Bureau of Prisons has a comprehensive infectious disease management program that has been remarkably effective in diagnosing 

and treating inmate patients with HIV infections as well as controlling the spread of HIV within the Federal prison system. 

The prevalence of HIV in the BOP’s inmate population has been 

between 0.9 percent and 1 percent, based on multiple surveillance 

testing. Currently the prevalence of diagnosed HIV infection is 0.9 

percent. 

Acquisition of HIV infection among inmates in the Bureau of 

Prisons is exceedingly rare. In a 1999 admission cohort, 4,826 inmates without HIV infection were retested several times over a 2- 

year period, with only one conversion. 

All sentenced inmates in the Bureau of Prisons receive a physical 

examination within 14 days and a preventative health assessment 

within 6 months of arrival at an institution. The assessment includes screening for signs and symptoms of HIV infection. HIV 

testing is conducted for all inmates with risk factors for infection 

and when otherwise clinically indicated. 

Inmates are reassessed at least every 3 years through their incarceration as part of our preventive health care program. 

Inmates are also subject to health care assessments during routine and non-routine physical examinations and during chronic 

care appointments. These visits provide ongoing opportunities for 

HIV testing throughout incarceration, including testing prior to release. 

With our infectious disease management program, the Bureau of 

Prisons has the following general categories of inmates for the 

presence HIV: inmates who volunteer at any time, when testing is 

clinically indicated, following a blood exposure event and during 

surveillance testing conducted randomly or serially. 

We are aware of the newly issued guidelines by the Centers for 

Disease Control and Prevention that recommend community standards be changed to include HIV screening as a part of routine clinical care in all health care settings. We have concerns, however, 

with the requirement in this bill to test all Federal inmates upon 

release, even in the absence of clinical indications. 

The Bureau of Prisons believes this testing requirement is not 

consistent with practical medical judgment for the Federal inmate 

population. Our available incident data and clinical experience indicate that Federal inmates are rarely contracting HIV infection 

while incarcerated in the BOP. 

We have been extremely successful in controlling HIV transmission within our facilities through a combination of inmate eduVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00060 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
57 

cation, a medically practical testing program and prevention of the 

behaviors linked to the transmission of HIV infection. 

We are concerned that the use of health care staff to test all inmates upon release will take away from the time these staff spend 

on other critical health care services. We need to ensure that important public health measures, such as securing post-release access and necessary medical care are provided to inmates. 

The BOP believes we should not risk shifting limited resources 

away from important post-release health care needs. 

Chairman Scott, this concludes my formal statement. And again, 

thank you for the opportunity to comment. 

[The prepared statement of Admiral Kendig follows:] 

58 

PREPARED STATEMENT OF NEWTON E. KENDIG


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Mr. SCOTT. Thank you. 

Did you want to start? 

Ms. WATERS. Thank you very much. 

First, Mr. Chairman, I would like to thank all of our panelists 

who are here today sharing such valuable information with us. 

Just sitting here listening to you, I have learned an awful lot. And 

I do have several questions. 

Mr. Brown, given the fact that you guys are leaders in testing 

inmates, what is the reaction of the inmates to the idea that they 

are being tested for HIV/AIDS? Is it done as part of a comprehensive examination when they come in, for example? How do you do 

it? 

Mr. BROWN. First of all, the inmates are very receptive to it, very 

receptive to it. We do have the opt-out provision, as your bill calls 

for. 

Ms. WATERS. Yes. 

Mr. BROWN. Those that choose to opt out usually do it because 

they already know their HIV status. It is part of our routine medical screening, just as we test for tuberculosis or venereal disease, 

we test for HIV. And as I said, there is the opt-out provision. 

Ms. WATERS. Mr. Brown, we have built-in confidentiality protections in the bill. Have you had a problem with people being exposed and being harmed in any way, similar to what has been described today? 

Mr. BROWN. Well, what was described was something that happened reportedly years before the initiation of this program. No, we 

have not had not one single case where there has been a breach 

of confidentiality. As Mr. Fornaci points out, if that should happen 

there will be swift consequences to anyone that is guilty of that violation. 

Ms. WATERS. Do you have anyone other that medical personnel 

that is handling medical records? 

Mr. BROWN. No, only medical personnel. 

Ms. WATERS. Okay. 

Dr. Kendig, what is the incubation period for the HIV infection 

that leads to AIDS? How long does it take? 

