Sentenced to Stigma: Segregation of HIV-Positive Prisoners - AL.com

available at all institutions. This is a clinical judgment, based upon the acuityof care required for the patient. Patients with HIV infection may requireisolation if, for example, they have pulmonary tuberculosis. HIV patientsshould not be medically isolated solely because of their HIV status. 124Best practice for HIV treatment and services is not “one size fits all.” People with HIV varywidely in individual health status, with many living for years without symptoms and withoutneed for medication. Those suffering from opportunistic infection or experiencingcomplications may need hospitalization and other targeted services. There is no onemedication regimen that is "best" for all patients infected with HIV. The time to startantiretroviral therapy (ART) for HIV depends upon several factors, including the person's Tcell count, age, underlying medical conditions, history of an AIDS-defining illness, and theperson's willingness to commit to lifelong treatment. Proper utilization of ART requiresongoing patient monitoring to assess therapeutic response and to identify adverse eventsrelated to chronic administration of potentially toxic medications. Patients who are startedon ART should generally have follow-up within one to two weeks to ask patients aboutadverse effects, adherence, and prevention of transmission. Once patients are clinicallystable on their ART regimen, medical visits generally decrease to every three months. 125Clearly, segregation is not intrinsically related to high quality medical care. When prisonerswere first segregated In Alabama and Mississippi decades ago, they initially received suchpoor care that federal court action was required. 126 In the US, forty-seven other states andthe federal Bureau of Prisons provide medical care to prisoners with HIV without segregatingthem from other prisoners. These include Florida and New York, the two states with thehighest numbers of prisoners living with HIV. These states, as well as Texas, California andmany others, make individual health determinations and distinguish between prisonersneeding routine medical care and prisoners requiring more intensive services. Prisoners inthe latter group are transferred to medical units where prisoners with a variety of medicalconditions, not only HIV, have greater access to specialty care. 127124 Ibid.125 U.S. Department of Health and Human Services, AIDS Info-HIV Clinical Guidelines, Guidelines for the Use of Antiretroviralagents in Adults and Adolescents, December 1, 2009.126 Moore v. Fordice, A-90CV-125 (N.D. Miss. July 19, 1999); Leatherwood v. Campbell, CV-02-BE-2812-W, U.S. District Court,Northern District of Alabama (2004).;127 Memorandum from Jackie Walker of the ACLU-NPP, “Communications with state prison officials re: HIV care” September 25,2009, on file with Human Rights Watch and ACLU-NPP.Sentenced to Stigma 40