By Stephen E. Mather
Maryland Newsline
Monday, Dec. 22, 2003

AIDS treatment advocates and at least one high-ranking prison system doctor are supporting the distribution of clean drug needles and condoms in Maryland’s prisons – where HIV infections among inmates are five times more common than among the general public.

“Whether we like it or not, people in prison are having sex and using needles,” said Paul Feldman, public affairs director for the National Association of People with AIDS, an advocacy group.

Prisons should give inmates “the tools” they need to stay healthy, Feldman said.

Maryland is second only to New York state in the percentage of inmates infected with the deadly virus, according to a 2002 Bureau of Justice Statistics report on the prison epidemic, which covers 2000 statistics nationwide.

Dr. William Ruby, deputy director of clinical services for the Department of Public Safety and Correctional Services, said he would support the distribution of needles and condoms if there was a monitoring system in place to make sure they are not used as weapons.

But a prison system spokesman said distributing them would be counterproductive.

Mark Vernarelli, director of public information for the Maryland Department of Public Safety and Correctional Services, said needles pose a security threat among prisoners who "can make a weapon out of anything."

And, he said, prisoners are provided with health information packets and condoms when they are released.

The Numbers and Causes

 There were 136 new HIV cases and 101 new AIDS cases diagnosed in Maryland correctional facilities in the year ending Sept. 30, 2002, making up about 6.5 percent of the state’s total new cases, according to recently updated Maryland AIDS Administration figures.

State statistics show that the majority of HIV-positive prisoners are drug abusers, said Dr. Edward Kassira, an epidemiologist with the Maryland Department of Health and Mental Hygiene.

Kassira said that good HIV treatment and prevention in prison is critical, because when prisoners eventually return to society, they can infect the nonprison population. “This is a big source of the spread of the disease,” he said.

Intravenous drug use outside prison walls is fueling HIV and AIDS in the Maryland’s prisons, Ruby said. The high number of infections of prisoners is a reflection of the wider epidemic in Maryland, he said.

The AIDS rate for all Marylanders was third-highest in the nation in 2002, at 34 reported cases for every 100,000 in population, trailing only Washington, D.C., and New York state, according to the U.S. Centers for Disease Control and Prevention.

Ruby said there is no way to tell how many of the prisoners are infected while incarcerated, because the state doesn’t require HIV tests. He said the stigma associated with the disease also means that some prisoners who know they are infected are afraid to tell officials.

Ruby said he believes the virus spreads inside prisons to some extent through drug needle sharing, sexual contact and tattooing, but that studies in other states have shown that less than 1 percent of HIV cases were contracted in prison.

Treatment Costs

Feldman said that in addition to humanitarian concerns, people should support preventing HIV infections among prisoners because of high treatment costs. People leaving prison “tend to be [the] low income” who will rely on publicly funded health care, he said. Treating an HIV patient can cost between $15,000 and $18,000 a year, he said.

“We’re going to pay,” Feldman said.

State Sen. Paula Hollinger, D-Baltimore County, agrees prevention would be cheaper than treatment. She said she supports distributing condoms to prisoners.

“I think that anyone who knows the prison system knows that [sex] does happen,” said Hollinger. “Overall, I don’t think we’ve ever done a very good job of healthcare in our prisons.”

Hollinger, who chairs the state Senate’s Education, Health and Environmental Affairs Committee, said that over the years she has heard complaints about the prison healthcare system during committee hearings.

Ruby said that every prison has infection control staff, and Maryland prisoners have access to HIV medications and specialist care.

He said that many of the system’s 994 known HIV-positive prisoners were homeless before they were sentenced, and the treatment they receive is better than what they could get outside. 

Prison is the first time many of them are “not high and on drugs,” and the experience can be a wake-up call that it is time to get treated, he said.