Admiral KENDIG. From the time of infection to the progression to 

AIDS on average is 10 years without antiretroviral therapy, on average. 

Ms. WATERS. So given that you don’t do routine testing, that it 

is only testing when it is indicated, or if there is an incident where 

there could have been transmission and you are trying to protect 

the workers there, is it possible that you could have inmates who 

could serve 5 or 6 years in prison and their HIV/AIDS status cannot have been detected by anybody? 

Admiral KENDIG. Certainly it is possible. 

I do want to emphasize, though, that we are very concerned 

about identifying all infected inmates upon entry to our system. 

Last year we tested well over 24,000 inmates. 

Our clinical practice guidelines make it very clear to our clinicians they should have an extremely low threshold for testing. And 

so if there is any indication at all that there are risk factors for 

HIV acquisition, we test those inmates upon entry and we repeatVerDate Aug 31 2005 14:14 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00068 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\052207\35600.000 HJUD1 PsN: 35600
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edly go back then, because we think it is critical to get them treatment. 

Ms. WATERS. Well, let us be clear. Let us be clear, because we 

don’t want to be confused. You do not have routine testing for all 

inmates coming into the system? 

Admiral KENDIG. Correct. 

Ms. WATERS. It is only done if it is indicated, or you mentioned 

something about a kind of surveillance or something like that. But 

you don’t have routine HIV/AIDS testing for inmates entering or 

exiting prison. Is that correct? 

Admiral KENDIG. If by ‘‘routine’’ you mean we offer testing to 

every inmate, no. But we do also in addition to the testing categories you mentioned, we have testing upon request, inmate request, at any time. 

Ms. WATERS. But again, we are clear, you don’t have it routinely 

for all inmates entering or exiting. And there is this incubation period that you just described, which it is not unreasonable to believe 

someone could serve time in prison, 2, 3, 4, 5, 6 years, and not be 

detected. Is that possible? 

Admiral KENDIG. It is possible. 

I would just mention, with all respect, that it is also possible 

with opt-out. Our testing that is risk-based is mandatory. With an 

opt-out provision, there is also the potential that inmates that have 

injection drug use histories or other high-risk behaviors would also 

not be detected. 

Ms. WATERS. Based on the question that I asked Mr. Brown 

about the reaction of inmates to the knowledge that they have testing available, it seems that what I am hearing is that most of the 

inmates want to know whether or not they are infected and they 

would welcome treatment and would be better positioned when 

they leave to manage their infection and not to infect others. 

Would you agree with that? 

Admiral KENDIG. I would. And that, ma’am, would certainly be 

our hope. We do show a videotape to all of our inmates currently 

where former Bureau of Prison inmates, both genders, all races, 

talk about their experience with HIV infection and encourage our 

inmates to be tested. And with this bill, we would continue to approach this with peer oriented education. 

Ms. WATERS. What percentage of your inmates are actually tested? What percentage of the people ask to be tested? 

Admiral KENDIG. I don’t have the answer to that question. 

Ms. WATERS. Describe your surveillance testing to me. 

Admiral KENDIG. We have two types of surveillance testing that 

are permitted through our policy and rules language. 

One is random testing, and that is to assess the prevalence, so 

it is broad-based, where we test across the Bureau of Prisons, to 

determine our prevalence. 

Ms. WATERS. How often is that done? 

Admiral KENDIG. It is done periodically. 

Ms. WATERS. But no set—— 

Admiral KENDIG. No. 

Ms. WATERS. And when was the last time? 

Admiral KENDIG. In 1999. 

Ms. WATERS. In 1999? 

66 

Admiral KENDIG. Yes. 

Ms. WATERS. This is 2007? 

Admiral KENDIG. Yes. 

Ms. WATERS. That is a long time. 

Admiral KENDIG. It is. 

Ms. WATERS. I would like to thank Mr. Jones for coming from my 

hometown. And I would like to thank you for your testimony. 

I am particularly interested in how you assist inmates who are 

exiting to be able to continue and maintain care. 

Mr. JONES. We help them by putting together a pre-release 

health plan, and it addresses a number of issues in their lives, because oftentimes for these clients HIV is a small part of what they 

have to deal with. Oftentimes, they are homeless, unemployed, so 

on and so forth. So we help them to address all of the issues going 

on in their life as well as HIV. 

