One of the ironies of the criminal justice system is that it brings many people into contact with regular health care for the first time in their lives, says Frederick L. Altice, M.D., HS '87, assistant professor of medicine and a CIRA-affiliated researcher. Because they're under constant penal surveillance, they can also be placed under close medical watch.

“It's an important opportunity to detect disease and to initiate treatment,” says Dr. Altice, who has served in recent years as a consultant to Connecticut's Department of Corrections, treating inmates with AIDS. “For those who are at risk for HIV and are still negative, it's a place where HIV risk reduction interventions should be introduced, in order to decrease their risk for getting HIV at a later time.”

Cases of AIDS, he says, can be found in prisons at a significantly higher rate than in the general population. “The war on drugs has basically instituted wide-spread mandatory sentences on drug users and it is drug users who are at risk for HIV,” he says. “It's the behavior that's occurring just before people come in to prison that is the riskiest. It is unprotected sex and sharing of injection equipment.”

Nationwide, according to Bureau of Justice statistics, AIDS cases were six times more prevalent in the prison population than in the general population. At the end of 1995, there were 5,099 confirmed AIDS cases in prisons, and AIDS was the cause of 34 percent of all inmate deaths. Unfortunately, most cases of HIV go undetected within the prison system, Dr. Altice says.

Dr. Altice has developed programs that link HIV-infected inmates to community health care when they leave prison. “The most basic and difficult problems such as stable housing and food,” Dr. Altice says, “are things that destabilize our patients when they return to the community. Stable housing remains one of the most crucial and unavailable unmet needs. The best we can do is get them into a shelter. Sometimes you have to put a Band-Aid on one wound while you're dealing with other wounds, such as accessing drug treatment and medical care.”