Why not test?

It's easy for blood-borne diseases to spread in prison. Sex and sharing needles for tattoos are the main ways diseases are shared among inmates. Condom distribution and in-prison tattoo parlors arguably are the best ways to stop them, but in Texas those ideas have never gained much traction. So as a minimalist first step, State Sen. Rodney Ellis wants Texas prisons to measure the problem; he proposes testing every inmate upon entry for HIV ("Should all new convicts have HIV tests," Austin Statesman, Aug. 24):

For years, prison officials have asked all convicts coming into the state prison system to be tested for HIV. About 80 percent have consented.

Now, a state senator wants to know whether they can make such tests mandatory.

"It's a public safety issue," said Sen. Rodney Ellis, D-Houston. "We're very concerned about the rapidly increasing infection rates."

Current prison system policy states that all incoming inmates "should be tested at intake," and under a proposed change to take effect next week, that would become "shall be tested" — unless the inmates refuse. At the same time, mandatory testing is done at intake for tuberculosis and syphilis.

Upon release, every inmate is tested for HIV as part of a mandatory DNA blood test.

Were prison officials able to test all incoming convicts, advocates of the testing say, they could know with certainty who was HIV-positive — information that would assist them in properly treating early infections. It could also provide statistical data on how many convicts are becoming infected or testing positive for the infection after they come into the prison system.

Inmates who test HIV-positive are not isolated from other inmates.

For some time, some medical experts have called for such mandatory testing in prisons, citing prisons as perfect incubators for a number of deadly diseases, including HIV and AIDS, and arguing that the nation's 1.4 million prison inmates have an infection rate five times that of the general public.

Diseases in prison return to society when the infected inmates are released, the experts say.

I've often heard the cynical view stated that Texas law required inmates to be tested for AIDS on the way out instead of on the way in because the state didn't want to provide expensive HIV treatments to inmates. But if 80% are tested on the front end, it sounds like the vast majority of inmates receive HIV testing unless they themselves refuse it.

Another medical elephant in the room the state supposedly dreads testing for is Hepatitis C. Treatments are expensive and conventional wisdom has it that the state doesn't want to pay to treat the up to 30% of Texas inmates, according to one estimate, who might have that disease. By comparison less than 2% of Texas inmates have tested positive for HIV.

This isn't an area I know a lot about. What do folks think about mandatory testing of prisoners for HIV or Hep C?

The state has a public health interest in running a safe prison and a constitutional duty to provide healthcare to inmates, but it's also a big cost driver. One question is, should tests be mandatory even if the inmate doesn't want them? Another: Is it ethical NOT to test when the incidence is so high and treatment options might be available?