And if they are positive, currently in L.A. County or in most of 

California, there is a transitional case management program. So if 

you are positive, you get linked on care on the outside. You get 

linked to a doctor, to housing in some cases. 

Our programs focus people who don’t know their status or have 

not been tested positive. We try to make sure that they stay negative, if they are negative. 

Ms. WATERS. And do you have some suggestions for us? In our 

bill we talked about on exit the counseling, 30-day supply of medicine and referral or follow-up. Do you have some way that you can 

suggest we should strengthen that? 

Mr. JONES. I think that it is great that you definitely include 

that in there, because the link from incarceration to being released 

is very critical, and if people are just kind of put out there into the 

community with no support, then it is a missed opportunity, especially because for most of the population they don’t get any public 

health messages. So I think the fact that you are giving them the 

medication and the counseling, that is great. 

Perhaps some education could happen for parole officers. In our 

experience, we have found that some parole officers don’t know how 

to deal with that type of information. And sometimes they use it 

against them. And so if we can help to strengthen the support of 

parole officers to support those inmates, that can be helpful. 

Ms. WATERS. Thank you very much. 

Mr. SCOTT. Thank you. 

Mr. Forbes? 

Mr. FORBES. Thank you, Mr. Chairman. 

I would like to echo Congresswoman Waters in thanking you all 

for being here, especially for your patience in putting up with us 

having to go back and forth today. 

I support this bill and am a cosponsor of the bill, but I do want 

to ask some questions that I think are important for us to try to 

understand. 

Mr. Jones, just a quick question for you, because I only have a 

few minutes. Did I understand you to say that you felt prisoners 

should have a right to have condoms? 

Mr. JONES. Correct. 

Mr. FORBES. Admiral, let me ask you a couple of questions too. 

67 

On this risk-based assessment, you have two population groups. 

One is the group of people that you would determine to have a risk 

assessment that would lend themselves to be testing positive for 

HIV. And then the other set would be obviously individuals that do 

not fall in that category. 

As to those who have a higher risk factor, your testing right now 

is actually greater than the testing that would be in this bill since 

there is an opt-out factor. Is that fair to say? 

Admiral KENDIG. I am not sure. And I agree, I don’t know whether or not we will identify more inmates or fewer inmates. They are 

two different strategies and it is—— 

Mr. FORBES. I am just talking about for the risk-assessed group, 

that one group. 

Admiral KENDIG. I think because it is mandatory we are more 

sure that we will be able to—— 

Mr. FORBES. Is there anyway you could argue that a mandatory, 

where you are testing everybody, would be less likely to pick it up 

than one with an opt-out provision? 

In other words, it looks like to me, if I am testing everybody, I 

have got a greater net to pick up everybody than if I had a provision where I am allowing people to opt out. Am I missing something on that? 

Admiral KENDIG. Correct. Correct. 

Mr. SCOTT. Can they opt out now? 

Mr. FORBES. I think the admiral said there is no opt-out provision for that set of people with risk assessments. 

Admiral KENDIG. Correct. 

Mr. FORBES. As for that other population group, the ones that 

you don’t do the risk assessment, how much more likely are they 

to have HIV than the general population outside of prison? 

Admiral KENDIG. First of all, I just want to clarify, everyone does 

get a risk assessment, regardless of their criminal history, their 

medical history, they get asked questions upon incarceration, and 

that is repeated during preventative health visits. 

We have an incredibly diverse population in the Bureau of Prisons and we have a subset of inmates who really are at very, very 

low risk for HIV, and that has been our strategy, because of that, 

to go through risk-based sting. But I can’t really quantify that for 

you. 

Mr. FORBES. This isn’t a trick question. I am just trying to get 

an answer. 

You bring the entire population in, in the prisons, and you do 

your risk assessment for everybody as they come in. 

Admiral KENDIG. Correct. 

Mr. FORBES. There is a group of people that you identify and say 

they have a higher risk factor for having HIV than the other group. 

Is that correct? 

Admiral KENDIG. Correct. 

Mr. FORBES. As to those individuals in that set, you have mandatory testing that they cannot opt out of? 

Admiral KENDIG. Correct. 

Mr. FORBES. So as to that set, you have got 100 percent testing. 

As to the other group, the group that you did not feel met that criteria for having a higher risk assessment, how much more likely 

68 

would that group be to have HIV than the general population outside of the prison? 

Admiral KENDIG. I think it would be fairly comparable. Again, 

we do have diverse subsets. 

Mr. FORBES. I understand that. But it would be fairly comparable? 

Admiral KENDIG. Yes. 

Mr. FORBES. In fact, it might even be lower because outside you 

are going to have some people who if you did an assessment you 

would say they have a high risk factor for having HIV. 

My point is, we don’t give testing to people outside the prison for 

HIV on a regular basis, do we? 

Admiral KENDIG. Well, the Centers for Disease Control new 

guidelines recommend routine care in all health care settings in 

this country if the prevalence is less than .1 percent. 

Mr. FORBES. What about other illnesses? 

Because I think one of our concerns is this—and this is a leading 

question. I am not saying this is what she was asking, but I heard 

Congresswoman Waters, maybe you just raised the question, that 

in a 10-year period of time somebody could go from HIV to AIDS, 

and I think one of our concerns is we would hate to have somebody 

in prison in that period of time, granted. 

But there are a lot of other illnesses that I would be equally concerned about. I am thinking about colon cancer, prostate cancer, 

lung cancer, pancreatic cancer, all of which if you miss you may 

have a smaller window than 10 years. Would that be correct? 

Admiral KENDIG. Correct. 

Mr. FORBES. Are you doing any testing on any of those illnesses? 

Admiral KENDIG. It is part of our preventative health care program. We have age-based, but this is all, again, risk-based criteria. 

We follow the U.S. Preventative Task Force guidelines for the most 

part on when to screen for chronic illnesses, like diabetes and hypertension, for cancers such as cervical cancer, breast cancer, and 

for any chronic infectious diseases. 

So we do have published specific guidance on when to screen for 

all of these different infections and it is all risk-based. 

Mr. FORBES. Mr. Brown, are you doing testing that is the same 

kind of testing on all of your inmate population that you do on 

HIV? Do you do that for the other illnesses, such as colon cancer, 

prostate cancer, pancreatic cancer, all of the ones that would have, 

actually, a lower window than 10 years before we may be in a terminal situation from those? 

Mr. BROWN. Keep in mind, we operate a municipal detention center, not a prison. But my response is the same as the doctors. 

There is a risk-based criteria that we use in making those type of 

assessments. They are done, but there is certain criteria. 

Mr. FORBES. Risk-based? 

Mr. BROWN. Yes, sir. 

Mr. FORBES. So HIV is the only one that you do that is not riskbased? 

Mr. BROWN. No, sir. 

Mr. FORBES. Oh, I am sorry. 

Mr. BROWN. No, sir. In addition to HIV, when people come in our 

system we test for tuberculosis, we test for venereal disease. There 

69 

is a serious of contagious diseases that all prison systems, including the Bureau, would test for if it met the ACA, the American 

Correction Association standards. 

So it is not just HIV. That is the exception, actually. 

Mr. FORBES. I understand. 

Last question that I would just ask, Admiral, you and Mr. Brown 

both, what do you have in terms of tangible evidence from individuals that you have tested, you have found that they have tested 

positive, how did that get us a better result? I mean, what behavioral patterns did you see change in them? How were we able to 

help them, treating them and those particular findings? 

Could both of you just address that for us? 

Mr. BROWN. Keep in mind that our testing results have indicated 

approximately 3 percent of our intake of 19,000 that come through 

our walls each year test positive for HIV. 

Now, it is not just a matter of giving them pamphlets, it is not 

just a matter of showing a videotape. We constantly, just as you 

would go to your physician and while you are waiting you might 

see a series of health related videos on the TV, we have that. 

The good congresswoman asked my colleague here what in addition would we ask to be done to improve the bill. Keep in mind, 

the average inmate reads at less than an 8th-grade reading level. 

It is not a matter of a pamphlet. You have got to bring groups in 

that prison and educate them constantly, not one time but constantly, keep this at the front burner, and that is what we do at 

the District of Columbia. 

Mr. FORBES. And Admiral? 

Admiral KENDIG. First of all, I hope I have shared my concern 

and my support for identifying people that are living with HIV infection. Unlike 10 or 15 years ago, we can provide life-saving intervention, so that is first key and paramount. 

But secondly, from a prevention and infection control standpoint, 

it is an opportunity to counsel the inmates about safe activities as 

far as blood exposures with cellmates that they need to avoid and 

obviously participation in prohibiting behaviors such as tattooing, 

injection drug use or sexual contact with other inmates that could 

transmit the virus to others. And then also pre-release, as far as 

going back to live with their families and the important measures 

they need to take to protect their loved ones. 

Mr. FORBES. Thank you all. 

Thank you, Mr. Chairman. 

Mr. SCOTT. Thank you. 

We are going to try to complete the questioning so we don’t have 

to keep you another half-hour. 

Do you have questions, any questions? 

Mr. COBLE. I was just going to apologize for my not being here, 

Mr. Chairman. 

I want to thank the admiral for the very cooperative exchange 

I have had with the BOP staff. Convey my best to Harley. 

I will hold my questions for later, Mr. Chairman. 

Mr. SCOTT. We are not coming back. 

Mr. FORBES. Now is later. [Laughter.] 

Mr. Fornaci, can you say a little about the consent form you had 

mentioned? 

70 

Mr. FORNACI. Yes. I believe that is even the procedure that is 

used at the DCJ with their HIV testing. And it basically says, ‘‘Yes, 

I have been told that I can opt out, and I have decided not to opt 

out.’’ 

Mr. FORBES. How does that differ from what is in the bill? 

Mr. FORNACI. Because the bill basically says we will give information, a written piece of paper that says that you can opt out. It 

doesn’t necessarily mean anyone is ever reading it. It doesn’t mean 

that anyone has ever acted on it. It something you stick in the person’s file saying, ‘‘Yes, I know about it,’’ and it is a little measure 

of control. 

Mr. FORBES. And, Dr. Kendig, what services are available after 

someone is released from prison that tested positive? 

Admiral KENDIG. Well, the Bureau of Prison’s philosophy is if 

possible to have all inmates go to halfway houses, as a part of reentry, so we can facilitate their transition to the community services. And so optimally we would be linking inmates to HIV services 

through the halfway house program. 

If they are a direct release, then we put together a transition 

care plan with their case manager and work with the social workers, particularly at our medical centers and some of our other facilities where we house large numbers of HIV-infected inmates to help 

with that transition plan. 

Mr. FORBES. If someone tests positive, do you consider that in 

their placement in prisons? 

Admiral KENDIG. Yes. We, several years ago, implemented a 

medical classification system in the Bureau of prisons, so we now 

actually designate inmates not just based on security needs, but 

based on their medical needs. We have some prisons in very remote 

parts of the country. We have had this occur, where we have had 

doctors in remote parts of the country in the community who say 

I have never taken care of an AIDS patient in my career. 

Because of that, we are strategically designating inmates with 

HIV infection throughout the Bureau of Prisons—— 

Mr. FORBES. But that is for medical treatment, not to segregate 

them from the population? 

Admiral KENDIG. Correct, it is for medical treatment and it is 

throughout our system, but there are a few remotely located prisons where we would not house HIV patients for—— 

Mr. FORBES. We just have a few seconds. 

Ms. Waters, do you have another question? 

Ms. WATERS. Yes, I wanted to be clear about what the admiral 

said about mandatory testing in response to Mr. Forbes’ question. 

When you say ‘‘mandatory,’’ is that really mandatory? I am told 

that if the inmate refuses the test, that he or she is written up for 

refusal to obey an order. And only in the event of an exposure incident involving a guard is an inmate forced to be tested. 

Admiral KENDIG. Correct. We do not do forcible testing. 

Ms. WATERS. I think it is important for you to have that cleared 

up because I think the way you were asked the question and the 

way it was answered, you were led to believe that in this testing 

procedure, that it was mandatory. 

Mr. SCOTT. That there was no opt-out. 

Ms. WATERS. There was no opt-out. 

71 

Mr. FORBES. That is what I thought it was. 

Admiral KENDIG. Well, I mean, it is different than opt-out. We 

don’t tell the inmates they have an opportunity to opt out. We say 

it is mandatory for the sake of your health and also for prevention 

purposes. 

Ms. WATERS. But if they choose to opt out, that is what I am describing, they can opt out? 

Admiral KENDIG. With sanctions, yes. 

Ms. WATERS. Well, the sanction is to be written up for refusal to 

obey an order. 

Admiral KENDIG. Yes. 

Ms. WATERS. Is that correct? 

Admiral KENDIG. Yes. 

Mr. FORBES. What is the sanction for that? 

Admiral KENDIG. It would depend on the specific case, and they 

would go through a disciplinary hearing process. 

Mr. FORBES. Did you indicate you tested 24,000 inmates? 

Admiral KENDIG. Yes, sir. 

Mr. FORBES. How many tested positive? 

Admiral KENDIG. Two and one-tenth percent. 

Mr. FORBES. Where did we get .1 percent from? 

Admiral KENDIG. That is our diagnosed prevalence, if you take 

our diagnosed number of inmates and divide it by our denominator. 

Two and one-tenth percent is when we do risk-based testing, we 

identify about twice as many individuals compared to our baseline 

prevalence. 

Mr. FORBES. Any other questions? 

We want to thank you for your testimony. This has been very 

helpful. I would like to thank the witnesses for their testimony. 

Members may have additional written questions which we will 

forward to you, and answer as promptly as you can in order that 

they may be part of the record. 

Without objection, the hearing record will remain open for 1 

week for submission of additional materials. 

Further, without objection, the Committee stands adjourned. 

[Whereupon, at 4:05 p.m., the Subcommittee was adjourned.] 

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PREPARED STATEMENT OF THE HONORABLE MAXINE WATERS, A REPRESENTATIVE IN

CONGRESS FROM THE STATE OF CALIFORNIA, AND MEMBER, SUBCOMMITTEE ON

CRIME, TERRORISM, AND HOMELAND SECURITY

I would like to thank Chairman Bobby Scott and Ranking Member Randy Forbes 

for organizing this hearing on H.R. 1943, The ‘‘Stop AIDS in Prison Act,’’ which I 

introduced last month. I would also like to thank both of them, as well as Judiciary 

Committee Chairman John Conyers and Ranking Member Lamar Smith, for all of 

their recommendations and assistance in drafting this bill. 

HIV/AIDS IN AMERICA

Twenty-five years after AIDS was discovered, the AIDS virus continues to spread. 

About 1.7 million Americans have been infected by HIV since the beginning of the 

epidemic, and there are 1.2 million Americans living with HIV/AIDS today. Every 

year, there are 40,000 new HIV infections and 17,000 new AIDS-related deaths in 

the United States. 

HIV/AIDS is spreading especially rapidly among women and racial minorities. In 

1985, women accounted for a mere 8% of new AIDS cases; by 2005 they accounted 

for 27%. In 1985, Hispanic Americans accounted for only 15% of new AIDS cases; 

by 2005 they accounted for 25%. In 1985, African Americans accounted for a quarter 

of new AIDS cases; by 2005 they accounted for half. African American women account for an astonishing 67% of new AIDS cases among women, and over 70% of 

new AIDS cases overall are found among people of color. 

HIV/AIDS IN AMERICAN PRISONS

HIV/AIDS is also spreading in our nation’s jails and prisons. In 2005, the Department of Justice reported that the rate of confirmed AIDS cases in prisons was three 

times higher than in the general population. The Department of Justice also reported that 2.0% of State prison inmates and 1.1% of Federal prison inmates were 

known to be living with HIV/AIDS in 2003. 

However, the actual rate of HIV infection in our nation’s prisons is unknown because prison officials do not consistently test prisoners for HIV. There is little 

knowledge about the lifestyles of those who enter our nation’s prisons, and there is 

usually no official acknowledgement that sexual activity—whether consensual or 

otherwise—is taking place in prisons. The only way to determine whether HIV is 

being spread among prisoners is to begin routine testing. Furthermore, if prison inmates are exposed to HIV in prison and then complete their sentences and return 

to society without knowing their HIV status, they could infect their spouse or other 

persons in their community. 

While we don’t know the rate of HIV infection in Federal prisons, we do know 

that racial minorities have high incarceration rates. According to Department of 

Justice statistics, 40% of Federal prison inmates in 2003 were black and 32% were 

Hispanic. So if prisoners leave prison with HIV/AIDS and don’t know it, the virus 

will continue to spread among minority communities. 

THE IMPORTANCE OF HIV SCREENING

HIV screening is essential to stop the spread of AIDS. About one quarter of the 

people living with HIV/AIDS in the United States do not know they are infected. 

The Centers for Disease Control and Prevention (CDC) reports that many infected 

persons decrease behaviors that transmit the AIDS virus to sex or needle-sharing 

partners once they find out about their infection. The CDC theorizes that sexually 

transmitted HIV infections could be reduced by more than 30% per year if all HIVinfected persons found out about their infection and changed their behavior in a 

manner comparable to those who already know of their infection. When people know 

their HIV status, they are more likely to act responsibly—to protect their partners 

and themselves. 

On September 21, 2006, the CDC published new guidelines for HIV screening in 

health care settings. These guidelines recommend routine HIV screening for all patients between the ages of 13 and 64, regardless of risk factors, under an ‘‘opt-out 

approach,’’ in which patients are notified that an HIV test will be included in their 

routine health care and they can refuse to take the test. However, separate written 

consent for the HIV test is not required. Instead, consent for an HIV test can be 

included in the general consent for medical care. 

The CDC’s new guidelines are an expansion of the CDC’s guidelines for HIV 

screening of pregnant women, which were issued in 2001. The 2001 guidelines recommended routine HIV screening for all pregnant women using an opt-out approach. The 2001 guidelines led to a dramatic 95% decline in perinatal AIDS cases. 

94 

DESCRIPTION OF THE LEGISLATION

The ‘‘Stop AIDS in Prison Act’’ would require the Federal Bureau of Prisons to 

develop a comprehensive policy to provide HIV testing, treatment and prevention for 

inmates in Federal prisons. This bill requires the Federal Bureau of Prisons to test 

all Federal prison inmates for HIV upon entering prison and again prior to release 

from prison, unless the inmate opts-out of taking the test. The bill also requires 

HIV/AIDS prevention education for all inmates and comprehensive treatment for 

those inmates who test positive for HIV. This bill has 28 cosponsors and bipartisan 

support. 

CRITICISM OF THE LEGISLATION

The legislation I introduced may be considered controversial by some people. 

There is a large and diverse group of stakeholders involved in HIV/AIDS policy debates, including HIV/AIDS advocacy organizations, gay and lesbian organizations, 

civil rights groups, churches and religious groups, the medical community, and even 

the entertainment industry. Everyone involved in these policy debates shares the 

same goal: the prevention and eradication of HIV and AIDS, but not everyone 

agrees on the most effective ways to accomplish this goal. 

One common concern that has been expressed about the ‘‘Stop AIDS in Prison 

Act’’ is that the bill does not require the Bureau of Prisons to obtain separate written consent from prisoners prior to an HIV test. I believe that requiring separate 

written consent as a pre-condition for an HIV test would defeat one of the main purposes of the bill, namely to help prisoners find out if they have HIV. Prisoners already have the right to obtain an HIV test upon request if they believe they are 

at risk. My bill would enable prisoners who do not know they are at risk to find 

out if they are infected. 

My bill does give inmates the right to ‘‘opt-out’’ or refuse routine HIV testing, and 

it requires the Bureau of Prisons to inform inmates both orally and in writing of 

this right. The claim that separate written consent should be required for HIV tests 

within Federal prisons is especially ironic, given the fact that the Bureau of Prisons’ 

current procedures do not allow prisoners to opt-out of an HIV test. Prisoners who 

refuse an HIV test are written up for refusal to obey an order and could face disciplinary action. Under the bill, prisoners could refuse an HIV test without fear of 

disciplinary action. Nevertheless, I would be pleased to work with concerned individuals to ensure that the opt-out language is effective at protecting prisoners’ rights. 

SUPPORT FOR THE LEGISLATION

I am honored that several prominent HIV/AIDS advocacy organizations are supporting the ‘‘Stop AIDS in Prison Act.’’ These include AIDS Action, The AIDS Institute, the National Minority AIDS Council, and the AIDS Healthcare Foundation. 

The bill also has been endorsed by the Los Angeles County Board of Supervisors. 

I request unanimous consent to submit letters and statements of support for inclusion in the hearing record. 

CONCLUSION

I firmly believe that the ‘‘Stop AIDS in Prison Act’’ will help stop the spread of 

HIV/AIDS among prison inmates, encourage them to take personal responsibility for 

their health, and reduce the risk that they will transmit HIV/AIDS to other persons 

in the community following their release from prison. I look forward to hearing the 

testimony of the witnesses on how this legislation would contribute to our nation’s 

efforts to stop the spread of AIDS and provide effective, compassionate care to people who are living with HIV. 

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